NHS England - Transformation Directorate

Developing a digital preoperative assessment pathway and clinical decision support

Worcestershire Acute Hospitals NHS Trust carries out preoperative assessments (POA) for around 11,000 patients a year over 3 hospital sites.

Patients had a 1 hour appointment regardless of procedure or medical history.

Some patients were on a surgical waiting list for up to 1 year, only to be classed unfit for surgery at POA. Many had conditions that could be improved while waiting. This caused further delays to their surgery.

Telephone assessments were based on a patient’s age and procedure rather than their health, sometimes leading to additional appointments. The Trust wanted to streamline the process and identify patients who need early assessment.

Situation

The Trust held a workshop with various teams and found that the POA process was inefficient and a barrier to improving the utilisation of operating theatres.

It was also noted that preoperative care teams spent increasing amounts of time assessing patients who were fit and healthy for their operation. These patients did not need an hour-long appointment or a hospital-based POA.

Aspiration

The Trust wanted to identify fit-for-surgery patients as early as possible in the preoperative pathway. This would give staff more time to identify patients at high-risk of being unfit for their operations.

Earlier POA interventions for high-risk patients would increase theatre utilisation and reduce cancelled operations.

Solution

The Trust decided that patients awaiting elective surgeries should begin the preoperative pathway at home, using a digital POA questionnaire.

The Synopsis platform launched across the Trust in February 2020.

Synopsis iQ is a digital POA pathway used by staff and patients in hospital and face-to-face. Patients can complete their POA questionnaire using a tablet while waiting to see a member of staff, or with a member of staff if they need support.

Synopsis Home lets the Trust begin a patient’s POA pathway from home. The patient can complete their POA questionnaire via a tablet, smartphone or computer without attending hospital.

This hybrid approach to POA integrates with the Trust’s patient administration system and electronic patient record. Staff across all hospital sites can instantly access this data to triage all elective surgery patients within a single digital dashboard.

Impact

  • The time taken to complete a POA reduces by 51% when a patient uses Synopsis Home.
  • 52% of patients chose to use Synopsis Home to avoid unnecessary hospital visits.
  • The Trust reached its target of 750 completed POA questionnaires using Synopsis by the end of the 1st month of deployment, demonstrating positive uptake by hospital staff.
  • The time between the patients referred for a pre-assessment appointment and completing their triage questionnaire reduced from multiple weeks to 3 days on average.

Patients who only used Synopsis Home between May to July 2020 saved 722 hours inside the hospital. This equates to:

  • 199 hours travelling
  • 5,271 miles
  • 1,025kg CO2

Functionality

Synopsis Home and iQ are digital forms, hosted by the Trust and accessed via a phone, tablet or computer.

Capabilities

The service:

  • supports the Trust to make in-depth clinical decisions
  • processes POA assessment data using over 250 tailored algorithms to generate clear outcomes
  • produces a searchable database of fit-for-surgery patients to fill last minute theatre slots

It also provides a collection of published clinical scores including:

  • the American Society of Anaesthesiologists Physical Status Classification
  • results of a STOP-Bang questionnaire to screen for obstructive sleep apnea
  • the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality with calculated cardiac and lung risk, and a mortality score

Scope

The Trust uses Synopsis:

  • at the start of the pre-op triage process, outside of the hospital
  • in a clinical setting during a face-to-face or telephone preoperative assessment
  • in a clinical setting, accessed by the POA team as part of the clinical decision-making process in the lead up to surgery

Key learning points

  • Key stakeholders, like preoperative nurses, anaesthetic consultants, preoperative administrators and preoperative secretaries, are engaged with the design of new processes.
  • The Trust now has a triaging guide to reviewing patient questionnaires and allocating appointments.
  • Reassure staff that patient answers are accurate, unless there's clear evidence of error, and they do not need to ask all the questions again.
  • There is clear communication with patients on how to register and access the system, including a helpline number and alternative arrangements if needed.
  • Processes are in place to ensure all completed assessments are closed and uploaded to the patient electronic record.

Key quotes

"We rapidly rolled out Synopsis iQ and Synopsis Home under the early stages of the pandemic. This was successful despite severe pressure due to changes in pre-op activity and staff redeployment. We were the first Trust to go live with Synopsis Home which was challenging but also enabled us to make changes and smooth teething problems as an early adopter.

As service lead with critical care skills, I was redeployed to ICU during the rollout which was challenging but the deployment of Synopsis was successful. The preoperative staff needed support when they returned to the service but quickly re-established their use of the Synopsis system.

The implementation of Synopsis iQ has led to a more streamlined and efficient process that allows the patients to have their preoperative pathway recorded in one place, which is visible to all relevant staff, across the Trust."

Rachel Foley, Clinical Benefits and Change Lead

Key contact

Rachel Foley, Clinical Benefits and Change Lead, Worcestershire Acute Hospitals NHS Trust

rachel-foley@nhs.net

David Bowen, Marketing Manager, Intouch with Health and Synopsis

david.bowen@vitalhub.com