Case study: Simla Ancharaz, advanced nurse practitioner at South West London Elective Orthopaedic Centre (SWLEOC) which is recognised as one of the largest joint replacement centres in Europe.
Simla Ancharaz has been SWLEOC’s project lead for LifeBox pre-operative health assessment app (ePOA) since it was first introduced to the hospital in summer 2019.
Before the COVID crisis struck in March last year, she said the biggest benefit of the digital app was saving time. Since the pandemic, however, LifeBox has come into its own, helping staff to remotely triage patients and make sure that patients receive their treatment in a timely way.
Simla said: “During the first surge of COVID, our surgeons went through the notes of every patient to clinically assess their priority. When the centre was given the go ahead to restart elective surgery on June 1, we were able to call patients already in the system and already pre-assessed. After carrying out checks to ensure patients’ conditions had not changed, we were able to start operations just over two weeks later.”
October saw 465 operations carried out and in November the centre reached 383 procedures – coming closer to its average of 480 cases a month prior to the pandemic.
Simla explains: “The team also introduced a series of one-stop clinics, meaning that once a patient has been assessed by a surgeon and an operation is confirmed as needed, they are then seen by the nursing team for their ECG, swabs and relevant blood tests, all on the same day. The patient is then provided with a LifeBox login to complete their electronic health questionnaire at home within the next 48 hours.”
“The completed electronic health questionnaire and tests results are reviewed by SWLEOC’s pre-assessment team with a phone call to patients to verify the health information provided. At this point, if all are within range and safe for surgery, the patient is deemed ready to be put forward for an operation and a date is given. This process used to take three to four weeks, now it takes just two days.”
All orthopaedic patients coming to SWLEOC from its four partner trusts are now pre-assessed via the LifeBox ePOA. For a small percentage of patients who do not have access to a smart phone or computer, the pre-assessment nurses will complete the health questionnaire with the patient over the phone.
The time-saving benefits of the LifeBox ePOA were already being noted by patients before the COVID-crisis struck. Instead of an average three hours for a face-to-face pre-op assessment, including travel and waiting times, this has now drastically reduced as patients are pre-assessed from home.
In feedback to SWLEOC, one pre-operative patient said they had spent just 13 minutes in the hospital, coming in only for blood pressure and swabs.
When the app was first trialled at SWLEOC last year, Simla had weekly meetings with the LifeBox team to adapt the digital tool to the centre’s needs.
“We made changes together such as making the screen layout clearer and terminology less ambiguous for the patients. We had weekly team meetings with the POA nurses, and their questions were brought to LifeBox and we went through them one question at a time. There were lots of meetings and the LifeBox team were very receptive.
“When the pandemic started, LifeBox gave us an advantage over other hospitals as we had our electronic system all in place”.
Simla will now be sharing her advice and experience about the ePOA when SWLEOC’s partner trusts begin using the app for other specialities over the coming months.
“Their teams will be able to come in and see our process and see how we have redesigned the way we work, and then they will be able to start from the point where we are at,” she adds.