Digital Pre-Operative Assessments for Leeds Teaching Hospital

Background

In April 2021 Leeds Teaching Hospitals NHS Trust (LTHT) approached Aire Logic to support the Trust in the recommenced programme to increase hospital capacity for planned operations. The COVID pandemic has seen an acceleration in switching many processes to digital and with NHS waiting lists at a record high, Aire Logic has been happy to support this work and make it happen quickly.

Challenge

Pre COVID the Pre-Operative Assessment (POA) process at LTHT was a lengthy face to face, paper based process which impacted patient, clinician and administrative time significantly. During the pandemic LTHT switched these appointments to be telephone based but although this saved time for the patient, it still did not create time savings for the clinicians and administrative staff, and in some cases it increased the length of the appointment. The original process would require a patient to attend an outpatient appointment in person at the hospital where they were asked to complete a detailed paper form. A Nurse or Health Care Assistant would then sit with the patient and go through their answers. On average each appointment would take 40 minutes not including the time taken to organise the appointment or the travel for the patient. During the peak of the pandemic the appointments then changed to a Nurse completing the form with the patient over the phone. The nurse would record the assessment in the Trust’s Electronic Patient Record, PPM+. This would take 60 minutes on average. A series of clinical reviews would then take place to ensure the data had been captured correctly.

Solution and Impact

Aire Logic’s Pre-Operative Workflow solution digitises the end to end elective patient POA process, enabling the digitisation of patient facing assessments and further steps in the process (e.g. coordination of pre-operative tests, or anaesthetic reviews). Using the new digital process, patients now receive a link to the POA via an SMS and complete this independently either on their smartphone or device that suits their needs. The new process is now being used across four hospital sites for over 10,000 patients a year. The system is also used to triage the small group of patients with more complex procedures that still require face to face and telephone contact. Since introducing the new process in May 2021, the team has been receiving most digital forms back on the same day as being sent, which is a great indicator of success.

Benefits

• Reduction of over 6,000 face to face appointments to date. This has direct patient benefits (less travel time, parking charges, etc), clear Infection Prevention benefits for the hospital, and a positive environmental impact.
• Clinical tests are now completed earlier in the pathway, before the patient receives a phone call.
• Patients report that they get much more value from the phone call as it is now effectively agreeing a perioperative management plan, rather than taking a history alone.
• The digitisation of POA has resulted in sending fewer letters to patients, and the Trust is no longer printing preoperative booklets (the total
  bill for which was £21,000 per annum in 2018)
• It has also significantly reduced the administrative work related to storing and moving the paper documentation between offices to support the process. Across one department it was calculated that staff spent the equivalent time of three full time admin personnel solely to keep track of paper documents. Based on AFC Band 2, the savings in administrative staff time alone was calculated at £57,000 per annum per department.
• Registered Nurse time is used more efficiently – each nurse is now able to assess one additional patient per shift while improving quality.