# Four days: urgent patients get the least time

> Among patients at Royal North Shore Hospital who did not complete their digital pre-operative questionnaire in 2025, the median gap between invitation and surgery was 4 days for Category A, 49 for Category B and 149 for Category C. The most urgent patients, with the most to gain from early assessment, had the least time. Invitation timing is a system setting, and it can be changed.

*Source: https://getpathways.ai/articles/urgent-patients-get-the-least-time*

Elective surgery in NSW is triaged by urgency, with clinically recommended
timeframes of 30, 90 and 365 days. The RNSH audit labels these Categories A, B
and C. Among patients who didn't complete their digital pre-operative health
questionnaire in 2025, the median gap between invitation and surgery was:

- **Category A:** 4 days
- **Category B:** 49 days
- **Category C:** 149 days

The most urgent patients, often those having cancer surgery or procedures that
can't wait, had the shortest window of all.

## What four days actually allows

A pre-op questionnaire isn't useful the moment it's answered. It has to be sent,
opened and completed. Then a nurse or anaesthetist has to review it, and someone
has to act on what it shows: order a blood test, adjust a medication, chase a
cardiology letter, book a pre-admission clinic.

Four days barely covers the first half of that chain. Prehabilitation, such as
building strength, improving nutrition, or optimising anaemia or blood sugar,
usually needs weeks.

The wider picture is just as stark. Of 787 non-completers with a recorded
interval, 236 (30%) were invited two days or less before surgery, on the day, or
afterwards. Twenty-three received their invitation after the operation.

## The other end of the curve

Timing fails in the opposite direction too. 186 patients (24%) were invited more
than 90 days before surgery, and the Category C median was 149 days.

Early is good, but early and never refreshed is not. Five months is long enough
for new medications, a new diagnosis, a fall or significant weight change. A
questionnaire answered in May may not describe the patient who arrives in
October.

## What good timing looks like

None of this is a patient behaviour. Invitation timing is a system setting, and
it can be changed:

1. **Start the clock at the decision to operate.** Trigger the invitation when
   the request for admission is submitted, not when a theatre date is confirmed.
2. **Match the channel to the urgency.** A Category A patient with days to spare
   needs a phone or voice-based assessment and same-week review, not a link in
   an email.
3. **Refresh instead of repeating.** For long-wait patients, a short check
   closer to surgery should ask only what may have changed since the first
   questionnaire.
4. **Measure lead time by category.** Report the share of invitations sent with
   enough time to act, split by urgency, as a standing pathway metric.

The proposed PAINITE pathway at RNSH starts at request-for-admission submission
for exactly this reason. Its voicebot arm also offers a channel that doesn't
depend on a patient finding, opening and finishing a web form in a narrow
window.

The audit's message on timing is simple. The patients with the most to gain from
early assessment were given the least time to complete it. That is fixable
upstream, before the invitation is ever sent.

*Source: Zhang D, Marks A, Doane M, et al. Barriers to current perioperative
digital platforms – how can innovation solve these issues? Poster, ASA CSC.*