An enhanced recovery app
Here Thomas Keen, Digital Quality Improvement Project Lead at UCLH, shares the UCLH enhanced recovery app, which is used to help patients and staff engage with data collection in enhanced recovery.
So far, we have learnt how a focused approach to perioperative care leads to better outcomes for high-risk patients. But how well do existing quality improvement processes support perioperative medicine?
The complexity presented by high-risk patients calls for a well-managed system of care across the pre, intra and post-operative period. Nevertheless, due to the pain of retrospective audit and challenges with legacy IT systems, multi-disciplinary teams (MDTs) in the NHS rarely have access to credible, timely audit data.
Coordinating improvement in the absence of data is a push. Without well-chosen outcome data, it is hard for clinicians to take a methodical approach to improving outcomes: without information on protocol compliance it is hard to find out where the system is falling down or needs to be calibrated.
At UCLH, we are interested in how real-time process and outcome data can aid perioperative clinicians in data-driven continuous improvement. We have been using a web-based mobile app to explore this. Early goals have been to:
- Cement pathway compliance as a default, through regular feedback of compliance data
- Track longitudinal quality improvement with credible outcome metrics
- Empower clinicians to channel organisational momentum towards patient outcomes (by providing clear data on the cost benefits of higher quality care)
- Curate a dataset to identify quality improvement projects, to distil best practice from clinical variation, and to risk-stratify patients
To date we have used the app across several surgical specialties at UCLH. To take colorectal resections as an example, the app feeds back data on compliance with the 19 elements of Enhanced Recovery.
The app provides data on several outcome measures, including standard ones like length of stay and in-hospital mortality, alongside validated classifications of morbidity (postoperative morbidity survey and Clavien & Dindo). Morbidity metrics provide a clear perspective on surgical quality (given the relatively higher rate of morbidity) than mortality metrics.
For patients (who have their own interface on the app), the software empowers them to feed back their experience direct to clinical teams. It also encourages them to chart their own compliance with the DREAM (DRinking, EAting, and Mobilising), as a way to take control of their recovery.
Data collection is shared between patients and clinicians, while the web-based app is available across all device types to make data input as easy as possible.
Taking the concept forward, our aspiration is to maximise the QI (Quality Improvement) potential of the data recorded on the app. One area of focus is training risk stratification models based on the data. Another is expanding the software user-experience to support running supplementary QI projects. We hope this will all come together in an invaluable new tool for the perioperative quality improver.
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