PRO-MAPP for joint replacement surgery: a slicker digital approach to preoperative assessments

As an application merging surgical experience, leading academia and software design, PRO-MAPP is specifically tailored to innovate and improve patient pathways. With healthcare systems under pressure from tight budgets, lengthy waiting lists, and evolving (and often complex) methodologies, the time to solve unnecessary operational lags has never been more striking.

In light of this, a programme developed by health economic research arm and consultancy York Health Economics Consortium (YHEC), in collaboration with Oxford Academic Health Science Network, placed four evidence-based digital solutions under the microscope for their transformative patient pathway abilities. PRO-MAPP was selected for its focus on preoperative assessment and digital patient outcome reporting, looking to showcase its digital effectiveness against standardised patient pathways for knee and hip replacement – one particular strand of clinical surgery blighted by long waiting times – at Nuffield Orthopaedic Centre.

The current healthcare burden

The pandemic’s hit on expanded patient waiting lists has been felt across multiple surgical cases, all equally difficult to solve in light of stripped-back resources and staffing. Existing pathways for joint replacement surgery suffers a range of challenges as a result of (or on top of) lengthy backlogs, including:

  • More than three preoperative appointments being undertaken before patients are deemed fit for surgery
  • Manual investigations being repeated unnecessarily
  • Expired preoperative checks (including blood tests)
  • Needless preoperative appointments being carried out on healthy patients

Digital pathway solutions can relieve the burden on the entire healthcare system’s human and material costs by simplifying each major step before surgery is carried out: lowering unnecessary face-to-face appointments; speeding up the steps between appointments, vital tests, and possible surgery; reducing the need for repetitive testing and data input; and fast-tracking those most fit or liable for secondary care (complex patients, e.g., those with high clinical frailty score that are over 65 years old).

Gaining the digital advantage

The PRO-MAPP application is designed to more swiftly and accurately identify patients fit for surgery and reduce numbers on backed-up waiting lists. Patients can be assessed via web or tablet, having been added to a waiting list following an outpatient visit. Health screening and occupational therapy questionnaires can be filled in on iPads by patients, with assistance available from staff.

Staff training, individually or in groups, takes 15 minutes on average, and this digital collection aims to accurately guide staff as to which investigations are required before patients leave clinics, including ECD, MRSA swabs or blood tests.

The digital interface speeds up diagnostics, operational decisions, and ensures complex patients can start preoperative investigations earlier, increasing the probability to be determined fit for surgery sooner. Optimising preoperative assessment can properly segment patients only requiring telephone appointments, saving resources and costs affiliated with necessary appointment visits.

Complex patients should start pre-op investigations earlier to avoid the risk of changes to health status or expired tests (and the need to repeat questionnaires and checks), as well as increasing the probability of being fitter for surgery.

In short: what we found

Based on a sample of 1000 patients, the investigation compared the PRO-MAPP pathway with a standard care pathway for those correctly (or incorrectly) identified as complex or non-complex patients. The number of tests undertaken (e.g. echocardiogram or chest x-rays) was dependent on this factor.

The study looked to identify the average differences between: patient management costs; the length of a patient’s hospital stay; the number of preoperative tests; the number of preoperative appointments; readmissions; cancelled surgeries; and repetitions for preoperative tests and appointments.

PRO-MAPP’s identification rate proved 98% correct for complex patients, and 95.4% for non complex patients. The length of stay was, on average, two days shorter for those on the PRO-MAPP pathway, while readmissions were lowered by 0.4%, and 1.3% fewer surgeries were cancelled.

In all, the PRO-MAPP pathway for knee and hip replacement saved £770 per patient in comparison to the standardised procedure. Per 1000 patients, this marks a difference of £726,944.

Future-proofing personalised patient pathways

Reducing the need for unnecessary face to face appointments, the lengths of hospital stays, and training and resources costs, the PRO-MAPP pathway is on course to speed up operations while alleviating budget stresses and achieving patient satisfaction. 92% of patients stated the questionnaire was ‘easy’ or ‘very easy’ to complete.

Staff similarly felt the bespoke application was helpful for the service, implemented according to speciality, workflows, staff numbers, and the level of training, support or technology needed. With reduced repeated health centre visits, health economic analysis also identified that PRO-MAPP has (so far) saved 51,381.6k of travel; a necessary step in improving climate issues through a reduced 8.8 tonnes of CO2 emissions.

Efforts are still ongoing to improve interactions between patients and staff, but PRO-MAPP has been included on NHS England’s website as a guide for providers on earlier screening, risk assessment and health optimisation in perioperative pathways. To learn more about our pioneering patient pathway solutions, get in touch with our team today!