Q Exchange
Road to Surgery; Surgical Prehab Pathway using insights database
- Shortlisted idea
- 2023
Meet the team
Also:
- Caroline Pritchard Pre-Op Consultant
- Ian Sadler Transformation Project Manager ICB
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
Patients are waiting up to 72 weeks for their orthopaedic operations. They are attending pre-op appointments assuming they will be going forward for their operation, but their healthcare conditions have not been managed while they have been waiting. Patients are experiencing further delay as they need support to manage their health needs in preparation for their operation e.g. controlling diabetes, reducing weight.
The project aims to provide earlier support to people on the waiting list so that they can prepare their ‘Road to Surgery’ so that they are ready to go forward for surgery at their Preop appointment.
The pilot has developed an innovative dashboard combining the surgical treatment list (STL) with shared care record identifying patients with long term health conditions. The next stage of dashboard development is to develop automated letter generation, explore texting and look at other health conditions e.g. smoking.
What does your project aim to achieve?
Provide patients on the Surgical Treatment List at BHT with Prehab information so that they can access support to manage their weight and/or diabetes increasing the number of patients who can progress to surgery at their Pre-Op appointment from (xx) to (xx) per month.
The pilot project is being evaluated, and early results indicate areas to develop are building automation of letters, running patient focus groups to get more insights into motivating factors to improve engagement with prehab, testing text messaging, linking in further with primary care Health Coaches, identifying other underlying health conditions from the database insights.
There is a strong link between obesity and low social economic status and a strong link with obesity and diabetes. The current patient pathway in itself is compounding health inequality as people who have a high BMI are having an inferior user experience of the orthopaedic surgery pathway.
How will the project be delivered?
In the pilot QI project patients from the surgical treatment list with a BMI above the recommended range for an adult and/or with Diabetes are sent a letter with Prehab advice and contact details for additional support with their weight/diabetes management. The next stage of the project is underway contacting this cohort by phone to evaluate the impact of the advice provided and to encourage access to support/further support if required.
If the letters have been successful the project can move forward to implementation for all patients waiting for surgery and develop automated letter generation.
Service user feedback will be key to developing the effectiveness of the prehab pathway.
The pilot was with Orthopaedic patients, for sustainability we would also like to work the Orthopaedic Team re-designing the pathway to ensure that future patients have information about prehab at the point of booking their operation at their Orthopaedic Outpatient consultation.
How is your project going to share learning?
QI work at Buckinghamshire Healthcare Trust is written up on a project on a page, shared across Divisions at Transformation Board, presented at QI and Clinical Effectiveness Conference. The project is supported by the ICB which will facilitate sharing across region including the Oxford Academic Health Science Network.
There will be transferable learning for other services in terms of managing people who are waiting for operations and interventions to be well prepared for their procedure when there slot comes up.
Also transferable learning in terms of considering a patient holistically in outpatients when booking a patient for a significant intervention such as surgery.
We don’t believe the dashboard is a first and are looking to write this up for publication. It has already been shared in the Thames Valley Network.
How you can contribute
- Experience of running similar Prehab projects.
- Advice on opportunities to further share learning.
- Ideas about demonstrating improvement / outcome measures which is always challenging when you are implementing a change in the area of prevention.
Plan timeline
| 24 Feb 2023 | 30-4-23 Evaluate pilot 1-5-23-31.12.23 Implement project extension |
|---|
Comments
Debbie Begent 14 May 2023
We believe we are one of only two Trusts identifying patients using a population management tool. Pilot project we have proved we can identify patients with underlying health conditions from their GP records. We have developed across the ICS a coherent strategy to agree who qualifies for prehab and have coordinated messaging.
Within our organisation we also have a Frailty dashboard and our ambition is to link the two. We have engagement from the Ortho Team. So potential to identify frail patients and collaborate on new pathways.
Excited to be shortlisted - funding will help us with phase 2 to further develop digital innovation to target health inequalities. through prehab requirements.
Debbie Begent 14 May 2023
The results are back from the pilot project and poster submitted at RCoA conference next week. We are ready and hopeful to progress to phase 2 of the project.
Dr Seema Srivastava MBE 21 Mar 2023
Hi Debbie
Great to see this focus on long waits in orthopaedics. I wondered about accessible information for people who don't speak/read English. I also wondered if you are using behavioural insights work (Q did a great webinar on this recently) to understand more about what changes behaviour in the patient groups you are focusing on. Good luck and I'll be following with interest!
Debbie Begent 14 May 2023
We have been shortlisted would be great to get your support
Debbie 21 Mar 2023
Thank you Seema it was an interesting presentation. I've sent the link to the project team and suggested we think about using a commitment question at the end of the letter. From the initial follow up phone calls we are also finding that we need to look more closely at the language used in the letters as people are not responding well term terminology such as obesity.
Thomas John Rose 14 Mar 2023
PDSA is not the best tool for a Service design or re-design project. It may be better to use something like the triple diamond method to establish a more in-depth, co-designed, 'P'. The first Q Lab project can provide some information on this method.
Debbie Begent 14 May 2023
We have been shortlisted, would be great to get your support
Debbie Begent 17 Mar 2023
Thank you Thomas I have not familiar with this, I will look it up.
Beckie Burn 7 Mar 2023
This has similarities with the work we're doing around interventions to optimise for surgery, would be great to share.
Debbie Begent 14 May 2023
We have been shortlisted - how did you get on?
Debbie Begent 13 Mar 2023
Hi Agree would be great to share learning. We are currently calling 100 patients in the pilot to see of they followed up on any of the advice provided in the initial contact letter, or if they need any more support/encouragement. Beckie has your work been specifically around orthopaedics? Have you had any luck with your efforts so far?
Faye Musselle 7 Mar 2023
Completely agree Beckie, it would be great to share thoughts and any learnings already had or that come in future.
Faye Musselle 6 Mar 2023
Hello,
It appears we have similar ideas regarding pre-habilitation (we have submitted an idea for pre-hab prior to cardiac surgery). It would be great to share ideas and eventually learnings.
Thanks
Debbie Begent 14 May 2023
Hi Faye - we have been shortlisted how did you get on?
Debbie Begent 13 Mar 2023
Definitely - do Cardiac patients require signposting to similar support for weight and diabetes management prior to surgery?
Comments are now closed for this post.