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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.