How trusts are tackling elective recovery with powerful digital population health and waiting list tools

Waiting lists have been under the microscope for years, with no government quite managing to implement a long-term solution to the problem. In fact, NHS waiting lists have continued to grow. There are 7.6 million treatments currently queued up waiting to be administered. Surgery waiting lists hit 1 million this year.

Clearly, something needs to be done and it is one of the main priorities for prime minister Sir Keir Starmer and the new Labour government. They have ambitiously pledged to eliminate the NHS waiting list backlog in England within five years.

In order to meet this objective, the NHS needs to work smarter. Some trusts, such as East Kent Hospitals University Foundation Trust, have been using population health management tools to provide a richer pool of information about the patients on their waiting lists. This includes details about which surgical patients are high and low risk.

These insights allow for better planning and more efficient use of clinician time, both important elements when it comes to tackling elective recovery.

Saving time and seeing more patients

The population health platform used by EKHUFT features a waiting list dashboard, which was developed and launched by Graphnet Health in March 2024, to automate risk stratification and triage of day surgery patients awaiting pre-operative assessment at East Kent University Hospital. It has reduced pre-operative consultation times by 27 per cent for surgical day cases – enabling more patients to be seen in a timely manner.

It has also increased clinical team productivity. When fully implemented, it will enable efficient and effective early pre-surgical health screening and triage, and guide medical optimisation and pre-habilitation, to drive improvements in perioperative outcomes. Sharing timely, relevant clinical information between healthcare organisations improves its accuracy, reduces duplication of clinical activities, and helps clinical decision-making.

Data on surgical waiting lists is integrated with the patient-level primary care record and allows clinicians to see primary care data on all patients awaiting surgery. For surgical patients, this enables high- and low-risk patients waiting for surgery to be instantly identified.

Over the course of six weeks, EKHUFT used the platform to assess and triage two groups of low-risk patients – “gold” and “green” patients.

“Gold” patients were normal, healthy patients (ASA 1 equivalent, with a BMI less than 35, non-smoking status, and alcohol less than 14 units/week). The “green” patients were those with mild systemic disease (ASA 2 but well-controlled). Pre-operative assessment clinics were launched for both groups in April 2024 with bookings made using a digital triage tool.

The impact

In total, 138 patients awaiting day-case surgery were booked into the clinics. The average consultation time was 22 minutes, 27 per cent less than the allocated time (30 minutes). The majority of patients (77 per cent) were digitally triaged correctly. The remaining 23 per cent of patients’ triage categories were manually revised due to incomplete patient information from primary care data – for example, in 25 per cent of the cases, BMI measures were not in the patient record.

The aim was to test the tool’s efficacy and assure clinical effectiveness, users’ trust and adoption. We compared the dashboard-allocated triage category to a standard clinical assessment of medical complexity at the POA clinic. The clinic manager also monitored various indicators, including the consultation time with each patient.

The results have been very positive. The time savings, for example, proved valuable as it allows more patients to be seen, and means we can allocate resources to additional triage and more complex patients. The digital risk stratification tool, which enabled us to identify high-risk patients, improved clinical team productivity by only booking patients with the highest perioperative risk into combined nurse and consultant clinics. The tool has helped us make every contact count.

Leading by example

It is encouraging to see other examples of a similar approach working well. Buckinghamshire Healthcare Trust, for example, has piloted a population health dashboard that combines its surgical waiting lists with the Buckinghamshire Shared Care Record.

Formed and launched in 2023 to enable targeted pre-operative support, the dashboard supports the identification of high-risk surgical patients to provide targeted support pre-surgery and also supports the identification of patients suitable for operation in elective surgical hubs.

According to Caroline Pritchard, consultant anaesthetist and perioperative service clinical lead for Buckinghamshire Healthcare Trust, the time savings have been extremely valuable. For example, previously, all pre-operative patients would have filled a 45-minute clinic appointment. Now, Dr Pritchard says manual triaging by a senior nurse has been completely removed, and 20 out of every 100 patients will avoid a pre-operative assessment completely.

The incorporation of primary care data allows clinicians to identify patients on waiting lists who have chronic conditions such as hypertension, diabetes or obesity, and those with co-morbidities. In addition, candidate lists for cancellations are helping fill cancelled slots, where the dashboard automatically stratifies patients who can be booked into available surgical appointments.

What’s next?

The plan at EKHUFT is to scale up the use of the platform to undertake medical screening and triage all patients referred to the pre-surgical preparation service. We intend to tackle health inequalities by using the dashboard in a collaborative project with Kent Community Health FT to identify cohorts of pre-surgical patients who would most benefit from community-based health promotion services while waiting for elective surgery.

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