Case studies

Use Cases

Waiting list prioritisation

University Hospital of North Midlands was spending a lot of administrative time and resource to manually validate patients on the waiting lists. They were not able to risk stratify patients with the existing system. This pathway has been transformed by sending electronic questionnaires (through Remcare app) to 2000 patients on surgical waiting lists to collect the following information: 


  • They still wish to go ahead with surgery 
  • Their choice of healthcare provider for treatment. 
  • Risk profile according to presence/absence of significant co-morbidities
  • Access to mobile devices/ digital literacy

Outcome:


  • Identified 16% of patients no longer needing surgery (potential DNAs / late cancellations)
  • 70% reduction in admin staff requirements
  • Identified around 600 ‘fit and healthy’ patients who can be called in at short notice (and increase theatre utilisation)
  • Signposted ‘unfit’ patients to GPs for optimisation of co-morbidities (reduce risk of late cancellations and improve patient outcomes)
  • Patients feedback reports that they feel supported whilst on the waiting lists
  • Around 25% of patients have been found to have digital poverty (diverted to conventional pathway)

Standardising the information gathering and risk stratification process has minimised variation in access to health care (as called for 2021/22 priorities and operational planning guidance) and monitor the waiting lists dynamically to prioritise patients who are at risk of poor outcomes using real-time data. This will achieve a fundamental transformation of these lists from being ‘waiting lists’ to ‘preparatory lists’ (as required by NHS reset framework) and minimise risk of patients deteriorating whilst waiting for surgery and presenting acutely to secondary care.

Adult pre-anaesthetic assessment service (Adult PreAMS)

Remcare has allowed digital transformation of the preAMS service for day case surgery patients with the following results:


  • Whereas previously every patient was seen in a 60-minute face-to-face appointment, Remcare has allowed identification and triage of low/medium-risk patients (53% of cases) to 30-minute virtual appointments
  • This resulted in a 25-40% increase in throughput with same staffing levels (meeting the target for NHS organisations to increase throughput with radical transformation of clinical pathways)
  • Non-cash releasing efficiency savings of £450,000 p.a (for a service that sees 24,000 patients p.a)
  • Allowed assessment to take place much earlier in the pathway (compared to 2 weeks prior to surgery in existing pathway) as recommended by the Centre for perioperative care
  • Enabled pre-ordering of tests prior to appointment thus reducing footfall and hospital attendances for patients
  • Standardise clinical pathways and minimise variation in decision making (as per GIRFT

Paediatric pre-anaesthetic assessment service (Paed PreAMS)

Remcare has allowed early identification and optimisation of ‘high-risk’ and anxiety issues in 63% of children prior to admission resulting in the following benefits:


  • Cost avoidance of £439,029 p.a (compared to a traditional clinical pathway) for a service that sees 10,000 children p.a

  • Eliminated-

  1.  need for physical restraints (5% in current pathway)
  2. need for anxiolytic medication (4% in current pathway)

  • Reduced-

  1.  ‘On day’ cancellations from 8% to 1%
  2. ‘On day’ theatre list order changes from 21% to 2.5%
  3. late theatre starts from 22% to 5%

Chronic pain Service

Remcare has enabled out-patient transformation by replacing the existing process of collecting pre appointment clinical information from patients using postal paper-based questionnaires to electronic questionnaires with the following benefits:  


  • Reduced DNA rates from 20% to 5%
  • Reduced admin staff requirements from 3 hours/ day (processing paper questionnaires) to 1 hour/ day (entering patient details on Remcare)
  • Reduced RTT length (time taken for obtaining pre appointment PROMs) from 4-5 weeks to 1-5 days
  • Improved patient experience (73% of patients preferred questionnaires over Remcare app to paper questionnaires)
  • Ensured 90% of patients have virtual appointments (2021/22 priorities and operational planning guidance calls for alteast 25% of appointments to be converted to virtual)

Feedback showed 95% of patients and staff reported the app to be ‘user friendly’ in the above specialities.


Pre endoscopy assessment and bowel preparation ( NHSx adoption funding secured for implementation)

Remote data collection and automated risk stratification is aimed to streamline the 

pre-endoscopy assessment pathway and expected to achieve:


  • Increase patient compliance for bowel preparation (by providing educational content on the app)
  • 70% reduction in demand for face-to-face consultations
  • Increase patient compliance and bowel prep education 
  • Reduce the current 15% rate of ‘on day cancellations’
  • Reduce staffing requirements by 40%

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