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The PACT programme: the next revolution for pre-surgical care

In the wake of the COVID-19 pandemic, healthcare systems worldwide faced unprecedented challenges, including surging waiting lists and operational inefficiencies. Oxford University Hospitals NHS Foundation Trust (OUH) rose to this challenge with an innovative solution: the Pre-Assessment Clinical Triage (PACT) programme, developed in partnership with digital health innovator PRO-MAPP.

To put the technology into action, UOH studied its impact on the care pathways for patients needing complex hip and knee joint replacement surgery, with orthopaedic services being an area of surgery blighted by backlogs.

Identifying the challenges

After the pandemic, OUH encountered a 35% surge in waiting lists. This was due to large backlogs, as well as new referrals, which meant that the the existing system was plagued with a number of issues:

  • An insufficient number of patients ‘fit’ to utilise theatre capacity
  • The identification of high-volume, low-complexity (HVLC) patients was inaccurate
  • Patients were repeating pre-assessment clinics (PAC) an average of 3.5 times before surgery
  • Administrative processes were paper-heavy
  • The visibility of patient status between appointments was limited

A more efficient operation was required to minimise the risks of repeated or unnecessary tests and appointments before surgery, which hinges on the collection of valuable data that can be lost with manual, paper-based systems. 

Calling on PACT for a solution

In collaboration with PRO-MAPP, and supported by the NHS Adoption Fund 2022, OUH implemented Pre-Assessment Clinic Triage (PACT) – a digital application designed to maximise the number of patients undergoing telemedicine pre-assessment while awaiting surgery.

PACT includes a number of key features that look to holistically tackle the problems of burdened waiting lists, including a digital intelligence tool (featuring a comprehensive health questionnaire), intelligent screening and test recommendations, criteria to assess patient readiness for surgery, seamless integration with Electronic Patient Records (EPR) and Cerner systems. PACT also allows for accessibility both in waiting rooms, and at home, which has proven to have a transformative impact:

Improved Patient Readiness
The pool of patients fit for surgery increased dramatically, from 28% to 77%.

Reduced In-Person Appointments
Face-to-face appointments decreased by 75%, streamlining the pre-assessment process.

Enhanced Efficiency
Theatre efficiency improved by 10%, optimising the utilisation of valuable resources.

High Patient Satisfaction
100% of patients reported being ‘very satisfied’ or ‘satisfied’ with the new pathway, while 92% found the questionnaire to be ‘very easy’ or ‘easy’ to complete.

Significant Cost Savings
Analysis by York Health Economics Consortium revealed an annual saving of £749 per patient, representing a 35% cost reduction.

Environmental Impact
The programme led to an 8.8 tonne reduction in CO2 production, equivalent to nine return flights between Paris and New York.

Making costs go further is a major consideration in relieving the healthcare service. Through PACT, cost efficiency is achieved substantially, with the total additional income gained equalling £791,988. £371,183 came from new patients, while increased elective activity equalled £420,805. Moreover, the reattendance savings per patient amount to £331.26, based on the latest national cost collection data.

The Role of PRO-MAPP

As the technology vendor, PRO-MAPP played a crucial role in the success of the PACT programme in improving communication between healthcare staff and patients, identifying complex orthopaedic cases earlier in the pathway, and more:

  • The system was rolled out in just 8 weeks, with ongoing evolution to meet emerging needs
  • PRO-MAPP ensured a seamless, smooth integration with existing hospital systems, including Cerner
  • The intelligent screening and recommendation system powered by PRO-MAPP’s technology was key to improving patient readiness and reducing unnecessary appointments through data-driven insights
  • The ease of use for the digital application’s interface contributed to high satisfaction rates among both patients and staff

Powered by PRO-MAPP’s innovative platform, further innovations are now looking to be introduced. There are plans for divisional implementation across NOTSSCaN surgical services, trust-wide roll outs to centralise elective access, partnerships with PRO-MAPP for an intelligent Waiting List Manager (iWLM) and the implementation of Patient-Reported Outcome Measures (PROMs).

After addressing the immediate challenges faced by OUH, PACT has set a new standard for pre-surgical care. As healthcare systems continue to evolve, collaborations like this between forward-thinking NHS trusts and cutting-edge technology providers will be crucial in shaping the future of patient care.

PRO-MAPP has also helped better identify complex patients and optimise patient pathways in a programme run by York Health Economics Consortium (YHEC), and has received recognition in the ‘clinical redesign’ category for our enhanced pre-op assessment project with OUH and Health Innovation Oxford & Thames Valley at the HSJ Partnership Awards. To find out more, get in contact with us.

How data-driven solutions can empower remote healthcare NGOs

Non-governmental organisations (NGO) are mostly associated with social or humanitarian work, including a range of worldwide groups focused on the health and wellbeing of populations on the fringe of national health services. All of these charitable groups, health NGO or not, face tough conditions, and rely on trained voluntary workers and monetary support as just two factors to carry out their respective causes. Add in healthcare’s notoriously tricky, cumbersome systems and advanced medical specialisms, and the job for these remarkable organisations is made evermore difficult.

Alongside the goodwill of generous donations, technological advancements are making exponential differences to ways in which healthcare NGOs can treat underserved patients, even in the globe’s more remote regions. When medical and resources are tight, operational innovation becomes key. But healthtech has even greater knock-on effects in transforming the ways volunteers, medical professionals and patients interact with each other throughout their clinical paths.

The unique problems for remote healthcare

Even the most trusted health systems in developed countries struggle with the pressures of growing populations and modern ailments. If you transfer these troubles to regions without skilled doctors, or even a hospital or small surgery, and healthcare NGOs’ importance is obvious. Like many NGOs, there’s a high level of cultural and social understanding they share with local communities, some of which may be less trusting in doctors, or feel there’s bias against those that can afford their treatment and those that can not. 

A healthcare system should, in a perfect world, give equal quality of care to every patient and prioritise those most in need. Not all providers can achieve this in less economical places, however. NGOs in the space do excellent work in providing as much special care as they can and educate local staff that can build rapport with patients. But unlike non-health-related NGOs, there’s a problem in being able to provide regular health check-ups with the same doctors and nurses, and to cross-reference health records (if any) with existing systems. Despite providing a bridge between patients and access to healthcare materials, NGOs can face difficult relationships with these healthcare facilities already in place.

This is why grassroots health NGOs, with enough economic backing and government agency support at their areas of work, must aim to put training procedures in place to improve preventative healthcare solutions for patients until public or private providers can better serve their needs.

From access to tracked pathways

Accessibility is the first hurdle to anyone seeking healthcare, which NGOs strive to provide at the basic level. But their continued success relies on sustaining projects (even with the rising cost of training, delivery, and infrastructure). There’s no immediate magic wand to provide everyone with more stable and regular healthcare, yet through partnerships with research institutions and technological partners, a focused grouped effort goes some way in optimising the clinical paths that work best – without wasting medical resources or the valuable time of voluntary staff. 

For one, technology is an outstanding educational tool. Through sharing audio and video training, it’s quicker to raise awareness about ailments, or to onboard local professionals or staff members that can learn the ins-and-outs of their specific roles for efficient procedural workflows at regional or pop-up surgeries. The same applies to support video calls between doctors and patients, where mobile or tablet is applicable, reducing queues of in-person appointments. WhatsApp is becoming an increasingly popular tool for reaching patients in remote areas, who are able to stay updated with doctors that can monitor their condition from wherever they are based.

When documentation is captured digitally, there’s consistency across care teams to track patient pathways – something we’ve experienced working with NGO Faith In Practice in Guatemala. This is why data is becoming such a key asset for remote health work; going beyond areas where paperwork is the only log for any health records, collecting real-time data on appointments or procedural notes is paramount to provide feedback, referrals, and to help each patient understand the next steps required. Ironing out these operations makes it more affordable to allocate fees to host clinics in remote areas, and helps account for only the materials needed with far less repeated manual labour, too.

A brighter future

Beyond this, data has the power to change healthcare systems outside of their individual surgeries. Collecting patient data builds up a reliable picture of the work of health NGOs’ in giving primary care, providing ample kudos to these services when they search for potential funding to better their healthcare programmes, a region’s infrastructure, or even to influence policymakers.

Maintaining health records provides better trust and communication between surgeries and patients for any pathway, no matter where they are in the world. Healthtech is certainly a cost-effective and vital lifeline to do just this, strengthening the great work health NGOs complete every hour, every day.