Clinical trial NCT05781789: Redesigning Pre-surgery Patient Journeys With Telehealth
Official title: Redesigning Pre-surgery Patient Journeys With Telehealth
Study type: OBSERVATIONAL
Overall status: ACTIVE_NOT_RECRUITING
Conditions: Surgery
Keywords: Preoperative evaluation
Telehealth
Lead sponsor: KK Women's and Children's Hospital
Sponsor class: OTHER_GOV
Collaborators: name: Nanyang Technological University
name: Duke-NUS Graduate Medical School
First posted: 2023-03-23
Enrollment: 258
Sex: ALL
Minimum age (years): 21
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patient participants are female patients booked for elective surgery at a tertiary women's hospital.

Healthcare participants are nurses, administrators, surgeons and anaesthetists working in the preoperative and surgeons' clinics at a tertiary women's hospital.

Brief summary: 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, the investigators propose to investigate the efficacy of a new pre-surgery workflow for elective surgical patients incorporating telehealth. The investigators 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:

1. Patient cost and time savings
2. Patient experience of the new model of care
3. Staff experience of the new workflow
4. Incidence of day-of-surgery cancellations

Detailed description: 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. The investigators 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 of the new workflow. The investigators 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.

Eligibility criteria: 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)

Primary outcomes:
measure: Proportion of eligible elective surgery patients assessed successfully via telehealth for preoperative evaluation
timeFrame: One year from the initiation of the implementation phase (Phase 3)
Secondary outcomes:
measure: Patient's perception and attitude towards a Telehealth model of care for preoperative evaluation
timeFrame: 5 months from July to November 2021
measure: Healthcare providers' perception and attitude towards a Telehealth model of care for preoperative evaluation
timeFrame: 5 months from July to November 2021
Other outcomes:
Locations:
city: Singapore
country: Singapore
facility: KK Women's and Children's Hospital
Study officials:
affiliation: Singapore General Hospital
name: Chai-Rick Soh, FANZCA
role: STUDY_CHAIR
References:
citation: Wong DT, Kamming D, Salenieks ME, Go K, Kohm C, Chung F. Preadmission anesthesia consultation using telemedicine technology: a pilot study. Anesthesiology. 2004 Jun;100(6):1605-7. doi: 10.1097/00000542-200406000-00038. No abstract available.
citation: Applegate RL 2nd, Gildea B, Patchin R, Rook JL, Wolford B, Nyirady J, Dawes TA, Faltys J, Ramsingh DS, Stier G. Telemedicine pre-anesthesia evaluation: a randomized pilot trial. Telemed J E Health. 2013 Mar;19(3):211-6. doi: 10.1089/tmj.2012.0132. Epub 2013 Feb 5.
citation: Mullen-Fortino M, Rising KL, Duckworth J, Gwynn V, Sites FD, Hollander JE. Presurgical Assessment Using Telemedicine Technology: Impact on Efficiency, Effectiveness, and Patient Experience of Care. Telemed J E Health. 2019 Feb;25(2):137-142. doi: 10.1089/tmj.2017.0133. Epub 2018 Jul 26.
citation: Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, Finch T, Kennedy A, Mair F, O'Donnell C, Ong BN, Rapley T, Rogers A, May C. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med. 2010 Oct 20;8:63. doi: 10.1186/1741-7015-8-63.
citation: Donelan K, Barreto EA, Sossong S, Michael C, Estrada JJ, Cohen AB, Wozniak J, Schwamm LH. Patient and clinician experiences with telehealth for patient follow-up care. Am J Manag Care. 2019 Jan;25(1):40-44.