A post-pandemic problem: how to solve healthcare’s stacked waiting lists

The planet is under pressure from a growing population, one where the concept of living to 100 is more plausible than ever before. Hospitals need to adapt and become more resourceful, even while struggling with strenuous budget cuts, staff shortages and evolving threats from the flu, Covid-19, and potential future ailments.

The subsequent queues backing up global healthcare systems are drastic. Waiting lists encompass a full range of clinical meetings: a consulting session, a minor or major surgery, an MRI or CT scan, a diagnostic test, or the backlog for receiving cancer treatment. In the UK, orthopaedics comprises the longest lists of any speciality, with total hip and knee replacements costing the NHS 1.5% of its entire budget.

While pre-pandemic times were lengthy enough, they are numbers healthcare providers are striving to return to. Is that possible? By relieving operational burden through technology and turning a switch in how pathways are handled – particularly smoothing the operational cogs between doctors and patients – more efficient and satisfactory healthcare may thrive.

Beyond a number’s game

Waiting lists affect every branch of surgery. Orthopaedics, by example, is commonly slowed through multiple assessments of a patient’s validity for surgery, the costs for primary or secondary and implants, and supplying ample training to better coordinate an over-stretched workforce.

These ‘incomplete pathways’ – where patients face continual waiting times after a referral – saw NHS England’s lists double from 2.3 million people at the start of 2010 to 4.6 million by the end of that decade. Hit by the pandemic, waiting times have grown on average by 80,000 per month while an estimated 75,000 joint replacement cases were lost in 2020. Oftentimes patients can wait for over a year to be seen. 60% of surgeries are also cancelled on the day due to lack of staff and bedding.

The aforementioned metrics speak for themselves, yet the domino effect on public health and wellbeing goes beyond these measures too. Potential patients can be put off by backlogs and skip seeking care altogether. They may spend outside of their means in the private sector. Some may depend on opiates to cure ongoing pain. Sadly other patients may die before being seen to, and delays may worsen symptoms.

When initial prognosis becomes outdated, patients require repeated tests and may need more complex surgery than previously determined, causing further assessments, wait times, and greater human and material costs all along the healthcare pipeline

Projections for patient pathways

In 2020, the demand for joint replacements looked set to increase by 40%, owing to the fact that morbidity and high resource use defines orthopaedic surgery. While the pandemic has endured past its peak, projections from the healthcare sector indicate that a prolonged crisis is inevitable, and one to be dealt with using realistic measures that are, luckily, becoming adopted into common practice.

Waiting lists for the NHS differ by region, but overall it is estimated to still exceed those of pre-pandemic levels: a backlog of around 6.5 million by 2027. However, when medical teams and patients buy-in to seamless digital pathway experiences, resources and procedures can be catered better to fit individual needs and preferences. Siloed working, lost data, resource misallocation and time spent on assessing low-risk cases all amass the operational burden and extend the queue to surgery where, instead, a unified data-led programme can support thorough risk assessment and provide satisfaction to patients.

The idea of shared decision making seeks to speed up consultation too; educating patients on the pathways they’ll navigate should they, their families, carers and specialists openly agree to pursue them. So-called ‘prepared lists’ aim to improve the understanding of any benefits, risks or alternatives, all before the need for further tests or surgeries.This in turn reduces visits to health centres for consulting sessions and checks.

Now’s the time for a rethink

So while the research indicates strong ideals and plans to improve waiting list management, the proof is in the action. Using the NHS as an example, backlog recovery aims set out by the government are still shooting below par.

Healthtech providers are providing solutions to optimise triage. Not only can doctors and patients communicate about bespoke patient pathways through simple digitised workflows, but when only necessary meetings or surgeries are undertaken, resources and staffing costs are saved. More time can be assuredly spent on training staff to effectively accommodate patients in need and nurture them back to health in the most suitable ways possible.

A change in expectations as to how health is given and received may be a cultural shift, but with waiting lists still far from the levels we saw before Covid-19, that change is needed. The technology is available to help solve this queuing problem in significant ways. We may not need to wait so long for better health pathways for all – it’s a space that’s well worth watching.

Want to find out how PRO-MAPP can assist with patient pathways? Contact us.

Royal College of Surgeons of England: Projections for primary hip and knee replacement surgery up to the year 2060: an analysis based on data from The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (2020) https://pubmed.ncbi.nlm.nih.gov/34939832/

British Journal of Anaesthesia: Turning ‘waiting lists’ for elective surgery into ‘preparation lists’ (2021)

Institute of Fiscal Studies: The past and future of NHS waiting lists in England (2024)

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!