Patient Pathways – PRO-MAPP

The need for improved pathways: an evaluation of 2024’s NHS waiting list statistics

Posted on November 20, 2024November 20, 2024 by Nada Elghorori

Waiting times for healthcare services in the UK shine a rather worrying light on the difficulty faced by the NHS. The metrics act as a key gauge to determine when, and why, healthcare delivery has become far more stretched. Notably of course, the covid-19 pandemic was detrimental to how critical appointments and surgeries could be conducted, with the influx of ill patients straining NHS England (NHSE) staff to the brink.

In the past decade, waiting list times have doubled. Pre-2020, the number of ‘incomplete pathways’ for patients stood at 2.3 million. As of early 2024, it’s an astonishing 7.64 million cases. This is a significant figure that demands a rethink to improve nationwide NHS operations, resource allocation, pre-assessment triage, and data-led technical training to ensure a positive uptick in the quality of patient and staff satisfaction, and timely access to care.

The short and long term impacts

Over 6 million patients are determined to be in a queue awaiting treatment, and this affects both patients waiting for immediate care and those facing substantial delays for planned appointments.

Urgent and emergency care

At the start of the year, on average, 1,760 patients seeking to see doctors and nurses in accident and emergency departments were waiting for more than twelve hours for admissions. With timely intervention necessary to see to these individual situations can be significantly life-threatening, inefficient patient pathways only contribute to poor knock-on effects for every new admission.

Longer appointment lists

Many services are burdened by unnecessary repeat testing and face-to-face appointments that could be handled over the phone for non-urgent issues. These inefficiencies significantly contribute to long waiting times for patients, often delaying access to life-changing surgical procedures. In July of this year, 76,132 patients waited over 53 weeks just for an initial outpatient appointment—a clear indication of the challenges in accessing even primary care. As waiting times increase, patients’ health conditions can deteriorate, leading to more frequent retesting (as prior tests expire), which only worsens the backlog and further extends queues.

As part of the NHS Long Term Plan community health services are offering complex health care solutions outside of hospitals – at houses, care homes, clinics, community hospitals and schools. As a result of changes in guidance and operations for service delivery, they have also experienced a waiting list increase for over a million patients indicative of continual reform to mitigate the hurdles that affect accessible healthcare.

The most burdened specialities

One of the largest concerns surrounding waiting times are the experiences of cancer patients, all of whom experience high variations in their pathway expectations; as reported in August, 69.2% of cancer patients were treated within 62 days of being referred.

Waiting times in the NHS for orthopaedics, and especially trauma and orthopaedics, have been a significant issue, particularly since the COVID-19 pandemic. It is now the specialty with the longest waiting times, having seen a 35% surge in its waiting lists.

By March 2024, over 800,000 patients were in line for orthopaedic procedures. In part, these backlogs are due to a combination of the healthcare system’s stretched resources, postponed surgeries during the pandemic, a sharp increase in referrals and, in some cases, limited funding. While the NHS aims to treat all patients within 18 weeks of referral, these compounding factors make this target increasingly challenging for orthopaedics.

Orthopaedic surgeries can be major procedures involving lengthy recovery times and require extensive post-operative care that can further strain hospital resources. Conditions requiring orthopaedic intervention – such as hip or knee replacements, spinal surgeries, and complex trauma cases – demand significant surgical time and specialised care that tend to have longer waiting times over interventions that are less resource-intensive.Trauma and orthopaedics also receive increased emergency referrals for acute injuries. This complicates scheduling for elective surgeries, while a high volume of both elective and emergency cases only causes further delays for patients awaiting treatment.

These delays vary across the UK. Some hospitals face longer queues than others due to regional demand, the availability of orthopaedic consultants, or operational capacity. As NHS facilities prioritise those with the most urgent needs, many orthopaedic patients face prolonged wait times, impacting their quality of life and, sometimes, the progression of their conditions.

In addition to the pandemic’s impact, several other factors contribute to delays in orthopaedic waiting times in line with NHSE and Getting It Right First Time (GIRFT) insights, as follows:

Workforce Shortages: A shortage of orthopaedic consultants, anaesthetists, and specialist nursing staff is a prominent challenge identified by the NHSE and GIRFT. Recruiting and retaining healthcare professionals in the field is challenging, while the demand for highly trained specialists is high. A staffing gap limits the NHS’s ability to meet patient demand, especially given the intensity of support required during and after orthopaedic surgeries.
Operating Theatre and Bed Capacity: NHSE and GIRFT emphasise the importance of adequate infrastructure, but many NHS hospitals face limitations in operating theatre and inpatient bed availability, restricting their capacity to perform the necessary volume of orthopaedic surgeries. Trauma and orthopaedics require dedicated theatre time and inpatient beds, which are often unavailable due to competing priorities across specialties. As a result, even if a hospital has adequate staff, it may lack the physical resources to treat all patients in a timely manner.
High Volume of Emergency Cases: Trauma cases, such as fractures and other serious injuries, are often life-altering and require immediate intervention, frequently taking priority over elective orthopaedic surgeries. This reactive demand complicates scheduling and can divert resources for planned elective surgery at short notice. GIRFT has highlighted the need to better separate emergency and elective care separation, which could help streamline orthopaedic pathways while requiring further resources.
Inefficiencies in Referral Pathways and Care Coordination: Pointed out by GIRFT, variations in referral practices across regions – combined with inconsistencies in patient management from primary to tertiary care – can result in unnecessary delays. Patients might be referred back and forth between departments or to external clinics without a clear, coordinated pathway. Standardising and integrating these pathways is a GIRFT priority; streamlined processes could reduce unnecessary delays and provide patients with faster access to treatment.
Demand Outpacing Capacity: An ageing population with an increasing prevalence of degenerative conditions (such as osteoarthritis) has driven up demand for orthopaedic procedures. As this often outpaces available resources and capacity, this leads to longer waiting lists. GIRFT and NHSE recognise the importance of population health management and early intervention initiatives to alleviate some of this demand, but these are long-term solutions that require time and investment.

Both NHSE and GIRFT are focusing on initiatives such as prioritising high-demand areas, and optimising scheduling and theatre efficiency, but until these changes are fully realised trauma and orthopaedics will likely continue to experience longer wait times than other specialties.

Eyes, and policies, on the future

As discussed, non-urgent assessment (led by consultants) has an enforced maximum waiting time of 18 weeks (per NHS constitution), all in a bid to see more patients in immediate need of medical treatment. Given this year’s hefty figures on waiting lists, this cap remains flexible to regular re-evaluations, making sure service quality is incrementally improved to keep up with treatment demand.

As we reach the end of 2024, there’s a brighter outlook given that waiting list projections see numbers dropping below 7.2 million before 2025. Much of this is due to innovations in how caregivers can be more efficient through each stage of a personalised patient pathway; where reporting, operations and resource allocation is streamlined to sustain continuous and speedy patient support. With healthtech providers and policy makers looking to support the NHS’ continuous improvement through standardised practice and nationwide analytical data, waiting list times should hopefully reduce across a range of areas.

The urgency to act has been taken seriously as we exit out of the pandemic’s most difficult hold on NHS services. Collaborations involving digital providers, clinicians, consultants and NHS programmes are leading the way to maintain a more patient-centric healthcare system. By regaining stability, the UK service can grant better outcomes for both hardworking NHS staff and the patients that they serve.

Standardising workflows and ‘Getting It Right First Time’: an overview of GIRFT

Posted on November 4, 2024November 7, 2024 by Michael Phillips

Backed by a range of Royal Colleges and professional associations, the Getting It Right First Time (GIRFT) initiative is part of a suite of programmes developed by NHS England. Bringing together powerful data analysis and reviews, it aims to enable healthcare services to improve patient care and pathways across the nation.

Let’s dive in to learn more about its origins, plans, and performance up to this point, as well as looking ahead to its potential future.

GIRFT’s original aims

GIRFT was originally conceived as a pilot methodology for reviewing orthopaedic surgery specialties by Professor Tim Briggs, with its landmark 2015 report coining the term. The research was hosted by the Royal National Orthopaedic Hospital NHS Trust (RNOH) and funded by NHS England. After his team covered more than 140 providers in over 200 hospitals, the subsequent programme (as we know it now) was launched in 2016.

The scheme aims to achieve standardisation for delivering quality patient care across NHS healthcare facilities. Often, clinical practice from site to site can differ greatly, affecting the efficiency of teams, their use of crucial resources, and the level of service they can deliver for patients already experiencing lengthy waiting times for orthopaedic assessments and surgeries.

GIRFT’s greater impact can be felt following the pandemic – a catastrophic incident for patients and NHS staff that faced a battleground each day. Covid-19’s ripple effect has unfortunately seen long physical queues for appointments, but GIRFT’s strategy places staff wellbeing and satisfaction as a high priority, acknowledging the dedication and mental health of key roles at NHS hospitals.

How does it work?

Making the most of data

To outline any discrepancies in operations across the country, GIRFT gathers and analyses national data in line with the methodology’s own benchmarking framework. Different arms of the NHS can compare their performance data against both regional or national standards; this allows them to gain empirical metric-backed evidence to inform the effectiveness of their clinical practice in adhering to patients.

Teamwork

Using the combined expertise and support of clinicians and management teams at various NHS trusts, the GIRFT’s recommendations can be put into practice and reiterated to determine the actionable, physical changes to healthcare services beyond the data insights. By encouraging meetings among practitioners, as well as data-gathering exercises and continuous learning, this hopes to rollout more standardised patient pathways no longer marred by diminishing variations. This alliance can contribute to the continual improvement of using GIRFT’s findings to foster better outcomes not just at one institution, but many.

Strategic plans

Designated ‘enhanced care’ areas have been established to provide flexible support to those requiring post-operative care. The scheme aims to improve patient management for a range of diverse clinical care scenarios, where appropriate and timely intervention can be applied to meet various degrees of clinical needs.

The results (so far)

The flag posts for better pre-operative assessments include reduced repeated testing, the removal of unnecessary face-to-face appointments, and fast-tracking high risk patients that urgently need to be seen by medical professionals. Plus, when resources and staff hours are implemented accordingly for the right tasks, it can have dramatic cost impacts for an NHS that is unfortunately facing financial burden.

Initial findings have seen that, particularly within orthopaedics, hospital trusts that have used GIRST’s assessments have saved outgoings ranging between £20 million to £30 million.

With greater uptake and collaboration involving other specialised trusts, these reductions look set to become more widespread for financial sustainability across the UK. In order to cover more surgical disciplines, GIRFT released 18 additional national documents in 2024 to analyse current procedures, and recommend improvements to deliver quality treatment to NHS patients.

Looking to the future

The environment for effective patient management has certainly improved through the GIRFT programme, and the post-pandemic era serves as a greater opportunity to be ambitious in getting more NHS trusts on board.

The initiative is constantly evolving as surgeries leverage the national data to hand and cross-collaborate to achieve a more effective ecosystem. With uniform pathways, not only can post-operative operations be smoothed for significant cost reduction, but staff and patient satisfaction can be essentially lifted too, revolutionising the running of a stretched NHS.

PRO-MAPP is pleased to have been chosen in GIRFT’s research as a vendor contributing to optimise patient pathways through our Pre-Assessment Clinic Triage product. Discover the full guide here, and chat to us to learn more about our inclusion.

The PACT programme: the next revolution for pre-surgical care

Posted on September 28, 2024September 30, 2024 by Mash Patel

In the wake of the COVID-19 pandemic, healthcare systems worldwide faced unprecedented challenges, including surging waiting lists and operational inefficiencies. Oxford University Hospitals NHS Foundation Trust (OUH) rose to this challenge with an innovative solution: the Pre-Assessment Clinical Triage (PACT) programme, developed in partnership with digital health innovator PRO-MAPP.

To put the technology into action, UOH studied its impact on the care pathways for patients needing complex hip and knee joint replacement surgery, with orthopaedic services being an area of surgery blighted by backlogs.

Identifying the challenges

After the pandemic, OUH encountered a 35% surge in waiting lists. This was due to large backlogs, as well as new referrals, which meant that the the existing system was plagued with a number of issues:

An insufficient number of patients ‘fit’ to utilise theatre capacity
The identification of high-volume, low-complexity (HVLC) patients was inaccurate
Patients were repeating pre-assessment clinics (PAC) an average of 3.5 times before surgery
Administrative processes were paper-heavy
The visibility of patient status between appointments was limited

A more efficient operation was required to minimise the risks of repeated or unnecessary tests and appointments before surgery, which hinges on the collection of valuable data that can be lost with manual, paper-based systems.

Calling on PACT for a solution

In collaboration with PRO-MAPP, and supported by the NHS Adoption Fund 2022, OUH implemented Pre-Assessment Clinic Triage (PACT) – a digital application designed to maximise the number of patients undergoing telemedicine pre-assessment while awaiting surgery.

PACT includes a number of key features that look to holistically tackle the problems of burdened waiting lists, including a digital intelligence tool (featuring a comprehensive health questionnaire), intelligent screening and test recommendations, criteria to assess patient readiness for surgery, seamless integration with Electronic Patient Records (EPR) and Cerner systems. PACT also allows for accessibility both in waiting rooms, and at home, which has proven to have a transformative impact:

Improved Patient Readiness
The pool of patients fit for surgery increased dramatically, from 28% to 77%.

Reduced In-Person Appointments
Face-to-face appointments decreased by 75%, streamlining the pre-assessment process.

Enhanced Efficiency
Theatre efficiency improved by 10%, optimising the utilisation of valuable resources.

High Patient Satisfaction
100% of patients reported being ‘very satisfied’ or ‘satisfied’ with the new pathway, while 92% found the questionnaire to be ‘very easy’ or ‘easy’ to complete.

Significant Cost Savings
Analysis by York Health Economics Consortium revealed an annual saving of £749 per patient, representing a 35% cost reduction.

Environmental Impact
The programme led to an 8.8 tonne reduction in CO2 production, equivalent to nine return flights between Paris and New York.

Making costs go further is a major consideration in relieving the healthcare service. Through PACT, cost efficiency is achieved substantially, with the total additional income gained equalling £791,988. £371,183 came from new patients, while increased elective activity equalled £420,805. Moreover, the reattendance savings per patient amount to £331.26, based on the latest national cost collection data.

The Role of PRO-MAPP

As the technology vendor, PRO-MAPP played a crucial role in the success of the PACT programme in improving communication between healthcare staff and patients, identifying complex orthopaedic cases earlier in the pathway, and more:

The system was rolled out in just 8 weeks, with ongoing evolution to meet emerging needs
PRO-MAPP ensured a seamless, smooth integration with existing hospital systems, including Cerner
The intelligent screening and recommendation system powered by PRO-MAPP’s technology was key to improving patient readiness and reducing unnecessary appointments through data-driven insights
The ease of use for the digital application’s interface contributed to high satisfaction rates among both patients and staff

Powered by PRO-MAPP’s innovative platform, further innovations are now looking to be introduced. There are plans for divisional implementation across NOTSSCaN surgical services, trust-wide roll outs to centralise elective access, partnerships with PRO-MAPP for an intelligent Waiting List Manager (iWLM) and the implementation of Patient-Reported Outcome Measures (PROMs).

After addressing the immediate challenges faced by OUH, PACT has set a new standard for pre-surgical care. As healthcare systems continue to evolve, collaborations like this between forward-thinking NHS trusts and cutting-edge technology providers will be crucial in shaping the future of patient care.

PRO-MAPP has also helped better identify complex patients and optimise patient pathways in a programme run by York Health Economics Consortium (YHEC), and has received recognition in the ‘clinical redesign’ category for our enhanced pre-op assessment project with OUH and Health Innovation Oxford & Thames Valley at the HSJ Partnership Awards. To find out more, get in contact with us.

A post-pandemic problem: how to solve healthcare’s stacked waiting lists

Posted on August 5, 2024September 30, 2024 by Elliot Burr

The planet is under pressure from a growing population, one where the concept of living to 100 is more plausible than ever before. Hospitals need to adapt and become more resourceful, even while struggling with strenuous budget cuts, staff shortages and evolving threats from the flu, Covid-19, and potential future ailments.

The subsequent queues backing up global healthcare systems are drastic. Waiting lists encompass a full range of clinical meetings: a consulting session, a minor or major surgery, an MRI or CT scan, a diagnostic test, or the backlog for receiving cancer treatment. In the UK, orthopaedics comprises the longest lists of any speciality, with total hip and knee replacements costing the NHS 1.5% of its entire budget.

While pre-pandemic times were lengthy enough, they are numbers healthcare providers are striving to return to. Is that possible? By relieving operational burden through technology and turning a switch in how pathways are handled – particularly smoothing the operational cogs between doctors and patients – more efficient and satisfactory healthcare may thrive.

Beyond a number’s game

Waiting lists affect every branch of surgery. Orthopaedics, by example, is commonly slowed through multiple assessments of a patient’s validity for surgery, the costs for primary or secondary and implants, and supplying ample training to better coordinate an over-stretched workforce.

These ‘incomplete pathways’ – where patients face continual waiting times after a referral – saw NHS England’s lists double from 2.3 million people at the start of 2010 to 4.6 million by the end of that decade. Hit by the pandemic, waiting times have grown on average by 80,000 per month while an estimated 75,000 joint replacement cases were lost in 2020. Oftentimes patients can wait for over a year to be seen. 60% of surgeries are also cancelled on the day due to lack of staff and bedding.

The aforementioned metrics speak for themselves, yet the domino effect on public health and wellbeing goes beyond these measures too. Potential patients can be put off by backlogs and skip seeking care altogether. They may spend outside of their means in the private sector. Some may depend on opiates to cure ongoing pain. Sadly other patients may die before being seen to, and delays may worsen symptoms.

When initial prognosis becomes outdated, patients require repeated tests and may need more complex surgery than previously determined, causing further assessments, wait times, and greater human and material costs all along the healthcare pipeline

Projections for patient pathways

In 2020, the demand for joint replacements looked set to increase by 40%, owing to the fact that morbidity and high resource use defines orthopaedic surgery. While the pandemic has endured past its peak, projections from the healthcare sector indicate that a prolonged crisis is inevitable, and one to be dealt with using realistic measures that are, luckily, becoming adopted into common practice.

Waiting lists for the NHS differ by region, but overall it is estimated to still exceed those of pre-pandemic levels: a backlog of around 6.5 million by 2027. However, when medical teams and patients buy-in to seamless digital pathway experiences, resources and procedures can be catered better to fit individual needs and preferences. Siloed working, lost data, resource misallocation and time spent on assessing low-risk cases all amass the operational burden and extend the queue to surgery where, instead, a unified data-led programme can support thorough risk assessment and provide satisfaction to patients.

The idea of shared decision making seeks to speed up consultation too; educating patients on the pathways they’ll navigate should they, their families, carers and specialists openly agree to pursue them. So-called ‘prepared lists’ aim to improve the understanding of any benefits, risks or alternatives, all before the need for further tests or surgeries.This in turn reduces visits to health centres for consulting sessions and checks.

Now’s the time for a rethink

So while the research indicates strong ideals and plans to improve waiting list management, the proof is in the action. Using the NHS as an example, backlog recovery aims set out by the government are still shooting below par.

Healthtech providers are providing solutions to optimise triage. Not only can doctors and patients communicate about bespoke patient pathways through simple digitised workflows, but when only necessary meetings or surgeries are undertaken, resources and staffing costs are saved. More time can be assuredly spent on training staff to effectively accommodate patients in need and nurture them back to health in the most suitable ways possible.

A change in expectations as to how health is given and received may be a cultural shift, but with waiting lists still far from the levels we saw before Covid-19, that change is needed. The technology is available to help solve this queuing problem in significant ways. We may not need to wait so long for better health pathways for all – it’s a space that’s well worth watching.

Want to find out how PRO-MAPP can assist with patient pathways? Contact us.

Resources:
Royal College of Surgeons of England: Projections for primary hip and knee replacement surgery up to the year 2060: an analysis based on data from The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (2020) https://pubmed.ncbi.nlm.nih.gov/34939832/

British Journal of Anaesthesia: Turning ‘waiting lists’ for elective surgery into ‘preparation lists’ (2021)
https://www.bjanaesthesia.org.uk/article/S0007-0912(20)30676-0/fulltext

Institute of Fiscal Studies: The past and future of NHS waiting lists in England (2024)

Personalised Patient Pathways: going beyond operational healthcare challenges

Posted on July 25, 2024September 30, 2024 by Mash Patel

Healthcare systems worldwide are under increasing pressure to deliver improved patient outcomes while under strictly managed budgets. It takes innovative steps to maintain this balance, but emerging solutions are making the necessary leaps to move the industry forward.

PRO-MAPP stands out in this regard as a software platform specifically designed to change the game for patient care delivery. From personalising individual care plans, to driving efficiency and lowering costs for clinicians, here are five compelling reasons for why PRO-MAPP is revolutionising the healthcare sector through smart technology.

1. Addressing healthcare challenges

The hurdles faced by healthcare providers are escalating. Under the stress of rising costs, patients have high expectations in regards to their duty of care, and managing new systems to solve operational problems (including streamlining workflows and improving patient outcomes) can be convoluted. Traditional approaches to care delivery often lack the flexibility and precision needed to address the diverse needs of patients effectively.

Instead, PRO-MAPP offers a complete solution that enables healthcare professionals to design and implement bespoke patient pathways that are tailored to individual clinical needs, maintaining a consistently high level of detail for every case.

2. Data-centric decisions

All patient pathways are different and healthcare providers must juggle various clinical scenarios, ranging from routine procedures to complex treatments. There’s only so much oversight and multi-tasking a human can handle in a fast-paced environment.

But by leveraging advanced algorithms and data analytics, PRO-MAPP generates customised care plans that take into account patient demographics, medical history, and their healthcare preferences. With a personalised approach, each patient is ensured that their specific requirements are met through their care path and increasing satisfaction.

3. Enhancing clinical efficiencies

Healthcare providers are tasked with a range of operational considerations that can affect the efficiency of end-to-end clinical workflows. These can include care coordination, task assignment, and resource allocation across whole clinical teams, where collaboration is key to ensuring a streamline care journey for every patient.

Automating these administrative tasks allows healthcare teams to focus on what matters – improving the patient experience – by reducing unnecessary delays, distributing resources accordingly and increasing productivity overall. Going a step beyond, real-time tracking and monitoring features also allow clinicians to monitor patient progress and identify potential bottlenecks for them to proactively intervene when necessary.

4. Measurable cost reductions

In addition to improving patient outcomes and clinical efficiencies, healthcare organisations are under scrutiny to deliver tangible cost savings in the current financial landscape. Optimising many of the care delivery processes above helps to reduce any unnecessary variations in practice and utilises care givers and materials more effectively. This has a direct knock-on effect to lowering costs.

Studies have shown that institutions using PRO-MAPP experience measurable reductions in operational expenses, including shorter lengths of stay, fewer readmissions, and lower medication errors. Each of these cost savings translate into significant financial benefits for healthcare providers and contribute to long-term sustainability and profitability.

5. Embracing advanced IT systems

The healthcare industry has a history of investing billions in monolithic IT systems with limited returns on investment which cannot adhere to the needs of personalised care options easily. Traditional IT implementations require lengthy customisation and integration processes, ultimately delaying the all-important provision of healthcare.

A departure from this trend looks to offer a solution that is both cost-effective and a value-driver from day one. These new-look platforms, including PRO-MAPP, can not only be rapidly deployed, but scaled to meet the evolving needs of healthcare organisations over time. An intuitive interface and user-friendly design also minimises the need for extensive training, ensuring adoption is rapidly accepted among clinical staff.

All healthcare providers should seek to enhance patient care, streamline clinical operations, and achieve cost efficiencies, especially as it’s becoming evermore possible using technological breakthroughs specifically designed for the industry. By enabling personalised patient pathways, enhancing clinical efficiencies, and delivering measurable cost reductions, PRO-MAPP emerges as a transformative solution for modern healthcare delivery – not only a strategic decision to improve patient outcomes – but also as a significant step to provide long-term success and sustainability for healthcare organisations.

To find out more about PRO-MAPP’s solution for personalised patient pathways, get in touch with our team today.

PRO-MAPP for joint replacement surgery: a slicker digital approach to preoperative assessments

Posted on June 21, 2024September 30, 2024 by Michael Phillips

As an application merging surgical experience, leading academia and software design, PRO-MAPP is specifically tailored to innovate and improve patient pathways. With healthcare systems under pressure from tight budgets, lengthy waiting lists, and evolving (and often complex) methodologies, the time to solve unnecessary operational lags has never been more striking.

In light of this, a programme developed by health economic research arm and consultancy York Health Economics Consortium (YHEC), in collaboration with Oxford Academic Health Science Network, placed four evidence-based digital solutions under the microscope for their transformative patient pathway abilities. PRO-MAPP was selected for its focus on preoperative assessment and digital patient outcome reporting, looking to showcase its digital effectiveness against standardised patient pathways for knee and hip replacement – one particular strand of clinical surgery blighted by long waiting times – at Nuffield Orthopaedic Centre.

The current healthcare burden

The pandemic’s hit on expanded patient waiting lists has been felt across multiple surgical cases, all equally difficult to solve in light of stripped-back resources and staffing. Existing pathways for joint replacement surgery suffers a range of challenges as a result of (or on top of) lengthy backlogs, including:

More than three preoperative appointments being undertaken before patients are deemed fit for surgery
Manual investigations being repeated unnecessarily
Expired preoperative checks (including blood tests)
Needless preoperative appointments being carried out on healthy patients

Digital pathway solutions can relieve the burden on the entire healthcare system’s human and material costs by simplifying each major step before surgery is carried out: lowering unnecessary face-to-face appointments; speeding up the steps between appointments, vital tests, and possible surgery; reducing the need for repetitive testing and data input; and fast-tracking those most fit or liable for secondary care (complex patients, e.g., those with high clinical frailty score that are over 65 years old).

Gaining the digital advantage

The PRO-MAPP application is designed to more swiftly and accurately identify patients fit for surgery and reduce numbers on backed-up waiting lists. Patients can be assessed via web or tablet, having been added to a waiting list following an outpatient visit. Health screening and occupational therapy questionnaires can be filled in on iPads by patients, with assistance available from staff.

Staff training, individually or in groups, takes 15 minutes on average, and this digital collection aims to accurately guide staff as to which investigations are required before patients leave clinics, including ECD, MRSA swabs or blood tests.

The digital interface speeds up diagnostics, operational decisions, and ensures complex patients can start preoperative investigations earlier, increasing the probability to be determined fit for surgery sooner. Optimising preoperative assessment can properly segment patients only requiring telephone appointments, saving resources and costs affiliated with necessary appointment visits.

Complex patients should start pre-op investigations earlier to avoid the risk of changes to health status or expired tests (and the need to repeat questionnaires and checks), as well as increasing the probability of being fitter for surgery.

In short: what we found

Based on a sample of 1000 patients, the investigation compared the PRO-MAPP pathway with a standard care pathway for those correctly (or incorrectly) identified as complex or non-complex patients. The number of tests undertaken (e.g. echocardiogram or chest x-rays) was dependent on this factor.

The study looked to identify the average differences between: patient management costs; the length of a patient’s hospital stay; the number of preoperative tests; the number of preoperative appointments; readmissions; cancelled surgeries; and repetitions for preoperative tests and appointments.

PRO-MAPP’s identification rate proved 98% correct for complex patients, and 95.4% for non complex patients. The length of stay was, on average, two days shorter for those on the PRO-MAPP pathway, while readmissions were lowered by 0.4%, and 1.3% fewer surgeries were cancelled.

In all, the PRO-MAPP pathway for knee and hip replacement saved £770 per patient in comparison to the standardised procedure. Per 1000 patients, this marks a difference of £726,944.

Future-proofing personalised patient pathways

Reducing the need for unnecessary face to face appointments, the lengths of hospital stays, and training and resources costs, the PRO-MAPP pathway is on course to speed up operations while alleviating budget stresses and achieving patient satisfaction. 92% of patients stated the questionnaire was ‘easy’ or ‘very easy’ to complete.

Staff similarly felt the bespoke application was helpful for the service, implemented according to speciality, workflows, staff numbers, and the level of training, support or technology needed. With reduced repeated health centre visits, health economic analysis also identified that PRO-MAPP has (so far) saved 51,381.6k of travel; a necessary step in improving climate issues through a reduced 8.8 tonnes of CO2 emissions.

Efforts are still ongoing to improve interactions between patients and staff, but PRO-MAPP has been included on NHS England’s website as a guide for providers on earlier screening, risk assessment and health optimisation in perioperative pathways. To learn more about our pioneering patient pathway solutions, get in touch with our team today!

Category: Patient Pathways