East Kent Hospitals University NHS Foundation Trust (EKHUFT) has revealed that innovative use of a new digital population health platform has reduced preoperative consultation times by 27% for surgical day cases – enabling more patients to be seen in a timely manner.
It has also increased clinical team productivity. When fully implemented it will enable efficient and effective early pre-surgical health screen and triage, and guide medical optimisation and pre-habilitation, to drive improvements in perioperative outcomes. Sharing timely, relevant clinical information between healthcare organisations improves its accuracy, reduces duplication of clinical activities, and helps clinical decision making.
The population health platform, which features a waiting list dashboard, was developed and launched by Graphnet Health in March 2024, to automate risk stratification and triage of day surgery patients awaiting preoperative assessment (POA) at East Kent University Hospital.
Data on surgical waiting lists is integrated with the patient-level primary care record – and allows clinicians to see primary care data on all patients awaiting surgery. For surgical patients, this enables high and low-risk patients waiting for surgery to be instantly identified.
Over the course of six weeks, EKHUFT used the platform to assess and triage two groups of low-risk patients – “Gold” and “Green” patients.
“Gold” patients were normal, healthy patients (ASA 1 equivalent, with a BMI <35, non-smoking etc.) The “Green” patients were those with mild systemic disease (ASA 2 but well controlled). Preoperative assessment clinics were launched for both groups in April with bookings made using a digital triage tool.
In total, 138 patients awaiting day-case surgery were booked into the clinics. The average consultation time was 22 minutes, 27% less than the allocated time (30 minutes). The majority of patients (77%) were digitally triaged correctly. 23% of patients’ triage categories were manually revised due to incomplete patient information from primary care data. For example, in 25% of the cases, BMI measures were not in the patient record.
Dr Simon Rang, Lead for Perioperative Medicine, East Kent Hospitals NHS Trust, explained:
“The aim was to test the tool’s efficacy and assure clinical effectiveness, users’ trust and adoption. We compared the dashboard-allocated triage category to a standard clinical assessment of medical complexity at the POA clinic. The clinic manager also monitored various indicators, including the consultation time with each patient.”
“The results have been very positive. The time savings, for example, proved valuable as it allows more patients to be seen, and means we can allocate resources to additional triage and more complex patients. The digital risk stratification tool, which enabled us to identify high-risk patients, improved clinical team productivity by only booking patients with the highest perioperative risk into combined nurse and consultant clinics. The tool has helped us Make Every Contact Count.”
“The plan now is to scale up the use of the platform to undertake medical screening and triage all patients referred to the pre-surgical preparation service,” added Dr Simon Rang. “We intend to tackle health inequalities by using the dashboard in a collaborative project with Kent Community Health Foundation Trust to identify cohorts of pre-surgical patients who would most benefit from community-based health promotion services whist waiting for elective surgery.”
