Redesigning Pre-surgery Patient Journeys With Telehealth

Study Overview
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Brief Summary
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Prior to surgery, patients undergo preanaesthesia assessment to ensure timely optimisation of medical conditions that could adversely impact perioperative outcomes. At the Preadmission Service (PAS) clinic of KK hospital, nurses perform the first triage to identify patients who require outpatient anaesthetic review in advance of surgery. While all elective patients attend the PAS clinic, only 8% are require outpatient anaesthetic review. The majority 92%, can be safely triaged to receive preanaesthesia assessment on the day of surgery. In this project, we propose to investigate the efficacy of a new pre-surgery workflow for elective surgical patients incorporating telehealth. We hypothesize that the redesigned pre-surgery journey incorporating telehealth reduces in-person consultation at the pre-admission clinic by up to 90%. Primary outcome is the proportion of eligible same-day-admission patients assessed via telehealth. Secondary outcomes are: Patient cost and time savings Patient experience of the new model of care Staff experience of the new workflow Incidence of day-of-surgery cancellations

Detailed Description
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Prior to elective surgery, patients undergo preanaesthesia assessment to ensure timely optimisation of medical conditions that could adversely impact perioperative outcomes. Preadmission Service (PAS) clinic nurses at KK Hospital perform pre-surgery triage to identify patients requiring outpatient anaesthetic review. PAS data shows that only 8% of same-day-admission (SDA) patients needed an anaesthetist's review; the majority (92%) can be safely triaged to receive preanaesthesia assessment on the day of surgery. The aim of this study is to investigate the service re-design, efficacy and effectiveness of a new telehealth pre-surgery model of care for elective SDA patients. We hypothesize that the telehealth pre-surgery new model of care will achieve an expected 50% uptake for SDA patients as the primary outcome during implementation. Secondary outcomes are patient cost savings, patient experience of the new model of care, and staff experience ofthe new workflow. We will use a sequential exploratory mixed methods study design, consistent with the 5-stage model for telehealth research. An implementation science framework - the Normalisation Process Theory, underpins our 3-phase study. Phase 1 (service redesign) explores the feasibility of presrugery telehealth via semi-structured interviews of patients and healthcare staff. Phase 2 (preimplementation) investigates efficacy of the telehealth model of care by addressing service fidelity, and patient and staff experience using administrative data. Phase 3 is a pragmatic trial to ascertain effectiveness of the telehealthmodel of care, addressing the primary and secondary outcomes stated. This novel study using implementation science to redesign and implement presurgery telehealth will inform scale-up, spread, and sustainability of a new model of care within SingHealth and other health clusters in Singapore.

Official Title
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Redesigning Pre-surgery Patient Journeys With Telehealth

Conditions
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Surgery

Intervention / Treatment
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* Other: Telehealth for preoperative evaluation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient participants: Age 21 to 70 years Listed for elective surgery English literacy Willing to provide signed consent Of any nationality Able to give own legal consent Exclusion Criteria: Healthcare participants: Age 21 to 70 years Healthcare professionals comprising clinic staff (surgical outpatient clinics, PAS), clinicians (anaesthetists, surgeons), and health service managers)

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patient participants<br>Patient booked for elective surgery and: Age 21 to 70 years English literacy Willing to provide signed consent Of any nationality Able to give own legal consent | Other: Telehealth for preoperative evaluation<br>* Conduct of preoperative evaluation remotely using Zoom application<br>* Other names: Video consultation;|
| Healthcare provider participants<br>Criteria: Age 21 to 70 years Healthcare professionals comprising clinic staff (surgical outpatient clinics, PAS), clinicians (anaesthetists, surgeons), and health service managers) working in the perioperative clinical areas | Other: Telehealth for preoperative evaluation<br>* Conduct of preoperative evaluation remotely using Zoom application<br>* Other names: Video consultation;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of eligible elective surgery patients assessed successfully via telehealth for preoperative evaluation | Of the total number of patients booked for elective surgery, the proportion of patients evaluated preoperatively by telehealth is measured. | One year from the initiation of the implementation phase (Phase 3) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient's perception and attitude towards a Telehealth model of care for preoperative evaluation | Quantitative study via one-on-one semi-structured interviews of elective surgery patients to evaluate their attitudes and perception of the new proposed telehealth workflow conducted in (Service Redesign) Phase 1 | 5 months from July to November 2021 | 
| Healthcare providers' perception and attitude towards a Telehealth model of care for preoperative evaluation | Quantitative study via one-on-one semi-structured interviews of healthcare providers working in the peroperative and surgery clinics to evaluate their attitudes and perception of the new proposed telehealth workflow conducted in (Service Redesign) Phase 1 | 5 months from July to November 2021 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Preoperative evaluation, Telehealth