Technology
across both Chelsea and Westminster Hospital and West Middlesex University Hospital sites. The implementation of the technology allows the Trust to fast-track patients who meet the ASA1 criteria, enabling effective decision making by optimising clinician time and improving coordination of patients along the pathway. The triage process has saved approximately
180 POA appointments of 45 minutes each (April 2022 pilot). The resources saved are being used to increase the time between POA assessment and surgery. A total of 36% patients were triaged as ASA1, and did not require a POA appointment. In addition, patients identified as ‘Fit to Proceed (short notice)’ can be offered surgery dates on under-booked lists and also feed into the Assisted Theatre Scheduling (ATS) criteria. The Trust found that:
l 407 patients reported they no longer want or need surgery.
l 7897 patients were available at short notice (10 working days’ notice).
l 222 patients without NHS numbers were identified.
l On-the-day theatre cancellations related to POA reduced to 1.2% (57% improvement).
Remote monitoring of wounds The technology can also be used to monitor surgical wounds, enabling faster identification of surgical site infections.2 “A photo of the patient’s wound is captured at the point of discharge. Once this baseline image has been captured, the patient will have a schedule to upload further images – at day seven, day fourteen and day twenty-one, for example. It is entirely web-based, so the patient doesn’t need to download the App. They just need their year of birth to authenticate their identity. Its simplicity means there is a high patient engagement rate of around 78% ,” Taylor explained. Clinicians can have access to an ‘at-a-glance
view’, along with surveys, to establish if there is deterioration or improvement. “If you have this real-time information, you can adapt the patient’s post-op recovery and change their treatment plan to avoid adverse incidents and readmissions. We have already seen a significant reduction in readmissions at partner hospitals,” Taylor commented.
SSI surveillance: key findings The NHS Transformation Directorate’s ‘digital playbook’ highlights the use of the technology for surgical site infection surveillance at NHS Lothian, where the technology has been successfully implemented.3 The Tracking Wound Infection with
Smartphone Technology (TWIST) tool allows 32
www.clinicalservicesjournal.com I March 2024
patients to report key symptoms of wound infection and submit photographs of their surgical wound. Patients can complete an online form anytime in the 30 days after surgery but are encouraged to do so routinely (receiving a reminder every three days), even if they have no wound concerns. This form of wound monitoring has been found to have four main benefits for patients in NHS Lothian within the context of a randomised control trial of approximately 500 patients: l Wound infections were diagnosed earlier; more patients with infections were diagnosed in the first seven days after surgery, compared to routine care (67% [n=14/21] vs 35% [n=7/20]).
l Fewer people needed to use healthcare services – GP attendances were almost halved (11% [n=25/223] vs 18% [n=49/269]), without increasing hospital attendances (3% [n=7/223] vs 4% [n=11/269]).
l More people who needed readmission attended emergency hospital services; for those who attended emergency services, 71% (n=5/7) needed re-admission, compared to 27% (n=3/11) in routine care.
l Patients reported a more positive experience – overall they found it easier (58% [n=65] vs 43% [n=48]) and faster (60% [n=54] vs 40% [n=36]) to access care, and felt they got better-quality advice (58% [n=77] vs 42% [n=55]).
The solution is also helping to drive improvements at other Trusts in the UK. Within obstetrics, Guy’s and St Thomas’ NHS Foundation Trust has reported that the technology helped to decrease reported SSI incidents, for example. The Liverpool Heart and Chest Hospital also saw a reduction in readmissions for cardiac surgery patients. Isla claims that it has seen an average six times reduction in the likelihood of readmission across six sites. In addition, 27 km of travel is typically saved per patient. Therefore, the technology has the ability to not only improve patient outcomes, but also
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