Working together with patients to optimise remote digital screening for a more effective preoperative assessment process.
Authors:
1 Open Medical Ltd
2 Barking, Havering, and Redbridge University Hospitals NHS Trust
Background
Research has shown that certain groups of people in the UK face significant challenges when it comes to getting healthcare (1, 2). This often results in them having worse health overall (1, 2). These groups include people living in areas where there isn’t a lot of money, people from different ethnic backgrounds, and those who have multiple or long-term health conditions. People with learning disabilities and those who identify as LGBTQ+ also face these challenges. This also applies to people who may feel isolated from society, such as those without a home or vulnerable migrants. These groups are often referred to as underserved communities in healthcare (1, 2).
Open Medical is a digital health company that is dedicated to helping healthcare organisations use digital technologies to improve their services. This process, known as “digital transformation,” changes how care is delivered. However, it’s not just about technology; it’s also a chance to rethink how to better serve those who aren’t getting the care they need. It’s an opportunity to make healthcare more accessible for everyone.
We teamed up with Barking, Havering, and Redbridge University Healthcare NHS Trust (BHRUT) to explore how we can better support patients from underserved communities who are preparing for surgery. We focused on the ‘preoperative assessment’ phase. This is when doctors and nurses check if a patient is ready for surgery or if they need more care to prepare for it. The study was funded by the National Institute for Healthcare Research (NIHR). The collaboration with BHRUT was crucial as this organisation serves some of London’s most deprived areas and a significant number of their patients are from underserved communities.
Methods
Our study involved talking with patients from underserved communities and healthcare professionals who provide care for them. We wanted to better understand their experiences, what they need, and how digital health can help them. To this end, we conducted three online focus group discussions, each with five patient representatives. These patients were from minority ethnic groups and brought a range of experiences. They had undergone different types of surgeries, held caregiving roles, suffered from long term health conditions, and had different English language skills. We also held a separate discussion with healthcare professionals including surgeons, anaesthetists, pre-operative assessment nurses and managers.
In the first session, we introduced the goals and plans of our study to patients, ensuring they understood what we aimed to achieve. The second session was more interactive; we held a workshop to discuss the remote digital screening process and a digital patient questionnaire. This allowed us to gather firsthand insights on how these digital tools may be optimised for better use.
We then analysed and reflected on the feedback and comments gathered during these sessions and discussed them with the healthcare professionals. This helped us understand how doctors, nurses, and managers felt digital health tools could help them support these patients better.
During the final session, we worked closely with our patient group to formulate a research question for a larger study. This question was based on the valuable feedback we received in the earlier sessions from both patients and healthcare professionals. This ensures that our future research directly addresses the concerns and needs of the communities involved.
Results
At first, we talked about how differences in language and cultures can make it hard for underserved communities to get good healthcare. Patients pointed out that individuals from underserved communities often find it difficult to use digital health tools especially when they are not fluent in English or belong to an older generation.
When we started discussing digital health in more details, we found other challenges. These weren’t just about language. They were about other practical things that need to be fixed to help everyone get better access to healthcare through technology. They also voiced that more focus should be placed on their social and emotional well-being. This can be achieved by providing high-quality care after surgery, offering more emotional and social support, educating patients, understanding the challenges faced by older and special needs patients, and improving the way patients interact with online forms. The education aspect they mentioned is about preparing people for what a surgery will involve, how long their recovery time might be, and helping them prepare practicalities around this. Patients mentioned that having these information help to ease their mind before undergoing surgery.
Healthcare professionals agreed that they often don’t fully understand a patient’s home situation. This can affect their decisions about whether a patient can safely have same-day surgery or be released from the hospital when they are medically fit for discharge. That is why they stressed the importance of understanding the social needs of patients better.
The clinicians also pointed out that due to limited resources, the National Health Service (NHS), the main healthcare provider in the UK, doesn’t necessarily have the resources to help people meet these social needs. Instead, patients should be encouraged to think about what they might need, and what they need to arrange before surgery. These include aspects like having a relative to help them move around after being discharged, making plans to ensure they are able to come for follow-up appointments and discussing potential financial hardship that might arise after surgery. Also, it’s crucial to involve caregivers early to provide support. We believe digital health tools can help meet these challenges and result in a better experience for all patients, includingthose from underserved communities.
Working with patients, this resulted in the following research question we wish to explore further:
‘Does including questions about emotional and social support in the electronic patient survey used in the digital screening pathway improve patient experience and health outcomes after surgery?’
Discussion
These questions must be designed to gather information that will help patients, their caregivers, and medical professionals as they prepare for surgery. We can learn a lot from similar initiatives like “joint school” programs and research on discharge planning and social care. This knowledge will ensure everyone involved is well-prepared and supported throughout the surgical process. Doctors and nurses emphasised that this preparation is crucial. It could enable more patients to have their surgeries and go home the same day, or help with better planning for when patients can leave the hospital.
Our project also pointed out some additional areas that need further exploration. Specifically, to look at how we can better help patients use and finish digital health forms or other online health tools. The participants suggested that hospitals should provide a help desk to assist people with these digital health resources – but this does impact one main benefit of online tools, which is that they can typically be completed at home. Involving caregivers more actively in this process could also be a helpful approach.
Conclusion
Language and cultural differences can sometimes make it hard for patients to talk to their doctors and nurses. However, if healthcare workers focus on understanding patients’ emotional and social needs, it can help them have better conversations to plan for after-surgery care and potentially leading to better surgical outcomes. This approach helps focus on immediate needs and practical matters. It may be more feasible and quicker to implement than expanding the NHS workforce with personnel who can speak multiple languages and have a deep understanding of cultural differences. This can make it easier to meet the diverse needs of the UK population. This approach may offer a more reasonable way to improve quality of care for underserved communities.
References
Wan, Y. I., McGuckin, D., Fowler, A. J., Prowle, J. R., Pearse, R. M., & Moonesinghe, S. R. (2021). Socioeconomic deprivation and long-term outcomes after elective surgery: analysis of prospective data from two observational studies. British journal of anaesthesia, 126(3), 642–651. https://doi.org/10.1016/j.bja.2020.10.019
Poulton, T. E., Moonesinghe, R., Raine, R., Martin, P., & National Emergency Laparotomy Audit project team (2020). Socioeconomic deprivation and mortality after emergency laparotomy: an observational epidemiological study. British journal of anaesthesia, 124(1), 73–83. https://doi.org/10.1016/j.bja.2019.08.022