Elective Recovery: Turning The Tide. Webinar Summary

In late February, we were pleased to host another interesting and very topical webinar, focused on how population health insights and actions can support elective recovery. 

We started with a welcome from Graphnet’s David Grigsby, who explained that many Trusts and ICBs have tried to tackle their waiting lists and improve their pathways by analysing their waiting list data. However, this only gets you so far. David said that growing numbers are seeing success through using primary care and other data, alongside patient treatment lists (PTLs), to inform how people on waiting lists are managed. This includes developing different preoperative pathways depending on a person’s state of health.

Caroline Pritchard on improving perioperative pathways. 

David introduced Dr Caroline Pritchard, Consultant Anesthetist and Perioperative Service Clinical Lead for Buckinghamshire Healthcare NHS Trust, who discussed how and why Buckinghamshire has combined its surgical waiting lists with the Buckinghamshire Shared Care Record.

“With the challenges that the NHS is currently facing, we need to be able to screen patients early, and optimize them so they’re fit and ready for surgery,” Caroline explained. “We saw an opportunity following the Combined Intelligence for Population Health Action (CIPHA) programme to better understand our surgical population.”

Caroline said that the incorporation of primary care data has made it possible to easily identify patients who need information on how to prepare themselves while waiting for surgery. It is also supporting surgical teams to understand the co-morbidity implications for theatre and helping them book the right patients at the right time.

On top of that, candidate lists for cancellations are helping fill cancelled slots. The dashboard automatically stratifies patients, which enables the instant identification of low-risk patients that can be booked in to available surgical appointments straightaway, filling cancelled slots immediately.

“We are still on the journey, but one of the main benefits so far has been the collaboration with our public health and primary care colleagues. Also, an understanding of the scale of the work we need to do, to improve the pathway for surgical patients.
“The time savings have also been extremely valuable. For example, previously, all pre-operative patients would have filled a 45-minute clinic appointment. Now, manual triaging by a senior nurse has been completely removed, and 20 out of every 100 patients will avoid a pre-operative assessment (POA) completely. This will save a minimum of 15-hours of nursing time, meaning they can spend more meaningful time with their patients, along with the cost of previously associated unnecessary investigations.”

One Wirral CIC share a pioneering approach.

Lucy Holmes, Wellbeing Lead at One Wirral CIC then talked delegates through the innovative data-led approach that her team have adopted. According to Lucy, getting and keeping patients fit for surgery has been more important than ever since the pandemic. 

Because patients are now on waiting lists for longer periods of time, their conditions can deteriorate, and their circumstances can change. This sometimes means that by the time their surgical slot arrives, they’re not fit not surgery, which can lead to postponements and disappointment. 

Prehabilitation has been proven to be highly effective for getting patients ready for surgery and is something that One Wirral has seen a lot of success with within the cancer space. However, there was no service for diabetes. So, they decided to launch one in 2023, using data to identify and support patients who may not be fit for surgery. 

The diabetes prehabilitation service uses the Cheshire & Merseyside Combined Intelligence for Population Health Action (CIPHA) population health management system, on Graphnet Health’s population health platform.

CIPHA surgical waiting lists at Wirral’s Arrowe Park Hospital are used to identify people with diabetes who are awaiting surgery and have a HbA1C over 69mmol/mol or a BMI over 40.

“That enables us to effectively triage the waiting list,” said Lucy. “We can identify those patients who are good to go and may only need a quick online preassessment, those patients who may need some attention, and those patients that are not fit for surgery and need targeted attention – such as health coaching, for example.”

Lucy shared the results that One Wirral has seen since the programme was launched nine months ago:

-    178 referrals. 
-    Average HbA1c drop from 73.4mmols to 63.25mmols over course of 12 weeks.
-    Average BMI drop from 34.2 to 32.99 over course of 12 weeks.
-    Average weight drop from 98.41kg to 95.45kg over course of 12 weeks.

When it comes to clinical support, 58 people have been reviewed by a diabetes specialist nurse, 37 have had medication added (such as SGLT2i, metformin or gliclazide), 19 insulin patients have received support with their insulin, and 6 patients have commenced on libre sensors.

Engagement and feedback have been overwhelmingly positive with patients attending appointments and exercise sessions with confidence and enthusiasm.

Following the presentations from Caroline and Lucy, Ian Nicholson, Graphnet Population Health Consultant, took everyone through a fascinating demo of the population health tool. 

Thank you so much to both our speakers for their amazing contributions to the webinar, and for sharing their fantastic stories and outcomes.               

Visit the Graphnet events page for details of the next webinar and other events.