Transforming post operative follow-up: consultant harnesses power of personalised video messages with PKB
Introduction
The Problem
The ability of 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
Consultant Trauma & Orthopaedic surgeon Mr Duffy has implemented a simple yet highly effective solution. Following a procedure he systematically records 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.
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
- 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. Extrapolating data from the programme duration so far equates to annualised savings of around 112.5 clinical hours for Mr Duffy. The equivalent of 28 additional theatres for just one consultant, this demonstrates the huge potential when implemented at scale*.
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 is recommending a three tiered implementation approach, starting with the core video, which HDFT is now rolling out across departments and collaborating with NHSE to support other Trusts looking to replicate. An important factor is the ability to implement the approach within a secure environment which can be tracked for audit purposes and is then accessible to the patient for future reference.
The video message service integrates seamlessly with PKB features such as care plans and questionnaires to enable holistic post-operative self management.
The multimedia solution we have introduced has proven to be a real success. All of the patients who have received a report have stated that they found the video message very reassuring. 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. We have received lots of enquiries about the innovations from other partners in the NHS and we are keen to share our learning to scale up the innovation for the benefits for patients.
*Estimates based on a system benefit calculator that assumes 15 minutes per outpatient appointment and four hours of clinical time equals one theatre session.
