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72% of patients who exceeded surgery pre-assessment BP limits discover to be totally normotensive

Carol Turner – Florence Simple Telehealth Project Manager NHS England TECS- Clinical Advocate 2014. NHS Mansfield and Ashfield Clinical Commissioning Group 

Streamlining Surgery Pre-assessment with the Implementation of Flo


High blood pressure is a relatively common reason for a surgical intervention having to be postponed.

Patients who may be affected by ‘white coat hypertension’ during their Pre-operative assessment use Florence to remotely monitor their own blood pressure for seven days which enables the nurses to decide on the right plan of care for them and prevent unnecessary postponement/cancellation of surgeries and inappropriate GP referrals. 

The King’s Mill Hospital (SFHFT) Pre-operative Assessment Unit was the first PAU in the country to implement FLO successfully for this cohort. SFHFT’s success subsequently prompted interest from other units who are now adopting it as part of their services. It is also now part of the local policy working in line with NICE Guidelines for Hypertension. 

Circle Nottingham Pre-Assessment Team has adapted the protocol in order to effectively streamline their Patient pathway.


Reducing unnecessary delays due to ‘white coat’ hypertension in pre-assessment clinic. 
Reducing on-the-day cancellations. 

A 6 month pilot demonstrated successfully that 73% of Patients that participated were found to suffer with ‘white coat hypertension’ and as a result of the findings were able to continue with their surgery without disruption to their care pathway.

Those Patients that were identified as potentially having true hypertension were referred to their GP for appropriate treatment in a timely manner which enabled their surgery to proceed safely and within a shorter period of time in comparison to those who were managed in the traditional way. 


72% of patients who exceeded our BP limits at pre-assessment were normotensive at home.

The system removes the need for the majority of patients to visit their GP. 

The system was strongly supported by patients and nursing staff.

The Team was accepted by the British Association of Day Surgery to present their findings at the Annual Conference in Nottingham; at which they also achieved 1st place for their Poster!

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