Technology
Harnessing smart phones to improve surgical care
Smart phone technology is being implemented by UK hospitals for preoperative assessment, as well as remotely monitoring patients’ wounds. The Clinical Services Journalspoke to Chris Taylor, a director at Isla, to find out how the technology could help improve perioperative care.
Smart phone technology could be used to improve perioperative care, reduce system pressure, and minimise on-the-day theatre cancellations. From improvements in pre- operative assessment, through to surgical site surveillance, there is a growing body of evidence to highlight the value of harnessing smart phone technology, whether it is capturing patient data prior to surgery, aiding the triage process, or monitoring wound healing and identifying surgical site infections. BD and Isla have joined forces on the
development of a smart phone platform, which can be used to capture important data, including photos, videos and patient forms, which can be used for triage, remote monitoring, and assessment of how patients’ conditions are changing over time. “The first pilot site for Isla’s technology was
secured in 2020 and we have quickly grown – rolling out the technology out across many NHS Trusts. We are having conversations with primary and social care, but the greatest interest so far has been within the secondary care sector,” Chris Taylor commented.
He explained that Isla is being used to reduce system pressure in four ways:
l Monitoring patients post-operatively to avoid complications – this tackles the huge burden of surgical site infection, which impacts nearly 1 in 3 surgical patients, costs the NHS over £1bn per year, and drives readmission and avoidable bed occupancy.
l Safe early discharge of patients whose recovery can then be accurately and safely tracked using updated videos, images, voice notes and clinical questionnaires.
l Collecting information continuously from patients to inform treatment without the need for face-to-face or video consultation – this dramatically improves efficiency.
l Collecting information from patients on the waiting list to understand whether they still require surgery and streamline the preoperative process.
Pre-assessment A number of hospitals are currently using the Isla platform for digital preoperative assessment triage, including the Chelsea and Westminster Hospital NHS Foundation Trust. The Trust’s use of the technology was featured in the NHS Transformation Directorate’s ‘digital playbook’. (These ‘digital playbooks’ are designed
to support teams to “reimagine care pathways” by showcasing tried and tested technologies to solve real-world problems.)1 Preoperative assessment (POA) is an important step on the patients’ pathway but not all patients are required to attend an appointment for assessment. Those with no relevant past medical history, having less complex procedures, can safely bypass this step. This saves unnecessary appointments for patients who are fit and healthy, freeing up resources for those requiring more extensive assessment. As patients are added to the waiting list, a Digital Health Questionnaire (DHQ) is automatically sent to all adult patients via text message with a link to an online form by Isla. A prompt to complete is sent 24 hours later, with six days to complete. Patients with clinical alerts (such as safeguarding) are excluded and default to the standard POA pathway. The DHQ comprises of three sections asking: l Section 1 – if patients still require surgery. l Section 2 – 15 health related questions. l Section 3 – if patients are available at short notice.
A patient who answers ‘no’ to all questions in section 2, has a BMI of less than 40 and is aged between 18 and 64 is classified as ASA1 (American Society of Anaesthesiologists grade 1). These patients can be scheduled for surgery without a POA if the procedure is not on the list of complex procedures agreed with the surgical specialties’ leads. A POA triage functionality has also been introduced, allowing the team to determine which patients needs to attend a face-to-face appointment and who is fit to proceed without one. The POA team would typically review and check triage questionnaires in approximately ten patients within 45 minutes. Analysis has shown that only 24% of patients require POA after triage. The questionnaire is resent in six months if the patient is still on the waiting list. The solution has been a success
March 2024 I
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