How do we Reduce the Elective Surgery Backlog with Digital Technology?
Mr Graham Walsh, Chief Clinical Information Officer and Consultant Orthopaedic Surgeon at Calderdale and Huddersfield Foundation Trust, has been working with BPMpathway to develop the orthopaedic pathway at the trust for patients having hip or knee arthroplasty. The pandemic has had a considerable impact on his practice, but also provided an opportunity to analyse efficiency, patient involvement and realise the potential to digitise pre and post-operative rehabilitation.
We interviewed Mr Walsh to find out more about the recent changes to the orthopaedic surgery pathway at Calderdale and Huddersfield Foundation trust.
How has Covid-19 impacted your practice, from an NHS perspective?
GW: I think the obvious impact is [that] for a good period of time we stopped operating, we converted all of our input into fracture and emergency care, and elective surgery took a back seat. Now we have a huge waiting list problem. We’re also facing potential changes to the way we can operate moving forward.
We have a patient group that are very different now. People don’t want to be in a hospital environment, where theoretically you could get Covid. Patients’ mind-sets have changed. What I’m seeing now is when we speak to patients about moving forward and having the surgery, [they] want to get home quicker.
So, moving forward what kind of changes will we need to be put in place to get things started again?
GW: I think the obvious thing is, we need to operate in Covid safe environments. Hopefully that will be less important in the coming months, as the vaccine starts to kick in and the numbers start to decrease. Hopefully we can then start planning surgeries in a way that we normally would. But I think now we’ve got to think of novel pathways, we can offer efficiencies and reduce hospital stay because the last thing we want is, as we increase our numbers, patients block beds and we can’t get other patients through.
When you refer to a novel pathway, what do you have in mind?
GW: We have always been challenged over efficiencies, we have always looked for efficient pathways and different ways of working. This has become far more important now than it ever has been.
I think the model of having inpatient stay has to be looked at. In arthroplasties I see no reason why patients need to be in hospital for any longer than the day of operation. Going into Covid we were doing about 30-40% of our knees as day cases. We’re now in a position where around 95% of our knees are done as day cases and I think we need to do more. Using those hospital beds for the acute care that needs to be in [hospital], but the elective higher turnover surgery should be done in a more ambulatory setting. We shouldn’t be in a position where we follow the old traditional model of bringing patients back into hospitals for their physio and rehabilitation.
Covid has taught us one thing, and that is remote working. Patients are now used to doing remote video consultations and there is no reason we can’t use that remote model for rehabilitation. With BPMpathway, one of the big things that patients’ loved was being able to message the physios. Quite often this would save a phone call to a consultant secretary or save an outpatient visit.
Having the wearable technology gives the patient the feedback they need to rehabilitate after the operation - I think those are the things we need to incorporate more into pathways. To almost produce a virtual pathway for surgery and keep patients where they should be, in the community.
But at the same time, having technology such as wearables so we can monitor their progress and make sure they’re on the right path, and if they’re not on the right path then we can bring them in.
What would you recommend patients do during this wait for their procedure?
GW: I think going into an operation prepared is one of the big keys. We know that arthritis causes joint pain, [which can mean] people don’t exercise and when you don’t exercise everything weakens and you then enter the surgery in a bad place. If you enter a surgery where the muscles have been conditioned and people have been exercising, it almost enhances your rehabilitation and you’ll get over the surgery quicker. So, the one plea is for patients to have some form of exercise leading up to it, and that can be guided with recommended exercises displayed on a digital platform. Using BPMpathway can assist with preparing patients for their surgery by encouraging them to perform daily exercises with remote guidance from their physiotherapist.
I think we need to give encouragement and feedback to a patient about how they’re doing. If they start in a bad place it’s going to take them a long time to get over the surgery, if they enter the surgery in a good place they’re going to do really well.
Is there anything else that you’re using digitally throughout your pathway?
GW: Since Covid has come through we’ve not been doing our arthroscopies under General Anaesthetic anymore, were doing them under Spinal. So I’m in a position where I can talk a patient through what they see and it has been a massive revelation. Patients absolutely love it, they can see their knee, they can see the pathology and they’re really grateful, you’re involving that patient in their theatre experience. The feedback has been fantastic. I think having apps for patients as well, those reminders for patients to take their medication, to do their exercises, that kind of thing is really helpful. The whole journey for a patient should be an interactive journey and they should likewise be able to message you. It’s not a big burden for a patient to send a message once a day and you, or the physios, answer it just to reassure them. I think patients becoming more a part of the pathway will help and I’m seeing that now.
Reflecting on the system of elective surgery during the pandemic has pushed forward a period of transformation. Hospital capacity and increased waiting times have triggered new ways of working, including digitisation, remote monitoring and a push towards day case surgeries.
Patients can now take an active role in their surgery and recovery process, leading to more successful outcomes. In contrast to the assumption that rehabilitation away from the hospital may be an isolating experience, patients now have a more active digital communication channel with the hospital where they can voice any concerns, as opposed to waiting until their next scheduled physiotherapy appointment.
As more elective surgeries go ahead in the coming months, there is potential for broader implementation of innovative solutions to help enhance patient experience, improve outcomes and increase efficiency.