Research undertaken by the Kings Fund has shown that the number of hospital beds has been declining for many years in England. Over the past 26 years the number of available hospital beds in England has more than halved. This decrease is more marked in beds for people with learning disabilities, mental illness and for longer-term care of older people.
The National Audit Office has suggested that hospitals with average bed occupancy levels above 85 per cent can expect to have regular bed shortages, periodic bed crises and increased numbers of health care-acquired infections. Such shortages can compromise patient’s effective recovery and can even put lives at risk. Consequently beds in the NHS are under intense pressure more than ever.
Bed space is further challenged by poor discharge planning but more significantly by patient readmission. Patient readmission is a critical issue for all hospitals and is a major expense to the NHS. With effective management this cost can be reduced if modern systems are made available to help hospitals manage and alleviate this pressure. Such systems would need to offer managers and clinicians the ability to change current practices at scale and pace rather than being incremental and offering marginal change and savings.
For a long time, physicians and nurses have recognised the importance of recovery in a patient’s treatment cycle. By closely monitoring the quality of a patient’s recovery, staff are able to detect any developing unwellness early allowing it to be quickly and effectively handled. Alternatively, if not treated, it could eventually develop into a serious condition thus requiring a longer hospital stay or if not detected, may result in a readmission, each consequence adding further cost and burden to the NHS. Consequently, better patient outcomes allow for reduced length of stay. Decreased length of stay reduces the level of resources a hospital needs to allocate so by allowing it to effectively reduce and manage its costs by attuning its services towards all patients.
Until now, monitoring a patient’s quality of recovery has been poorly measured and evaluated. Data collection can be very haphazard, confusing to patients and staff and limited in scope. Some basic methods currently used in some hospitals are labour intensive and offer limited clinical value due to their lack of depth and range. Consequently a significant opportunity exists to develop the art of postoperative quality of recovery monitoring and evaluation as a clinical tool. This would be achieved by creating a modern patient centric system that harnesses the power of big data whose interface allows for differing language and cultures to be immediately understood. So rather than placing patient’s secondary to IT systems an opportunity exists to develop a flexible web-based solution using evidenced based comparative data to measure, evaluate and improve patient outcomes while helping to develop best clinical practice.
An international team including researchers at City University London’s School of Health Sciences have been working to address the issue of measuring and evaluating the quality of patient recovery after surgery (post-operative recovery).
Over recent years, an innovative and unique tool has been developed which has the potential to benefit all patients, doctors, hospitals and the NHS. An easy to use web-based system allows doctors, researchers and managers to monitor and evaluate a patient’s recovery from surgery. It is called PostopQRS™. (Postoperative Quality of Recovery Scale).
PostopQRS™ is at an exciting stage of its development with over 50 research clinicians having successfully used the technology in studies. PostopQRS™ currently exists in research trial mode and is not yet optimised for general launch but endorsement received to date from evaluators indicate that it could have a significant impact on monitoring and evaluating post-operative recovery. PostopQRS™ has uniquely received endorsement from two societies related to enhance patient recovery and so this helps validate City University London belief, that with the right type of support, PostopQRS™ has the ability to transform the current clinical service model to benefit both patients and the NHS.
By using a tablet or smart phone, with a minimal amount of training, hospital staff, be it a doctor, nurse or carer can evaluate a patient within 6 minutes, assessing their physical, emotional, pain and cognitive health domains. Due to PostopQRS™ ease of use, simple interface and its ability to quickly process data, readings can be taken repeatedly at predetermined times throughout the period of patient care. It can be done in person or over the phone after a patient has been discharged so offering post discharge support and monitoring.
The data collected can be used to:
- Objectively assess how a patient recovers from surgery using evidenced based data
- Analyse trends from groups of patients enabling the manipulation of ‘big data’ to identify best practice, trends and outcomes and comparing hospitals in their delivery of patient treatment interventions.
- Help improve recovery from surgery for elderly and high risk patients
- Evaluate a patients physiological, emotional and cognitive health after surgery as well as their medical condition
- Evaluate techniques and conditions to support doctors as they plan post-operative and discharge care
Benefits of PostopQRS™
PostopQRS™ will have immense benefits to patients:
- A patient being monitored by PostopQRS™ will know that their care is being regularly monitored on multiple levels, not just the medical outcome of their surgery. The system allows doctors to monitor post-surgery anxiety, sickness, cognition and many other important factors. At the moment these are not monitored in a way that demonstrates if one area impacts on another.
- They will benefit from an early warning system, if they are not recovering then the system will quickly flag this to their doctor.
- The patient will know that they are receiving the best intervention, structured in the best way for their particular problem.
- Allows for a fundamental shift towards care that is co-ordinated around the full range of a patient’s needs (rather than care based around a single disease).
PostopQRS™ will have a considerable impact on the NHS:
- The system will save doctors time, improve their abilities to monitor their patients and improve care levels. They will be able to review and monitor all their patients remotely and in real time.
- The system will allow hospitals to know how different doctors are performing against their peers, they will know what interventions work best for which medical condition and help guide resource allocation (for each medical condition) and investment decisions.
- The system will allow the NHS to compare hospitals with each other, guide their investment decisions based on data and will be able to direct resources for the biggest benefit to patients.
- It allows for a more integrated care system as the tool fosters a new level of patient centred care and allows for a genuine patient partnership in their recovery.
- Data collected will help managers decide on how services are commissioned and paid for and will allow them to compare how improvements in care are delivered across hospitals, regions and nationally within the NHS.
PostopQRS™ will provide an outstanding research tool to enable healthcare professionals to make major improvements to the quality of patient care:
- to identify what can be done to stop patients developing chronic pain after surgery
- to understand what long term harm may result from anaesthesia, particular following repeated anaesthetics
- to learn what outcomes should be used to measure the success of anaesthesia and peri-operative care
- to improve recovery from surgery for elderly and high risk patients
- to assess for which patients does regional anaesthesia give better outcomes than general anaesthesia
- to enhance recovery programmes measuring short and long-term outcomes
- to help improve communication between teams looking after patients throughout their surgical journey
The future of PostopQRS™
With the exception of corporate charitable support from a major healthcare company, this project has been self-funded by the institutions represented by the international team managing the project. More development is required before PostopQRS™ can be fully launched as a self sustainable model. The objective is that it will be run as a self-funded system by clinicians and managers from hospitals, pharmaceutical companies and other bodies paying a subscription to access the tools processing and reporting abilities which will help to guide investment, spending, future research and best practice across the UK and internationally.
There is already considerable interest from NHS hospitals, private healthcare providers and international health systems who would benefit from implementing the technology. As the lead research partner, City University London is keen to launch this system which is very much aligned to the School of Health Sciences Allied Health Care agenda.
The University aims to secure at least £150,000 for key parts of the project which are currently preventing the team from developing a sustainable, patient focused business. This includes:
- Funding for the salary of a Project Manager to take this exciting system to the stage where it can be launched as a self-sustaining enterprise
- Upgrading the features and mobile functionality of the website to be customer friendly so that patients will be encouraged to use the system
- Formalising and producing the supporting and commercial infrastructure to allow for self-sustaining operations
- Securing ISO certification, subcontractors and IP to ensure the project can become a viable enterprise
Measuring and evaluating the quality of patient recovery is the focus of PostopQRS™. The tool can quickly alert clinicians and carers if patient’s recovery is becoming compromised. Rather than providing fragmented information about a patient treatment (or series of patients) PostopQRS™ proactively passes on the full picture of recovery rather than pockets of ad hoc information to carers and clinicians. Accordingly, the system provides a more holistic picture of a patient’s journey through recovery so providing a more integrated doctor/patient care pathway.
We expect that PostopQRS™, as a tool, will make a significant difference for all surgical patients and improve communication between surgical and non-surgical teams looking after patients throughout their surgical journey.
This innovative system is designed to measure and evaluate the outcomes for patients after surgery having the potential to benefit patients from six years old and upwards. Currently there is nothing that can deliver such comprehensive support to patients, doctors, and the NHS and drug providers so completion of the development programme will allow PostopQRS™ to become self-sustainable so it can be promoted to a wider audience.
For more information please contact David Street by email on David.Street.firstname.lastname@example.org or call on 0207 040 5556.
Image credit © Flickr user daveynin