The time around an operation
A third of on-the-day cancellations are due to people not being clinically ready for treatment
Patients who are not fully ready for treatment are at greater risk of significant complications after surgery, which can result in a hospital admission up to three times longer than average and can lead to longer-term health problems and reduced chances of survival
The earlier pre-operative screening will also help identify patients with additional health needs who would benefit from extra support both before and after surgery, such as help to stop smoking or get physically fitter, or engagement with mental health services
Waiting lists for elective surgery are still recovering after hitting an all-time high during the first wave of the Covid pandemic, with thousands of people waiting over two years for surgical procedures
Limited ability for organisations to engage with those patients on the waiting list, to support patients in waiting well, determine whether the procedure is still required for the patient, as well as determine whether the patient needs to be moved up the waiting list due to deterioration
What is the NHS doing about it?
The NHS Elective Care Recovery Plan will shortly outline plans to roll out access to specialist teams made up of nurses, care coordinators and doctors, who will screen patients and work with them to develop personalised plans ahead of their surgical procedure.
Earlier pre-operative screening
Validating waitlist via questionnaire to prevent DNAs
Support patients awaiting operations with care plans and a library of resources
Send patients digitally appointment and appointment letters
Make sure information is shared about patient requirements ahead of apt/treatment - and can check this is being actioned (care plans, questionnaires)
Validate support required by collecting data from patients to triage/stratify them ahead of interactions (care plans, questionnaires, messaging)
Make sure information to support informed consent is shared (care plans, library)
Care plans for all stages of peri-operative care, consent, pre-operative assessment, post-operative, post-op rehab and enhanced recovery
Key PKB features
PKB have a care plan toolkit with examples of care plan templates created. There is also a process for teams to have care plans amended or created for you to look at here.
Post-surgery to support enhanced recovery programs
Clear information for patients on how to use PKB to self-manage their health care
Comms to staff on the new clinical and patient pathways
How teams are currently using PKB for Peri-operative care
The team manage the cohort of patients admitted for surgery who have a diagnosis of Diabetes. PKB is used as part of a Diabetes/Surgical improvement project for patients with Diabetes throughout the Perioperative process. From Pre-assessment through to postoperative discharge follow-up. Enabling the use of the library for information and health and well-being support throughout the perioperative process.
The team also uses the function of sharing key documents (Passports/letters/advice), messaging and library.
PKB is used to collect patient information ahead of surgery. Information is assessed to confirm patient suitability for surgery and determine the surgery pathway. Patients are expected to complete a health and lifestyle questionnaire (PKB consultation) at home. The results are assessed and patients are streamlined to an appropriate surgical pathway. Once the surgery is performed, patients are discharged from an inpatient list either to GP care or to an outpatient setting.
The Ortho Prehab team are using consultations, library resources and a care plan on PKB to support patients awaiting joint replacement surgery. The care plan and resources form an 8-week prehabilitation programme with everything from exercise videos to mental health activities. Patients would otherwise have no in-person support as they are low priority, compared to higher priority patients who attend a 12-week course in person.
The ERAS renal team are using PKB to digitalise their journal. Patients will be made aware of the journal pre-surgery and then asked to complete from immediately after surgery and for 10 days to monitor vitals.
The team have a care plan that informs patients about what they should do ahead of surgery and has a place to document progress immediately post-op to help with a quicker discharge.