Telehealth to manage pre-operative hypertension to avoid surgical cancellations

Hypertension is the most common avoidable medical condition for postponing anaesthesia and surgery. However, ‘white coat’ syndrome is a phenomenon in which patients exhibit hypertension only during a clinical visit and so needs to be identified in order to reduce cancelled operations.


Challenges with being able to identify patients who have white-coat hypertension prior to surgery ahead of the day of their appointment, which results in a high number of same-day cancellations.


To monitor patients ahead of their preoperative assessment to determine if a patient really is hypertensive, or to identify white coat hypertension. To help patients to understand how their lifestyle affects their blood pressure, and the importance of taking their antihypertensive medication, where appropriate.

Solution and impact

Sherwood Forest Hospital deployed Florence within their pre-operative assessment pathway to reduce the number of avoidable cancelled operations and shorten the pathway to surgery for patients with white-coat hypertension.

Florence is used by NHS hospitals, general practice, mental health and community teams. It uses targeted, behavioural, psychology-based smart messaging to help engage patients and change behaviour. Florence brings a human element to remote healthcare with friendly interactions which support patients to make positive behaviour changes to manage their health better, as agreed with their healthcare team.

Florence interacts with friendly and familiar SMS text messages to the patient’s mobile phone, with patient-reported readings and/or symptoms available to clinicians in almost any healthcare setting.

Florence is condition agnostic and targeted where the patient at home might benefit from motivation and prompting towards better healthcare engagement or health literacy; or reporting symptoms and home measurements including blood pressure, weight and oxygen saturation as examples. Florence’s technology can be linked to a wide range of illnesses and healthy living services, including asthma, diabetes, hypertension, smoking cessation and weight management.


Use of Florence resulted in many clinical and non-clinical benefits including an improvement in the identification of pre-operative risk factors, a reduction in short-notice cancellations and an improved pathway back into primary care. Further benefits include:

  • improved satisfaction with patient/nurse care
  • compliance with medication and appointment reminders, reduction in DNA
  • improved physical health and mental wellbeing
  • a patient-led focus
  • patients' lives no longer revolving around provision of services


Clinicians create a patient profile via the Florence web-based portal and decide the type and frequency of text messages the patient will receive. All responses are linked back to the clinician’s system so that they can review, monitor or escalate, where necessary. Florence also links with other Technology Enabled Care Services (TECS) systems including Interactive Voice Response, smartphone and tablet telehealth systems and various other devices.


Persona-based text message service linked to a clinician’s web-based portal.


Improves adherence to self management guidance remotely using psychology based interactions targeted at improving patient confidence and motivation to self manage better. Improved engagement and adherence to self management consequently improves the clinical outcomes for patients and creates efficiency for the NHS.

Key figures/quotes

“Florence is a low-cost, low-risk innovation with a strong track record”
The Kings Fund

“The benefits Florence can deliver are wide ranging”
The Health Foundation

“Flo has been formally evaluated, with positive results”
Nuffield Trust

Find out more

Find out more on Florence’s website

Read a case study on Florence on the NHS England and NHS Improvement website

You can get more information about Florence on Clinitecs website here

Staff nurse Kelly Crutchley talks about her experiences using Florence in this video