Twinning solution

Mobile app on preoperative patient preparation for Major Ambulatory Surgery

Twinning type

Full adoption

Main policy priority

Digital tools for citizen empowerment and for person-centred care


Fundación Pública Andaluza Progreso y Salud (Spain)


Azienda Ospedaliera Universitaria Federico II (Italy)

Short description

This multifunctional mobile app prepares preoperative patients for Major Ambulatory Surgery (MAS) by providing personalized information adjusted to their clinical conditions. It monitors compliance with preoperative recommendations by establishing a communication channel between patients and health care professionals.
The twinning provides an overview of the patient-specific recovery milestones and gives information regarding their expectations, responsibilities in the pre- and post-operative time, combined with personalized instructions for the procedure-specific protocols for the general wellbeing of the patients and in case of complications. Furthermore, the solution aims also at contributing to the standardization of preoperative patient management in day surgery, facilitating the set-up of shared training programs.
The full adoption twinning will be organized in 3 phases: Adaptation, Adoption and Scale Up. This includes testing interoperability with local ICT systems, developing a pilot study with 50 patients and finally, exploiting and disseminating the clinical and financial outcomes of the pilot study as the starting point of executive projects.


Twinning activities

The DHE twinning’s work plan was aimed at adopting the Listeo+ solution in the Campania Region. The plan included the general coordination of activities (management), the implementation of the study activities and the adoption of the solution. The work plan was designed keeping in mind that the DHE twinning Listeo+ aims for a full adoption of the solution and the need to adapt the solution to the local context.


The availability of the Listeo+ ICT system in Campania contributed to the standardisation of pre-operative patient management in day surgery and to facilitating the set-up of shared training programmes. In Campania there are 20 vascular surgery units distributed throughout the entire region, where about 120 surgeons, 240 nurses and 480 other specialised professionals work. Given the long waiting list, the number of patients who drop out from the service provision is high, since they prefer to turn to other healthcare organisations inside or outside the region. The approach that the Campania Region is implementing to strengthen health services for patients is grounded in the use of digital solutions to promote health, prevent and control disease, address patients’ unmet needs and reduce health inequalities by improving accessibility to health services.

Added value and benefits

Varicose veins are commons and are a major burden on surgical services. Due to patients’ good general health and the workload of most surgical services, often a low priority is awarded to this problem resulting in a substantial waiting list. To solve this problem, day-case surgery was introduced in daily clinical practice. Day-case surgery using EndoVascular Laser Ablation (EVLA), Radio Frequency Ablation (RFA) and Mecanochemical Ablation (MOCA) performed as outpatient procedures are safe and feasible and the complication rate is similar to an inpatient procedure. Day-case surgery greatly lowers the medical cost for each patient compared to inpatient surgery and increases revenue for hospitals. A well-informed patient is essential for achieving good day surgery outcomes. There is limited time to provide patients with the vast amount of information they require about their preoperative preparation, surgical procedure, anaesthesia and postoperative recovery. Traditionally, verbal instructions are reinforced on a number of occasions and accompanied by clear written information. Listeo+ solution provides personalised information to surgical patients on their date and time of surgery that can be personalised to their clinical conditions. In addition to sending reminders about critical aspects of the operation at different times, Listeo+ monitors compliance with preoperative recommendations by establishing a communication channel between patients and healthcare professionals which facilitates intervention in case of possible adverse events. This innovative tool based on mHealth apps helps patients meet the preoperative recommendations and, consequently, reduces the rate of cancellations in the ambulatory setting.

Barriers and success factors

The application works only with Android devices. Owners of iOS devices are excluded at the moment. There are no notifications able to warn the user when a new recommendation is unlocked as the days go by. It would be useful to generate alerts if the user does not perform a critical recommendation in time. Due to the COVID-19 pandemic, FOUND and ANDALUCIA were forced to reschedule the project activities. Listeo+ is a sanitary project, where the twinning partners are a regional health authority and a healthcare organisation, which, in these difficult circumstances, were under a lot of pressure and had the priority of providing assistive care. Thus, although they maintained their commitment with the twinning activities, they needed flexibility with deadlines.


The availability of the Listeo+ ICT system in Campania will contribute to the standardisation of pre-operative patient management in day surgery and to facilitating the set up of shared training programmes.