The enhanced recovery app at UCLH

So we’ve been practicing enhanced recovery for a number of years, but we were really keen to make sure that every patient got the very best version of our pathway. With a complex pathway with lots of different elements, it was not uncommon that some patients missed out on some of those elements of care. And in part, that was due to the multidisciplinary nature of a pathway. So we thought by centralising the pathway within an app, it would make it very easy for all the different professionals that are involved in any one patient’s care to identify exactly what’s being done for a patient as they move through a pathway, and for us to ensure that elements of their care weren’t missed out.

But the advantage the app has is it’s easy to use, it’s electronic, and it has a multidisciplinary approach. The whole idea behind it is multidisciplinary, and not just for clinicians, but it actually involves patients as well. So I like the fact that it was small, easy to use, and can be used both by patients and by clinicians. This software, I have been using this now for one and a half years. We started in 2015. It was really good using it the first time. The patient themselves, they were so happy, depending on the age group of the patient. They loved it. And also it just made them have that sense of autonomy of doing things.

Because they know that I’ll come back with the app, give them to figure out what they’ve done. Hi, you’re going home today. Yes. How do you feel? Yeah, it is nice to be going home. I want you to give us just a feedback how do you feel about what we’re doing or the care. It is just that I can’t thank the staff on the ward enough for everything they’ve done for me. I have admit, I was expecting to be here more than two weeks as well. So it shows how quickly I have recovered. We presented this data. It was very nicely presented. It was very neat. It was motivational for the staff, for the clinicians, and for the staff involved.

It gave us lots of information very quickly. And we can see where it’s going to go from there. So, already, some of the aspects of clinical care that we practise, we’re adapting them, because we can see already what we’re doing. So the advantage, I think, of doing this, using this kind of app, is that we can use it as a continuous audit tool. And I really like that about it.

So importantly, we recognised, by looking at the feedback generated by the app, that patients that weren’t able to mobilise on day one after their operation were at a significantly increased risk of developing complications. And, as an anaesthetist, it made me think, what can I do to help? And it made me re-evaluate how best to prescribe really effective postoperative analgesic regimen that will benefit those specific patients that haven’t been able to get up and move about the day following their surgery. Yesterday didn’t walk. Today he can’t walk. What should we do? What’s the problem? And then we’ll look at it. It has helped my job, because I’m always in touch with the patients.

So what I find very interesting is that we can set alerts. So if our data, if our performance, is coming off what we expect to be, then we can act on it very quickly. Here we have the graph that shows how compliant we are with, with the enhanced recovery, when the catheters have been taken out, what percentage are we working at, so it gives us the full picture of how we are doing. Can I have feedback on the app? How do you feel about using this app? Yes, it’s very easy to fill in. So yeah, I’m happy about it. The patient the class of length of stay.

So it gives us a clear picture whether we are doing well, or we are lagging behind with length of stay. All right then, John, I’ll see you tomorrow. It is not time consuming, because as I go, it gives me a glimpse of the patient straight away Perhaps the elderly patients who may not be so confident or comfortable using these kind of devices. But I think they’ll be surprised that this is actually very easy to use. This is like reading a book. So the app has already moved into different surgical specialties and throughout a number of different hospitals. But I think one of the most exciting parts of the app is to really involve the patients even more in their care.

And, specifically, outside of the walls of the hospital itself, such that their recovery, and most importantly their long-lived recovery is supported by the app.