Post operative monitoring and communication using a mobile app to improve patient experience and safety at Kettering General Hospital NHS Foundation Trust

It is estimated that the annual cost to the NHS of managing patients with wounds is between 4.5 billion and 5.1 billion.

Of the 2.2 million people with a wound, 29% having acute wound related to an abscessed burn surgery or trauma, and delayed healing is commonly caused by surgical site infection (National Wound Care Strategy Programme NWCSP 2021).

Poor communication post operatively between patients and clinical teams, can result in clinical deterioration and an increased demand on local emergency services. NWCSP guidance (2021) identifies that effective discharge planning, patient information to support self-care and surveillance for Surgical Site Infection (SSI) and Surgical Site Dehiscence (SWD) are required.

Situation

At Kettering General Hospital NHS Foundation Trust, there was no patient feedback on wound care and post-operative rehabilitation that was visible to all clinicians. There was a lack of continuity of care with the surgical team leading to duplication and poor coordination of care.

Outpatient clinic appointments are distant inflexible opportunities. Patients in pain and with complications immediately after surgery can find it difficult to find specialised care in a timely manner.

Aspiration

• Improve the reporting of wound related problems and early identification of surgical complications post discharge and the Patient Reported Outcome Measures (PROMs) reporting.
• Increase patient confidence in self-management and in their recovery at home.
• Reduce the pressure on GP (General Practitioner) and Emergency Departments (ED) for post-operative wound care management.

Solution

The Post Op mobile app enables patient involvement in reporting wound care, patient outcome measures and communication tool to clinical teams. The patient facing rehabilitation resources for physiotherapy and wound care will enable real time and continuous education of patients and engagement. Patient involvement in their care journey is empowering and increases patient satisfaction and safety.

Post Op gives a clear overview of the patient recovery - identifying early signs of infection and complications but also flagging more at-risk patients and helps planning a more individualised recovery.

1. Preoperative information and prehabilitation regimens can be provided to support preparation for surgery.
2. Postoperatively patients are shown how to take a wound image and complete questionnaires on the app.
3. Once home the patient provides wound images and PROMs questionnaires.
4. Clinical teams review the patient submissions via an interactive dashboard. If a problem is identified advice can be given via the app or a follow up appointment arranged.
5. The discharge point is determined by the speciality depending on their follow up requirements: 1 year for orthopaedic patients with implants; 5 years for colorectal cancer surgery patients; 30 days wound surveillance for day case surgery patients.

Impact

• The pilot study at Kettering General Hospital has onboarded 50 patients to date. A formal evaluation is planned with more than 100 patients using the platform.
• 2 post operative wound infections have been identified in patients following day case surgery who would not previously have been followed up routinely.
• The patient experience of the app was excellent with patients feeling included and informed on the treatment plan.

Functionality

• Mobile App
• Wound image tracking: patients take photos of their wound using app on camera phone.
• Patients receive PROMS questionnaires to complete on app at scheduled intervals. Every day there are 2 prompts to patients to update their data. The data or activities are decided by the clinical teams. These can be changed at any time.
• Patients communicate with their surgical team via text message on app.
• Communication alerts notify the clinical team when a patient sends a message via the app.
• Physiotherapy resources: information and videos guide patients through prehabilitation and rehabilitation regimes, and includes pain scores before and after exercise.
• Recovery update: patients view how their recovery is progressing and the timeline of progress.
• Image library: patients view their wound images in a show reel, that conveys the recovery journey.
• Dashboard: the information available on the dashboard includes wound images, PREMS, PROMS (SSIS – Bluebelle study, EQ5D-5L quality of life, PHQ9- for mental health, specialty-based PROMS). There is also a care plan showing the compliance of patients with the requested activities allowing a clinician better insight into patient compliance with activities following discharge.

Capabilities

• Direct messaging between the patient and surgical teams. Aligns with Getting It Right First Time (GIRFT) guidelines.
• Improves efficiency of mandatory PROMs and SSIs data collection to share with NHS bodies for audit purposes.
• Clinical teams can see patients' recovery status with real time data dashboard.
• Clinical teams from different care settings can liaise with each other through the app connecting primary and secondary care. Primary care teams can be added by the hospital administrator by sending a simple invite via email. Once accepted, they have full access to the clinician app to view the patient details and communicate with the secondary care and infection control teams.
• No integration with KGH EPR (Electronic Patient Record) at present as they are using it as a standalone platform. Post Op can be integrated easily through open APIs (Application Programming Interface) and uses the latest FHIR/HL7 protocols.

Scope

• The Post Op mobile app can be downloaded at the new patient clinic to help with prehabilitation by improving access to patient education resources at home.
• The app can be used in the immediate post op period whilst as a hospital inpatient, following discharge to home or at a step-down facility.
• The service can be used at home, in any setting in the community even if the patient is away on holiday without the need to stay local.

Key learning points

• The clinical teams need to understand how these fits into their standard operating procedures (SOP), or if a new SOP needs to be created.
• Digital transformation team needs to work with the clinical team to complete due diligence on data protection and data impact assessments and if needed budget approval.
• The procurement or finance team needs to work simultaneously to avoid unnecessary delays and duplication. This can be done easily by involving the stakeholders early in the implementation.
• When using the app, the messaging tool can be used to save time for clinicians if used correctly.
• Patients are advised the app is for wound care and recovery related queries and should not be used for urgent clinical concerns.
• Patient messages first point of contact are the surgical specialities clinical nurse specialists who receive notifications when patients message. These messages can be triaged during the day and handled in order of priority.

Digital equalities

For patients who are not able to use smart phones or do not have access to the technology, relatives or friends are trained to help them upload information with their smartphones. If this is also not an option, a follow up programme instigated by the clinical team using a regular phone will enable constant communication. The time freed up from using the app can be used to provide a closer service to those without access to the technology.

Key quotes

“This app is going to be the next ‘must’ in the NHS. It's very easy to use, keeps you, as a clinician in contact with our patients so easily, gives the patients the reassurance they are taken care of, and not forgotten, that there is someone there for them when they need help or are unsure if they need help or not.”

Ms Adriana Raicu, Consultant General Surgeon, Kettering General Hospital.

“Post Op is a great way to refine relationships between patients and clinicians. Is an excellent tool to monitor patients’ recovery post discharge and to promote surveillance of surgical site infections, enhancing patient’s outcomes. This is going to be a game changer for post op monitoring, so easy to use!”

Sara Monteiro, Infection Prevention Control Nurse, Kettering General Hospital

“This is a no brainer for us to commission.”

Ian Roddis, Chief Digital Officer, Kettering General Hospital

Key contact

Sara Monteiro, Infection Prevention Control Team

sara.monteiro@nhs.net

Dr Chindu Kabir, Chief Executive Officer

chindu@postop.ai