Therapists at Ascot’s Heatherwood Hospital, part of Frimley Health NHS Foundation Trust, have been able to help 14% more patients per month prepare for surgery following the trial of a new digitally led approach to identifying, prioritising and supporting elective hip and knee replacement patients.
The therapies team has a crucial role in preparing patients for surgery, with their support facilitating earlier recovery, safe discharge, and minimising surgery cancellations/postponements.
The project, which ran from January to June 2024, and is now fully embedded at Heatherwood Hospital, uses an innovative digital waiting list tool, which was created by Graphnet Health. It is part of Graphnet’s CIPHA population health platform and integrated into Connected Care, the Frimley Health and Care Integrated Care System (ICS) shared care record.
Clinicians can use the tool to identify which patients will require therapy intervention prior to surgery. Before this, therapists would not have had the details of these patients until the date of their nurse surgical pre-assessment appointment at hospital.
There have been significant improvements in increasing the amount of preparation time patients have from their pre-assessment date to their surgery date. This means they have had longer to prepare for their surgery, including prehab exercises, diet improvements, preparing their home and organising support for carers. During the pilot, 125 additional patients were pre-assessed with only 10 patients receiving less than 6 weeks’ notice.
The demand on hospital staff has also been reduced, due to increased use of virtual pre-assessments. Patients must still attend their nurse surgical pre-assessment appointment, to discuss the plan for their surgery. However, the patient does not need to see the therapist face to face if they have already been contacted virtually. This saves the patient time in their pre-assessment appointment and reduces pressure and the number of patients for the therapist in their clinic. This allows the therapist to focus and spend more time with the complex patients.
Emma Sheppard, Pre-assessment Occupational Therapist at Heatherwood Hospital, and project lead, explains: “We identify knee and hip replacement patients using the waiting list tool and then call them. They can either choose to have their preassessment via the phone or see us at the face-to-face surgical pre-assessment meeting – but we find that most of them opt for remote.
“Patients that have the MyFrimleyHealth Record are sent a link to the Frimley Orthopaedic website where they can find all the information that has been discussed with them virtual. This includes prehab exercise videos, preparing for surgery information and links to other useful organisations, such as the Royal College of Anaesthetics.
“We’ve had some very positive feedback from patients so far. They feel like they’re not just sat on a waiting list. They have had contact from a real person, and the support and advice mean they’re getting on with their exercises and other important prehab preparation weeks earlier.”
Along with other benefits, the digital tool has helped the team identify eight people that needed to be removed from the waiting list, as they weren’t medically fit for surgery, or it had been completed elsewhere.
The aim now is to continue using the waiting list tool to identify and support elective orthopaedic patients, and to grow the use of virtual therapy pre-assessments. The goal is for 30% of patients to be virtually assessed by the therapies team by 2025, and 50% by 2026.
It is also hoped that the success at Heatherwood Hospital will lead to the approach being rolled out to other sites across the Frimley ICS.
Frimley is part of the collaborative CIPHA (Combined Intelligence for Population Health Action) programme, an 11 ICS supplier supported consortium covering 17m patients. Members work together to develop, trial and deploy major transformation initiatives based on data from patients’ digital health records.
