Transformation Directorate

A virtual pre-operative patient education class

Fit 4 Surgery (F4S) was initially established as a face-to-face session delivered fortnightly to a maximum of 10 patients.

The sessions were adapted to be delivered virtually in response to the Covid-19 pandemic. This meant F4S could run weekly for an unlimited number of patients and meant patients from a wider geographic area could attend.

This was incredibly beneficial to patients, as Cambridge University Hospital NHS Foundation Trust (CUH) is a tertiary referral centre for a number of specialities, meaning patients are located throughout the East of England.


Evidence shows that patients who are well prepared for surgery have a better surgical journey, with less complications and shorter lengths of stay.

The process of prehabilitation uses interventions, such as lifestyle modifications including smoking cessation, alcohol reduction, increased exercise to positively influence a patient’s fitness for surgery.

The pre-operative period is ideally situated to initiate these interventions as patients are more likely to be motivated while awaiting surgery. Patients are empowered to be active participants in their surgical pathway through increased awareness of anaesthetic and pain relief options, plus information about post-operative recovery, including physiotherapy and mental health support.  


F4S aims to deliver a high-quality, patient centred information service to promote active preparation physiologically and psychologically before surgery.

The F4S team wanted to ensure that the service was protected from the Covid-19 pandemic and subsequent lockdowns and restrictions by offering a digital service.


  • The virtual education session is held on Zoom once a week, with each session lasting 60-80 minutes. The benefit of using Zoom were the low costs to the Trust, free access for patients and the ease of use of the platform, especially as the general public become increasingly familiar with digital solutions during lockdown.
  • Patients from any surgical speciality can be referred by their surgical team, or via the pre-assessment specialist nurses. Patients can be referred via an Epic order (digital referral via EPR) or by emailing the pre-assessment administration team.
  • Patients are offered the next available F4S session and provided the Zoom link by letter or alert to MyChart by the preoperative assessment administration team.
  • The virtual session is delivered live each week by the F4S team.
  • Patients log into a group waiting room before being admitted to the session. All patients are asked to maintain confidentiality during questions by asking only generic questions, with any personal questions responded to after the session via telephone by one of the F4S team.
  • Questionnaires are administered through Jisc online surveys via a link sent to patients at the end of the Zoom session. Data can then be collated and analysed digitally, without any manual data entry requirements.


From 396 completed patient surveys:

  • 94.8% of patients scored ≥ 8/10 when asked how satisfied they were with the service.
  • 92.6% scored ≥4/5 when asked if they felt better prepared.
  • 77.4% of patients selected they would make “some lifestyle changes”.
  • 15% sought to make “lots of lifestyle changes”.
  • 7.6% responded that they would make “no” changes to improve their functional capacity.

Patients were asked to self-report the main things they had learnt from the session. Common themes were:

  • the importance of pain relief
  • pre-op breathing exercises with spirometer
  • keep moving and exercise
  • eat well

In a post-operative survey a total of 65.8% of patients reported making pre-operative lifestyle changes, which included:

  • improving exercise levels by walking more
  • completing pre operative breathing exercises using a spirometer
  • decreasing alcohol consumption
  • healthy eating habits.


  • Freely accessible platform delivering an interactive live virtual class.
  • Accessible from smartphone, tablet or computer.
  • Surgery specific information available on CUH website.


  • Can be accessed by multiple clinicians simultaneously to address patients, whether the clinician is on site or working from home.
  • Patients and their relatives or carers can dial in separately from different locations to share the experience of attending F4S.
  • Sessions can be pre-recorded which allows the team to cover absence.


  • Patients seen in surgical outpatient clinics should attend F4S as soon as surgery is considered as a potential treatment pathway.
  • This service is flexible and accessible from a variety of locations, including internationally, depending on the device patients are using.
  • Using Epic patient portal, MyChart to automate appointments has potential to increase referral rates and attendance.

Key learning points

  • Promotion of the service to surgical specialities is crucial in order to establish a functional referral pathway.
  • Aim to have patients referred as soon as possible in their surgical journey – some patients who attend F4S do not go on to have surgery, but report that the lifestyle changes are still beneficial.
  • Consider all stakeholders in the pathway – this will increase the chances for the patient to be referred e.g. specialist nurses, administration teams, surgical booking co-ordinators, surgeons, pre-assessment specialist nurses.

Digital equalities

  • Family, friends or carers can join virtually for support.
  • Hard copies of documents and information are available from the Pre-Assessment Department.
  • CUH accessibility software – ReciteMe; Automated translation and text-to-speech audio.

Key figures and quotes

  • 765 patients seen so far.
  • Maximum of 100 patients per clinic, as per Zoom Pro licence.

Find out more

Centre for Perioperative Care – Fitter, Better, Sooner

Royal College of Anaesthetists – Preparing for surgery

F4S information and presentation slides on CUH website

Key contact

Claire Luck, Lead Pre-Assessment Nurse, CUH

Sarah Woods, Lead Pre-Assessment Nurse, CUH

Amanda Saunders, Senior Physiotherapist, CUH