Optimising patient flow and filling surgical slots through an electronic preoperative assessment process

Covid-19 resulted in an increase of patients waiting for surgery and patients requiring preoperative assessment.

The earlier a patient can be preoperatively assessed, the more time it provides for medical and physical optimisation, improving postoperative outcomes.

Situation

NHS Lanarkshire, with three general hospitals, were stretched by Covid-19, with high staff absence and a growing waiting list for elective surgery.

The hospital wanted a transformation to meet net zero targets by reducing patient and staff travelling and keeping patients from attending the hospital.

They also needed consistency of approach across the hospitals, as well as nurses and anaesthetists being able to work remotely.

Aspiration

• Patients can complete the pre-operative assessment form from home.
• To create an efficient triage process to identify patients that do not need to come to hospital, reducing clinical time required per patient and increasing the workforce efficiency.
• Reducing the time for preoperative assessment, benefiting both patients and care teams.
• Using digital to increase the capacity of assessments that can be completed, reducing the delays in pre-assessment.
• Surgery waiting list management has become more efficient as patient communication and in-app questionnaires are automated.  

Solution

NHS Lanarkshire hospitals launched “Elsie”, ePreOp mobile app by Buddy Healthcare. It was designed to replace the previous paper-based preoperative assessment process, which required every patient to attend a hospital appointment to answer questions with a nurse, no matter their fitness for surgery.
While preparing for surgery, patients are now guided and educated through a preoperative care pathway by the Elsie mobile app to:

• access specific hospital-based information e.g. when arriving for surgery, how to find the surgery unit, or where to park.
• receive prehabilitation information to inform the patient about keeping fit for surgery.
• use in-app, two-way communication to allow the patient to ask questions, advise of a change of circumstance and for staff to provide information in reply.
• automated care pathway instructions and reminders, i.e. fasting and medicine reconciliation details.
• receive clearly communicated updates on any changes to events.
• provide feedback and influence service improvements.

Remote patient assessment and tracking:

With Buddy Healthcare's electronic preoperative assessment platform, the surgical teams in three NHS Lanarkshire hospitals can now remotely assess and track patients' progress and surgical readiness. The care teams use the clinical dashboard to gather and visualise patients' submitted health data. The clinical dashboard allows the care teams to manage a clinic or department of patients and monitor progress. It notifies of uncompleted tasks or reduced engagement when necessary.

Filling surgical slots by identifying flexible patients:

The BuddyCare digital platform helps to fill surgical slots caused by late cancellations. With the patients' submitted and viewed data, NHS Lanarkshire's care team can quickly and easily identify fit patients ready for surgery with short notice to fill cancelled surgery slots.

Impact

Reduced paper and printing requirement by approximately 50 pages per patient.

Reduced unnecessary hospital appointments and travel for patients: around 70% of patients do not need to visit hospital. Only those who need tests, scans or needing observations, swabs/ bloods require to visit hospital.

Nurses can handle around 4 times the number of patients than previously, so they are moving all patients who are referred, as soon as they can, then refreshing if necessary. This way, more patients can be slotted into free space at short notice.

The digital solution enhanced the pre-operative assessment clinic efficiency by significantly reducing the time to assess each patient. Before, nurse was allocated 5 patients per day. Now they can handle up to 20, depending on complexities.

The waiting list management became optimised and automated for fit for surgery.

With the patients' submitted and visualised data, NHS Lanarkshire's care team can quickly and easily identify fit patients ready for surgery with short notice to fill the gaps.

Functionality

Elsie is a patient facing mobile app, which is cloud-based and web-accessed with SaaS deployment.  It uses the hospital’s colours, fonts and brand.
Through the app, patients receive:

• Procedure and hospital information package
• Preoperative assessment questionnaire
• Updates on timescales
• Prehabilitation instructions
• Medication and fasting reminders
• Arrival instructions
• Patient Reported Experience Questionnaires (PREM) questionnaires

Capabilities

• Safely assess more patients for surgery, quicker and remotely.
• Patients and care teams can safely send two-way messages through the platform.
• Prevent patients attending hospital, unless necessary for tests, or scans.
• Consistency of education for patients, across 3 hospitals.
• Complied PDF of patient data.
• Greater visibility of patient data, including when working remotely or on other hospital sites.
• Up to date data, including social, non-prescribed medications.
• Patients can be identified via the app care path, that they are supported both at home and by their employer, to come to Hospital at short notice to fill surgery slot cancellations.

Scope

• Patients can complete pre-operative assessments at home.
• Care personnel can monitor and manage patient flow work on patient lists, from anywhere.

Key learning points

• A working relationship between NHS Lanarkshire key stakeholders and Buddy Healthcare provided comprehensive customisation and involved clinical staff in pathway redesign.
• Onsite project management support was vital to successful implementation and was provided as part of the Buddy Healthcare package.
• Digital preoperative assessment process automated regular patient communication without increasing care personnel workload.
• NHS Lanarkshire reached waitlist patients digitally through an app, instead of calling or letters and ensured that patients stayed compliant and fit for surgery whilst meeting the hospital's duty of care.
• NHS Lanarkshire got accessibility of patient information by multiple users within different departments and specialisms
• Health Board got its own triaging system in place and can identify fit for surgery patients and patients at risk.
• Reduction of letters, paper records, phone calls, and costs through digitised preoperative assessment process. Before NHS Lanarkshire digitised its preoperative assessment process, the hospital printed 50 pages of paper on average for each patient attending a surgery.

Digital equalities

NHS Lanarkshire run two systems; Fully digital for connected patients and an accessibility system for non-connected, where a nurse calls a patient at home and digitally fills in their questionnaires.

Buddy Healthcare support most European languages and can support other languages, in any form within a very short period.

Key figures and quotes

• Reduction in paper and printing requirement by approximately 50 pages per patient.
• 92% of the patients would recommend the Elsie app to friends and relatives in a similar situation.
• Patients rated the Elsie app in terms of usefulness of 4.5/5.

"Before COVID-19 there was an 8-week wait for Patients to get a pre-operative assessment appointment. We were very short-staffed and our processes, while very robust, were very old-fashioned. Everything was on paper, whereas the rest of the hospital is digital. This has been an enormous project for our team across Lanarkshire, easily the biggest innovation we have seen in the last twenty years"
Dr Miriam Stephens, Lead for preoperative assessment, NHS Lanarkshire

“One of our issues is we don’t have enough space for our staff to work on site in Wishaw. With Elsie, we can get our nurses to work more flexibly. We won’t need to wait for one of our doctors to physically come to the pre-assessment clinic anymore. They can do their work remotely, on any site in Lanarkshire. It will make our processes much more efficient. It feels like we are catching up with the rest of the working world.

We had long felt an electronic system would be better, but with Buddy Healthcare's Elsie app, we have a fully interactive system. The patients don't have to take time off to come all the way to hospital, or even do a telephone appointment in many cases. They can fill in a lot of the details themselves on the app. Our specialist nurses will check it, and for a lot of patients, they won't need to see us at all at pre-assessment.”

Mandy Gilroy, Senior preoperative assessment nurse, NHS Lanarkshire

Find out more

• Read the NHS Lanarkshire case study
• Read more about electronic pre-operative assessment and waiting list management
• Read more about Elsie from NHS Lanarkshire’s patient awareness landing page.

Key contact

Dr François Taljard, Consultant Anaesthetist, NHS Lanarkshire

francois.taljard@lanarkshire.scot.nhs.uk

Gary Birks, Buddy Healthcare (UK) Ltd Oy

gary.birks@buddyhealthcare.com