Table 1

Measures (outcome, process and balance) and measurements

Outcome measures (aligned with the aim and monitored for the duration of the project)
Source of data: hospital electronic booking system
  • Primary referrals.

    • Percentage of suitable patients identified, referred and assessed weekly through the virtual pathway.

  • Secondary referrals.

    • Percentage of patients incorrectly referred to PAAC through the virtual pathway but requiring an additional in-person assessment due to medical-related, anaesthetic-related or surgical-related issues.

    • Percentage of patients unnecessarily referred for in-person assessments but having no contraindications for virtual PA.

Process measures (reflecting factors in the system that might cause unplanned variation in the outcome throughout the project)
  • Number of patients not referred to PAAC was recorded manually and reported monthly by the OT manager and CNM2 based on the number of patients who arrived in OT without PA.

  • Number of patients who were referred to and received an appointment for PA consultation but DNA for each pathway was extracted from the hospital electronic system weekly.

  • Number of patients whose surgeries were delayed or cancelled due to incomplete PA was recorded manually by the CNM2

Balance measures (not directly related to the aim and occurred when changes designed to improve one part of the system introduced unwanted changes elsewhere, that is, time, staff and resources allocation and satisfaction)
  • Service user and provider experience surveys.

  • Cost-effectiveness analysis.

  • Mean time for virtual and in-person consultations was measured during the last 4 weeks of the project.

  • PAAC capacity use was expressed as actual activity (number of patients assessed per day) and theoretical (maximum) capacity (number of new and return patients PAAC can assess per day provided all agreed rules and assumptions are adhered to in terms of clinic times, staff rostering, equipment, etc).45

  • CNM2, clinical nurse manager; DNA, did not attend; OT, operating theatre; PA, preoperative assessment; PAAC, preanaesthetic assessment clinic.