Frank Evans, Marketing Assistant for TPP, outlines how NHS trusts have been overcoming traddional barriers to surgical preparation.

The pre-operative assessment is an integral part of any patient’s care journey when having an operation. It ensures clinicians get vital information regarding a patient’s medical history, general health and any other potential comorbidities. 

However, the process is not without problems. These assessments are often conducted face-to-face and can take anywhere between 45 and 90 minutes, regardless of whether a patient is fit and healthy or has multiple comorbidities. When factoring in attendance time and travel, the entire pre-operative assessment process can often last hours for patients, even if they are an ASA (American Society of Anaesthesiologists) Grade One, meaning they have no recognisable health conditions.  

Clinicians using SystmOne have been working to tackle these problems. They have made use of SystmOne’s shared and comprehensive electronic patient record as well as the clinical development toolkit to improve accuracy, efficiency and the patient experience during the pre-operative assessment process. 

Information Access 

Many of the inefficiencies within pre-operative assessments stem from healthcare professionals in secondary care lacking easily-accessible information about their patients. The onus is often placed on patients to know their full medical history, as well as any current issues that may be of particular importance for an anaesthetist and clinical team to know. For healthy patients, the assessment can be an unnecessarily protracted process, adding stress to the often-stressful experience of going for an operation. On top of this, the reliance on patients to provide important medical information can frustrate patient-clinician confidence and cause further stress. 

Record Sharing Benefits 

SystmOne’s ‘one patient, one record’ system is a valuable resource for clinicians looking to overcome common problems in the pre-operative process. Structured SNOMED codes provide important patient information that, if captured and displayed effectively, turns the pre-operative assessment from a process of capturing patient data into one focussed on validating it.  

To access this data, Alwyn Kotze, Consultant Anaesthetist at Leeds Teaching Hospitals NHS Trust, developed a code base that allows clinicians to run an enquiry of nineteen-thousand codes relevant to the pre-operative assessment process in the patient’s care record. The view presented by this enquiry flags up any relevant issues within an individual’s electronic patient record (EPR). This code-base has also been used by clinicians at both Airedale NHS Foundation Trust & The Mid-Yorkshire Hospitals NHS Foundation Trust (MYHT). 

Receiving patient data before a meeting has multiple benefits: reducing worry for patients through a better-informed and less-protracted process; giving staff more efficient and accurate patient information and saving clinician time. In the case of pre-operative assessment for ASA Grade One patients, using SystmOne to capture important data before the meeting reduces meeting times from 45 minutes to just five.  

Pre-operative Assessment at Airedale NHS FT  

Dr. Julian Hood, Consultant Anaesthetist at Airedale NHS Foundation Trust, led a project assessing the potential use of a SystmOne view based on interrogation of the shared record. Initial testing showed that assigning ASA grades using the view had an accuracy of close to 90 per cent for those assigned an ASA grade of one or two, with 98 per cent of cases within one ASA grade of those given after a full face to face assessment. 

The view “negates the need for time-consuming data entry and led to the successful introduction of telephone pre-assessment, saving nurse and patient time and enhancing patient experience,” says Dr Hood.  

Building on initial tests, a streaming clinic was set up where routine observations and investigations were made by a preoperative nurse who studied the SystmOne view against a screening checklist, offering telephone assessments for patients meeting low risk criteria. Through this, half of streamed patients were successfully triaged into a low-risk pathway.  

The view has been further enhanced into a visualisation, which, together with data taken from a direct entry questionnaire and template, has been used to produce a holistic source of information for the anaesthetist on the day. Direct access to the relevant code base has also been useful in the context of the Covid-19 pandemic where the development of telephone pre-assessment has been an essential tool when restoring normal activity in a Covid-safe setting. 

Pre-operative Assessment at The Mid-Yorkshire Hospitals NHS Trust 

Consultant Anaesthetist Dr Nicole Moll and the team at MYHT have also been exploring different uses for the pre-operative code base. When compared to their usual health questionnaire, only one patient’s status differed from the SystmOne view, due to them recently starting new medication that was not on their medical record. Even when accessing the view alongside a face-to-face assessment, Dr Moll notes that “nursing staff found it easier to ask focussed questions after checking the SystmOne record”.  

As at Airedale, the pre-operative assessment view has helped MYHT implement a telephone pre-assessment system during the pandemic, using the summary as a triage tool for 400 patients who could not be pre-assessed. 

“The waiting list team will be able to fill earlier vacant slots with patients classed as ASA1/2 – likely to require pre-assessment phone reviews only – allowing more time and potential anaesthetic review for higher grade patients” says Dr. Moll, highlighting another potential use of the pre-operative view. 

Dr. Moll is also keen to explore other uses as well. For example, it could be used to flag up relevant issues earlier in the process, asking patients to arrange a review in primary care to address any issues that arose, saving clinical time and further increasing efficiencies. 

The digital future of the pre-operative assessment 

TPP’s patient-facing app, Airmid, offers further opportunities for improvements within the pre-operative process. Its ability to integrate with other health apps means it can capture data not yet within a patient’s medical record or could be used by clinicians to send out pre-operation forms for patients to fill in, providing them with important information before the meeting is even held.   

Going forward, TPP hopes to continue working alongside clinicians to streamline the pre-operative process, eventually removing the need for any face-to-face pre-operative assessment when a patient is identified as an ASA Grade One, saving substantial clinician and patient time.