Digitally supported elective pathways at West Hertfordshire Hospitals NHS Trust (WHHT)

Preoperative assessment (POA) at West Hertfordshire Hospitals NHS Trust was a paper-based, face-to-face process. Guidance on this process was patchy and information gained from a patient’s POA was not always visible when key stakeholders needed it.

Situation

The main challenge that the Trust faced was managing the waiting lists backlog.

Streamlining the POA was key in getting back to full operating capacity.

Using a digital platform for surgical workflows would ensure that the Trust could continue to provide a high quality, safe and effective service.

Aspiration

Patients requiring elective surgical procedures need a coordinated and multidisciplinary team. This includes:

• surgical and anaesthetic specialists
• POA teams
• speciality nurses
• waiting list scheduling teams

Moving the perioperative pathway from a paper-based referral system to a digital version would help combat the elective surgery backlog.

The digital POA would:

• coordinate patient management
• gather patient data
• streamline the assessment process into one unified system across all specialties
• reduce the number of unnecessary delays and cancellations
• unite administration and clinical teams together through better communication and collaboration

Solution

The Trust launched the digital POA in 2020 to adjust to working practices at short notice.

The Trust commissioned Open Medical to digitise its entire perioperative pathway to tackle the waiting list backlog.

The cloud-based platform serves pre-op, intra-op and post-op pathways across 11 surgical specialties and clinical support teams.

The software provides information to prioritise patients for surgery, from pre-admission tests to post-discharge review and rehabilitation.

The whole pathway is streamlined, including list planning and management, and linked to the POA status on a single system.

Impact

The impact on the Trust has been significant. The POA has helped to:

• streamline process
• improve collaboration between clinical and administrative teams
• improve patient safety
• improve information governance

It’s difficult to accurately compare statistics for digital POA versus paper. But, there's a good understanding of the impact for both the Trust and its patients.

• 21% of digital POAs need escalating to an anaesthetist to review. Around 30% of the paper-based POAs were escalated for review.
• An anaesthetist reviewed patients within an average of 7 days. Before, a high proportion of escalated patients waited for a longer period of time.
• 54% of escalated patients were identified as classification 2 of the American Society of Anaesthesiologists’ Physical Status. Policies will be reviewed to further reduce who is escalated to an anaesthetist.
• 48% of all pre-assessed patients had to isolate for 14 days before surgery, despite only 24% of patients being classed as high risk of coronavirus complications. The implications of isolation criteria going forward need to be considered in elective recovery.
• 64% of patients undergoing a clinical harm review (due to long waiting periods) needed reprioritising. In 43% of cases this rose by a priority score of 1. In 21% of cases this rose by a priority score of 2. The implications of this on waiting list management will become clear as elective recovery continues.

Functionality

Pathpoint SurgiCare places the patient-clinician relationship at the centre of a smart, accessible platform.

All the information needed is available and compatible with hospital systems.

Patients receive the screening questionnaire and any patient information via a secure one-time link.

The cloud-based platform serves the full perioperative care pathway to tackle the waiting list backlog.

Caregivers across surgical, nursing and anaesthetic teams are linked together. It's a central digital hub for remote pre-assessment and postoperative monitoring.

Capabilities

Pathpoint SurgiCare is capable of:

• customising digital waiting lists
• automatically triggering preoperative assessment workflows
• customising POA pathways including general, local, and one-stop pathways
• direct patient communication with tools to provide information and guidance
• facilitating surgical risk assessment scoring, including COVID-19
• waiting list scheduling and management
• monitoring postoperative symptoms
• automatically triggering governance
• scoring and reporting on patient-reported outcome measures
• estimating procedure time when consultant, procedure or both are selected
• name and time stamping on an audit trail
• harm review assessments for long waiting lists and notifying consultants
• creating a separate anaesthetic escalation workflow

Scope

Built for growth, the cloud deployment forms part of:

• the Pathpoint engine
• care pathway management
• clinical workflow solutions

This processes approximately 50,000 patient pathways a month alongside the Pathpoint eTrauma and eDerma products at 25 NHS Trusts.

Clinical and administrative teams can manage the entire perioperative care pathway when used in a hospital.

The platform can be accessed by clinical and administrative teams across specialities using a secure link once a user profile has been created. The system can also be accessed with a mobile device if permissions have been granted through a secure web link.

Key learning points

• Define the roles and responsibilities of the project from the start.
• Understand the complexity of each specialty within the organisation, from administration and clinical perspectives to cross-department boundaries.
• Engage stakeholders from top to bottom within the trust.
• Engage with Open Medical at every stage and follow up to ensure all user requirements are met.

Key quotes

"We were using paper before and the emergence of COVID-19 really expedited our need to go digital. There was a massive drive nationally to do this, and the Trust was also very keen to use this opportunity to shift towards a paper-light approach."

Isabel Hlomani, Lead Preoperative Assessment Nurse, WHHT

"Pathpoint SurgiCare is fully cloud-based, so we can securely access patient information remotely from wherever we are working. It's far more reliable than our previous paper-based solutions, as patient information is fully centralised and every action is tracked."

Dr Savita Marathe, Lead Anaesthetic Consultant, WHHT

"All the information is consolidated on the Pathpoint SurgiCare platform and we are able to see everything in one place instead of on multiple spreadsheets. This has allowed us to streamline our entire process."

Loretta Gendle, Deputy Business Manager General Surgery, Urology and Breast, WHHT

Find out more

Case study on the West Hertfordshire Hospitals NHS Trust digital elective pathways on Open Medical's website

Key contact

Dr Savita Marathe, Lead Anaesthetic Consultant, WHHT

savita.marathe@nhs.net

Isabel Hlomani, Lead Preoperative Assessment Nurse WHHT

isabel.hlomani@nhs.net

Dr Michael Shenouda, Medical Director, Open Medical

michael@openmedical.co.uk