Colorectal surgery: increasing patient safety and teams confidence on discharges

ULS Coimbra

Post-discharge follow-up is the leading approach to prevent 30-day readmissions but it is also a manual, time-consuming process that burdens clinical teams with no tools to do it efficiently. Discover how UpHill increased ULS Coimbra capacity by automating best practices.

Follow-up capacity

66%

patient adherence

91%

Negative predictive value

Hospital Insights:

45.000 Surgeries annually
7% Post-surgical readmission (CCR)
58% of Post-surgical complications happen between the 3rd and 14th days post-surgery

Lengthy waiting lists for elective surgery are a daily struggle for patients and a headache for hospital managers. On one hand, they postpone the expected benefits of treatment, while pain and disability remain; on the other hand, delaying the procedures can have a significant impact on a facility’s financial security.^1,2

The root causes of surgical waiting times can be attributed to various factors. Most commonly, it is due to a lack of resources, such as insufficient staff^3,4 - which in addition is overloaded tasks for which they are overqualified^5-7 - and equipment. On the other hand inefficiencies and blockers to adequate care navigation are increasing patient no-shows and intra-operative cancellations,^8-10 contributing to increased waiting lists.

Problem:

High rates of no-shows and surgical cancellations due to navigation issues
Lack of safety in early discharges
Inability to adjust follow-up based on patient risk

With this program, Unidade Local de Saúde Coimbra(ULS Coimbra) addressed two major areas: capacity and patient navigation.

Project Goals

Ensure care consistency and support clinical decisions based on the best evidence.
Reduce appointment length and the time spent on records within the perioperative journey.
Improve clinical records quality by obtaining information directly from the patient.
Increase patient adherence to best practices in the perioperative, by centralizing information in a patient portal.
Increase teams' confidence and patients' safety on discharge.
Improve early identification of red flags after hospital discharge.
Reduce the use of hospitals’ resources in follow-up monitoring.

Solution

UpHill's solution on peri-intervention was applied to optimize peri-surgical journeys, both addressing patients' and healthcare teams' needs.

A dedicated portal was delivered to patients covering all pre and post-surgery recommendations to reduce anxiety, increase care plan adhesion, improve surgical outcomes, and reduce no-shows.

Additionally, all patients were instantiated on a personalized care journey, making their status and progress visible to all health professionals. Automated follow-ups were triggered after discharge in order to keep patients on track and identify red flags timely.

“UpHill provided a huge added value, because it allowed us to add two moments to the nursing appointments, enabling our teams to detect more complications.”

João Filipe Fernandes

Nurse Director's Advisor

Multidisciplinary care journey covering pre and post-surgical tasks

The digital care pathway for colorectal surgery represents a comprehensive intervention designed to provide continuous and multidisciplinary medical care, covering pre-, intra, and post-OR tasks. It works as a single source of truth, changing dynamically based on patient progress, and ensures that all healthcare professionals have the information needed to make the right decisions, at the right time.

A dedicated portal designed to empower patients and enhance adherence to care plans

Undergoing surgery can be daunting, and educating patients on aspects like surgery, anesthesia, intraoperative care, and postoperative pain management helps alleviate anxiety, improve compliance with pre-surgery guidelines, and promote recovery. This leads to improved surgical outcomes and fewer no-shows. UpHill’s patient portal provides access to clinically validated information tailored to each patient’s health literacy level, covering topics relevant to their condition and perioperative journey. This ensures patients are well-informed and confident in navigating each step of the process.

Redefined processes and flows streamlining pre-surgical navigation

Using validated questionnaires and scores, such as ASA score, UpHill automatically stratifies patients and allows anesthetists to fast-track low-risk patients to surgery. Moreover, our care orchestration software not only recommends but also automates the ordering of pre-surgical tests. This minimizes the requirement for in-person interactions per patient and enhances accurate decision-making processes.

“To see patients actively using the system, knowing that our health professionals recognize the time-saving benefits, and for us—the IT team—to feel that our intervention is minimal, it’s fantastic!”

Rui Gomes

Head of Information Systems

Automating follow-up to facilitate the early detection of exacerbations

Post-surgical patient monitoring not only enhances patient safety but also instills physicians’ confidence in discharges. UpHill employs an automated post-discharge follow-up system, leveraging clinically validated questionnaires. This system empowers physicians to discharge patients securely while continuously monitoring their progress in real time, enabling the early identification of warning signs.

“Out of more than 200 patients that joined the program, none has had any type of complication that was not flagged through the follow-up questions after discharge”

Manuel Rosete, MD

General Surgery Hospital Assistant

Impact and Insights

Over 500 patients included
66% patient adherence
227 red flags identified through automated follow-up
93% of notifications were resolved without in-person observation

Solution details and highlights

Follow-up frequency increase (from 2 to 4 checkpoints) within the postoperative recovery;
Non-invasive medical devices or procedures;
An omnichannel approach to obtain patient information, using familiar patient channels (SMS, phone call, and email);
Use of questionnaires that were validated and automated;
Intelligent application of the information collected to update patient status;
Interoperability capabilities linking different systems reduce task repetition;
Automatic alert generation to warn health teams of patients’ red flags;
GDPR-compliant, ISO27001 and ISO13485 certified.

Clinical Disclaimer

This data is specific for this use-case in this institution and is presented as an example of how UpHill Route indirectly improves patient management processes in a context in which clinical decision support systems are used. Data was collected by the institution itself. UpHill Route does not claim any direct clinical benefit leading to patient safety increase or hospitalization reduction.

References

Abate, S. M., Chekole, Y. A., Minaye, S. Y., & Basu, B. (2020). Global prevalence and reasons for case cancellation on the intended day of surgery: A systematic review and meta-analysis. International journal of surgery open, 26, 55–63. https://doi.org/10.1016/j.ijso.2020.08.006
Gillies, M. A., Wijeysundera, D. N., & Harrison, E. M. (2018). Counting the cost of cancelled surgery: a system wide approach is needed. British journal of anaesthesia, 121(4), 691–694. https://doi.org/10.1016/j.bja.2018.08.002
Perera, S. K., Jacob, S., Sullivan, R., & Barton, M. (2021). Evidence-based benchmarks for use of cancer surgery in high-income countries: a population-based analysis. The Lancet. Oncology, 22(2), 173–181. https://doi.org/10.1016/S1470-2045(20)30589-1
Anesthesiology: Supply, demand and recruiting trends - Merritt Hawkins. (n.d.). Retrieved January 13, 2023, from https://www.merritthawkins.com/uploadedFiles/anesthesiology-white-paper-merritt-hawkins-2021.pdf
Carbajal, E. (n.d.). 29 physician specialties ranked by 2021 Burnout rates. Retrieved January 20, 2023, from https://www.beckershospitalreview.com/hospital-physician-relationships/29-physician-specialties-ranked-by-2021-burnout-rates.html%E2%80%8B
Wolstenholm, J. (2022, November 18). Physician burnout in 2022: Everything you need to know. Retrieved January 20, 2023, from https://www.leveragerx.com/blog/physician-burnout-report/
Compère, V., Besnier, E., Clavier, T., Byhet, N., Lefranc, F., Jegou, F., Sturzenegger, N., Hardy, J. B., Dureuil, B., & Elie, T. (2022). Evaluation of the Time Spent by Anesthetist on Clinical Tasks in the Operating Room. Frontiers in medicine, 8, 768919. https://doi.org/10.3389/fmed.2021.768919
Mekonen, Semagn & Ali, Yigrem & Basu, Bivash. (2020). Global Prevalence and determinants of preoperative anxiety among surgical patients: A systematic review and Meta-analysis. 10.1016/j.ijso.2020.05.010.
Kaddoum, R., Fadlallah, R., Hitti, E. et al. Causes of cancellations on the day of surgery at a Tertiary Teaching Hospital. BMC Health Serv Res 16, 259 (2016). https://doi.org/10.1186/s12913-016-1475-6
Koh, W. X., Phelan, R., Hopman, W. M., & Engen, D. (2021). Cancellation of elective surgery: rates, reasons and effect on patient satisfaction. Canadian journal of surgery. Journal canadien de chirurgie, 64(2), E155–E161. https://doi.org/10.1503/cjs.008119