Transforming post operative follow-up: consultant harnesses power of Digital Personalised Video messages with PKB
Winners of the 'Supporting Elective Recovery through Digital’ category at the HSJ Digital Awards 2024
67% reduction in post-op follow up within the Knee Arthroscopy team.
It puts patients’ minds at ease, provides answers to many of their questions and in many cases removes the need for further appointments or written communications - allowing the clinician to spend additional time helping other patients.
Introduction
Mr Duffy, a Consultant in Trauma and Orthopedics at Harrogate & District NHS Foundation Trust (HDFT), is transforming post-operative follow-up care by utilising Patients Know Best’s (PKB) messaging service to send Digital Personalised Video messages to his patients. PKB is currently the only Patient Engagement Platform (PEP) able to support this personalised service.
Recognising that patients often struggle to retain information after day surgical procedures, he records details about their knee arthroscopy surgery which can be securely stored in the patient’s PKB health record to access at their convenience. Welcomed by patients, this easy to replicate programme reduces unnecessary follow-up appointments and minimises pressure from unscheduled GP or emergency visits, freeing up valuable clinical time.
This project directly supports the NHS Switch to Digital plans, Operational Planning Guidance & 10 year plan for reforming elective care for patients - https://www.england.nhs.uk/publication/reforming-elective-care-for-patients/
The Problem
The ability for patients to remember or retain information is known to be significantly reduced immediately after surgery, primarily due to the effects of medication and the stressful environment. Traditional ward rounds may prove ineffective when research shows 40-80% of medical information is found to be forgotten immediately, and even retained information is prone to misinterpretation (JRSM 2003). Moveover, some day-surgery patients leave the hospital without the opportunity to consult with their clinical team or receive adequate guidance.
As a result, patients can feel unsure about their surgery and struggle to manage their recovery leading to unscheduled visits to the GP or emergency departments.
Research also indicates that up to 50% of scheduled follow up appointments could be avoided if patients had access to robust post operative information. Addressing this challenge could significantly contribute to the NHSE’s goal of reducing outpatient follow-ups by 25%.
The Solution
Mr Duffy has implemented a simple yet highly effective solution. Following a procedure he systematically records digital personalised video messages providing patients or their caregivers with step-by-step explanations of their surgery and guidance for recovery, from bandaging wounds to appropriate exercises. The video, accompanied by a report and images, are securely uploaded and sent as messages within PKB. Patients are notified via email and through the NHS App to access and review them at their convenience. They can also share the information with caregivers or other clinical teams, thereby reducing the need for multiple debriefs. Additionally, Mr Duffy records responses to frequently asked questions which are available to all his knee surgery patients through the PKB library, efficiently enhancing his personalised approach.
Patients registered with PKB can also make use of other resources such as symptom tracking to further support their recovery.
For more information watch their video about the project and the simple processes to implement and the benefits they are getting.
The outcome
Evaluating the pilot phase, a patient satisfaction survey demonstrated the positive impact and high level of comprehension amongst those receiving a video message:
- 92% patients who responded said they were aware of their weight bearing status post operatively
- 95% patients offered the pathway were under the age of 65. Therefore patients of working age, so reduces the need to take time from employment to attend a hospital appointment
- 100% were aware of how to manage their dressings post-operatively
- 100% were aware of when they could drive again and when they could restart their specific activities.
Traditionally about 50% of patients require clinical assessment around 4-6 weeks after surgery. The remaining cohort, however, are seen for reassurance. The pilot assessment indicated that using the video model meant only about 15% of this reassurance cohort would still need a follow-up appointment versus 75% using the legacy approach.
Humber and North Yorkshire’s Innovation, Research and Improvement System calculated the post-innovation savings:
- 67% reduction in post-op follow-up appointments within the Knee Arthroscopy team.
- 10,800 clinical minutes saved, releasing 285 new patient appointments.
- 60% cost efficiency savings by the team - saving £240 per patient for an annual saving of £108,000.
- Based on 720 appointments avoided so far, including the avoided travel to and from the appointment this translates to an estimated 12.78tCO2e saved for just one surgical pathway within the trust.
- Per 450 procedures = 112 hours of clinical hours. Equates to 28 additional theatres for one consultant.
Learnings and next steps
Following the pilot’s proof of concept, a scalability assessment recommended broadscale application including arthroscopic procedures, hand surgery, gynaecology, urology and general day surgery.
Mr Duffy has led the way in this innovative yet simple approach, collaborating with NHSE to produce resources to help and support other Trusts who want to roll this out to patients too.
Humber and North Yorkshire’s Innovation, Research and Improvement System (also known as IRIS) have an Adoption & Spread Implementation toolkit, and access to these resources provide Trusts with a model for rolling out, including with making consistent videos. IRIS has also created a model for predicting benefits, which Trusts can use to make their business case.
To date 6 Trusts using PKB have adopted the programme:
- Harrogate and District NHS Foundation Trust
- Calderdale and Huddersfield NHS Foundation Trust
- East Sussex Healthcare NHS Trust
- Mid Yorkshire Teaching NHS Trust
- York Teaching Hospital NHS Foundation Trust
- Dartford and Gravesham NHS Trust
