Case Study: Transforming Worcestershire Acute’s pre-operative assessment process

The challenge

Worcestershire Acute Hospitals NHS Trust found it was spending increasing amounts of time assessing patients that were fit for surgery and so did not actually require an hour appointment for a pre-operative assessment in hospital. With some of these ‘fit for surgery’ patients spending an hour or more with the POA team at their appointment, this meant less time for staff to spend with patients that required more detailed pre-operative care to ensure their operations went ahead.

The trust needed to transform the way it carried out pre-operative assessments to make it more efficient for patients waiting for operations and the staff that deliver their care. This transformation centred around a digital solution that would facilitate instant data sharing between staff and patients, minimise the paper trail, and reduce the number of pre-operative assessments carried out face-to-face in hospital.

Following the onset of the COVID-19 pandemic, it was also essential for the new way-of-working to support infection control measures by keeping unnecessary hospital visits by pre-operative patients to a minimum.

“Our elective surgery patients can now complete their health history questionnaire from the comfort of their own home, in their own time, then submit the answers in real-time to our clinical teams."
The solution

Working alongside Intouch with Health, Worcestershire Acute Hospitals NHS Trust deployed digital pre-operative assessment (POA) health questionnaires using Synopsis iQ and Synopsis Home in February 2020.

Following the deployment, patients no longer need to visit hospital to complete their POA health questionnaire. Instead, using a link sent by the trust  to their phone or tablet, patients waiting for elective surgery can complete their questionnaire at home, in the office, on a train or while waiting to catch the bus home from work. They no longer need to block time out of their day to physically travel to hospital for their POA appointment with a nurse; instead, Synopsis gives patients the option to complete their POA questionnaire anytime, anywhere.

For the trust’s staff, Synopsis has replaced a resource-heavy, time intensive paper-based POA process with a digital solution that saves time and facilitates instant information sharing. When a patient completes their questionnaire via Synopsis iQ, the answers are shared instantly with the trust’s pre-op team, removing the need to use, access and store paper records. Risk assessment levels are supported (including ASA, POSPOM and Stop-Bang scores), alongside cardiac risk and lung risk levels, providing care teams with all relevant information to triage patients with high levels of efficiency and accuracy.

With all this information digitally at their fingertips, pre-op teams can:

  • quickly identify patients at high risk of being unfit for their operation based on the answers to their POA questionnaire
  • action relevant interventions to reduce the risk of surgeries being cancelled
  • increase patient through-put and maximise theatre utilisation across the trust.
“100% of Anaesthetic referrals and reviews are completed on Synopsis. We are seeing an increasing trend of patients choosing to use Synopsis Home to complete their pre-operative questionnaire from home (currently 64%). "
The results

The introduction of Synopsis at Worcestershire Acute Hospitals NHS Trust has facilitated a reduction in the number of patients attending hospital for a full POA, reducing the hospital activity time of a pre-assessment by 21% , while increasing pre-operative capacity.

Since launching Synopsis:

  • Due to the current COVID-19 action plan 100% of the patients are not attending the Hospital and all patients are being pre-assessed remotely. Assessments using Synopsis iQ without Synopsis Home are being done via telephone with a nurse / HCA
  • Between Go-Live of Synopsis Home on the 21st May, and the 30th June, 50% of pre-op patients used Synopsis to complete their POA questionnaire outside of hospital.
  • In July, this number increased further, with 64% of patients using Synopsis Home to complete their POA questionnaire out of hospital
  • Across the trust’s four hospitals, teams reached their target of completing 750 POA questionnaires using Synopsis by the end of the first month of deployment (February), demonstrating positive uptake by hospital staff
  • In March, staff completed 795 POA questionnaires using Synopsis, a steady 6% increase on the first month of deployment
  • The lag time between the patients being referred for a pre-assessment appointment and completing their triage questionnaire has been reduced from weeks to days. On average a patient is sharing their triage questionnaire back to the hospital within just 3 days
  • POA can be completed safely within a two week period as a result of an increasing number of patients completing their questionnaires remotely

Removing face-to-face POA visits by patients has supported the trust’s infection prevention and control measures in the wake of COVID-19 by minimising the number of patients in hospital buildings and enabling vulnerable pre-op patients to continue to shield from home and only attend hospital if absolutely necessary.

Patient benefits for using Synopsis Home:

For patients that use Synopsis Home there are many benefits with not having to attend the hospital around time, carbon and costs. These are estimated by the West Midlands CHU as;

  • 33 minutes saved travelling to and from the hospital
  • 84 Kg CO2
  • 15 miles on average
  • 2 hours within the hospital
  • £5.20 for fuel and parking fees

For the patients that have only used Synopsis Home since May 2020, this group of patients has saved;

  • 199 hours
  • 1,025 Kg CO2
  • 5,271 miles
  • 722 hours inside the hospital
  • £1,877.20
In the Trust’s own words

Rachel Foley, Senior Sister Pre-Operative Assessment Countywide, WRH Theatre Admission Unit at Worcestershire Acute Hospitals NHS Trust, said:

“Earlier POA interventions are allowing us to identify patients at high risk of being unfit for their operation and intervene sooner and with more effective medical input to ensure they stand the very best chance of their surgery going ahead. Our elective surgery patients can now complete their health history questionnaire from the comfort of their own home, in their own time, then submit the answers in real-time to our clinical teams.

“This also helps improve patient experience. Current wait times for surgery can be lengthy, and if a patient is told last minute they are unfit, it can be very frustrating.”

“After assessing answers submitted by patients using Synopsis Home, our clinical staff can quickly triage and separate the patients that are fit and ready for their operation and don’t require a full POA in hospital from those that do. Staff also benefit from referrals and replies being contained within one system, alongside completed risk assessments.”

“100% of Anaesthetic referrals and reviews are completed on Synopsis. We are seeing an increasing trend of patients choosing to use Synopsis Home to complete their pre-operative questionnaire from home (currently 64%). Hospital staff and patients continue to gain confidence in using the system to restart elective activity.”

“The majority of pre-op assessments are now requested within just two weeks of surgery, and Synopsis Home is proving vital in supporting us safely complete the assessments within this timeframe. The ability to digitally triage patients has also eliminated the need for some patients to attend hospital for their pre-op assessment. Patients who do attend hospital complete the questionnaire on an iPad, resulting in less staff time required to complete the assessment.”

Find out more

If you'd like to find out more about the Synopsis digital pre-op platform, please contact the team on info@intouchwithhealth.co.uk 

Transforming Worcestershire Acute’s pre-operative assessment process