Redesigning Pre-surgery Patient Journeys With Telehealth

KK Women's and Children's Hospital

Status: Active, not recruiting

Conditions: Surgery

Treatments: Other: Telehealth for preoperative evaluation

Study type: Observational

Funder types: Other

Identifiers

NCT05781789

AM/HRT/008/2021

Details and patient eligibility

About

Prior to surgery, patients undergo preanaesthesia assessment to ensure timely optimisation of medical conditions that could adversely impact perioperative outcomes. At the Preadmission Service (PAS) clinic of KK hospital, nurses perform the first triage to identify patients who require outpatient anaesthetic review in advance of surgery. While all elective patients attend the PAS clinic, only 8% are require outpatient anaesthetic review. The majority 92%, can be safely triaged to receive preanaesthesia assessment on the day of surgery. In this project, the investigators propose to investigate the efficacy of a new pre-surgery workflow for elective surgical patients incorporating telehealth. The investigators hypothesize that the redesigned pre-surgery journey incorporating telehealth reduces in-person consultation at the pre-admission clinic by up to 90%. Primary outcome is the proportion of eligible same-day-admission patients assessed via telehealth. Secondary outcomes are:

1. Patient cost and time savings
2. Patient experience of the new model of care
3. Staff experience of the new workflow
4. Incidence of day-of-surgery cancellations

Full description

Prior to elective surgery, patients undergo preanaesthesia assessment to ensure timely optimisation of medical conditions that could adversely impact perioperative outcomes. Preadmission Service (PAS) clinic nurses at KK Hospital perform pre-surgery triage to identify patients requiring outpatient anaesthetic review. PAS data shows that only 8% of same-day-admission (SDA) patients needed an anaesthetist's review; the majority (92%) can be safely triaged to receive preanaesthesia assessment on the day of surgery. The aim of this study is to investigate the service re-design, efficacy and effectiveness of a new telehealth pre-surgery model of care for elective SDA patients. The investigators hypothesize that the telehealth pre-surgery new model of care will achieve an expected 50% uptake for SDA patients as the primary outcome during implementation. Secondary outcomes are patient cost savings, patient experience of the new model of care, and staff experience of the new workflow. The investigators will use a sequential exploratory mixed methods study design, consistent with the 5-stage model for telehealth research. An implementation science framework - the Normalisation Process Theory, underpins our 3-phase study. Phase 1 (service redesign) explores the feasibility of presrugery telehealth via semi-structured interviews of patients and healthcare staff. Phase 2 (preimplementation) investigates efficacy of the telehealth model of care by addressing service fidelity, and patient and staff experience using administrative data. Phase 3 is a pragmatic trial to ascertain effectiveness of the telehealthmodel of care, addressing the primary and secondary outcomes stated. This novel study using implementation science to redesign and implement presurgery telehealth will inform scale-up, spread, and sustainability of a new model of care within SingHealth and other health clusters in Singapore.

Enrollment: 258 estimated patients

Sex: All

Ages: 21 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patient participants:

Age 21 to 70 years Listed for elective surgery English literacy Willing to provide signed consent Of any nationality Able to give own legal consent

Exclusion criteria

• Healthcare participants:

Age 21 to 70 years Healthcare professionals comprising clinic staff (surgical outpatient clinics, PAS), clinicians (anaesthetists, surgeons), and health service managers)

Trial design

258 participants in 2 patient groups

Patient participants

Description:

Patient booked for elective surgery and: Age 21 to 70 years English literacy Willing to provide signed consent Of any nationality Able to give own legal consent

Treatment:

Other: Telehealth for preoperative evaluation

Healthcare provider participants

Description:

Criteria: * Age 21 to 70 years * Healthcare professionals comprising clinic staff (surgical outpatient clinics, PAS), clinicians (anaesthetists, surgeons), and health service managers) * working in the perioperative clinical areas

Treatment:

Other: Telehealth for preoperative evaluation