Transforming surgical waiting lists: A shift from waiting to preparation

In the face of unprecedented challenges exacerbated by the COVID-19 pandemic, a critical imperative has emerged - transforming waiting lists from passive queues to proactive preparation lists. This shift represents a pivotal move towards enhancing patient outcomes, reducing surgical regret, and achieving the goals outlined in the Elective Recovery Delivery Plan.

A call for transformation with NHS targets

As NHS England and NHS Improvement set forth their priorities for the healthcare system's recovery, addressing the record-high waiting lists takes centre stage. With a 4.6 million individuals awaiting elective care, the call for transformation is loud and clear. The urgency lies not only in responding to the backlog but in fundamentally changing how we approach waiting, aligning with the NHS targets to do things differently, sustainably, with patient engagement and care at the core.

By April 2024, the NHS is targeted with determining their highest surgical priorities and implementing five core patient focused requirements:

  • Patients should undergo screening for perioperative risk factors as early as possible in the pathway.
  • Patients identified with risk factors for poor perioperative outcomes should receive proactive, personalised support to optimise their health before surgery.
  • Patients waiting for inpatient procedures should be contacted by their provider at least every three months to check if their health status has changed and how such changes will impact the need for surgery.
  • Patients waiting for inpatient procedures should only be given a date to come in for surgery after they have had a risk assessment and have been confirmed as fit for surgery.
  • Patients must be involved in shared decision-making conversations to discuss the benefits, risks, alternatives, and likely outcomes of the surgery, as well as the postoperative recovery period.

    From waiting lists to preparation lists

    The crux of the matter lies in altering the narrative of waiting. Instead of patients passively waiting for surgery, the emphasis is on actively preparing them for when the NHS is ready. This paradigm shift, from waiting lists to preparation lists, is more than a semantic change; it's a strategic approach to actively engage patients, improve postoperative outcomes, reduce surgical regret, and optimise the utilisation of precious NHS resources.

    The approach to preparation is supported by a clinical cross working group including Anaesthetists, Surgeons and General Practitioners to implement screening to identify risk factors for poor health outcomes, continued risk assessment of a patient’s risk from surgery, and supporting patients to ensure that their health is optimised and managed prior to surgery, including the management of behavioural changes such as smoking. 

    The perioperative care blueprint

    At the heart of this transformation is the perioperative care blueprint, championed by the Centre for Perioperative Care (CPOC). The waiting period becomes an opportune time to proactively address risk factors, optimise health conditions, and encourage lifestyle changes for high-risk patients. Initiatives like prehabilitation programs and multidisciplinary optimisation not only enhance patient well-being but also contribute to streamlined care, reduced complications, and improved hospital efficiency. 

    Importantly, the Centre for Perioperative Care also recognises that perioperative care pathways cover both the pre-operative and post-operative phases with the aim, through Enhanced Recovery, to expedite the return to normal health following major surgery. Enhanced Recovery compliments the activities of the preoperative phase, providing guidance, such as fitness and exercise guidance, to create an end to end pathway of support for the patient to reduce the likelihood of post-surgery complications and the need for readmission.

    The role of digital

    In the digital age, technology plays a pivotal role in realising the vision of preparation lists. Digitising perioperative care pathways offers avenues for active and structured patient engagement, reminders and instructions, exercise programs, remote monitoring, pain management and virtual counselling, aligning seamlessly with the needs of patients awaiting surgery. Leveraging digital tools also enables healthcare teams to better coordinate and optimise perioperative care, contributing to improved outcomes, reduced variations in care and improved hospital efficiency. 

    The digital landscape to support end to end perioperative care pathways is fragmented, with many different solutions satisfying only different phases and activities of the full pathway.  For example, digital solutions exist to support the needs of waiting list management, pre-operative assessments, and remote patient monitoring.  Buddy Healthcare has worked with the health service in Finland to develop a care coordination platform that supports all the operational and patient needs of the end to end perioperative care pathway.

    The shift from waiting to preparation represents a holistic transformation in the approach to surgical waiting lists. By embracing this paradigm shift, aligning with NHS targets, implementing perioperative care blueprints, and leveraging digital solutions, we pave the way for a healthcare landscape where waiting is not merely an idle period but an active phase of preparation for better patient outcomes and system efficiency.

    About Buddy Healthcare

    Buddy Healthcare was established in 2016 and works with leading hospitals across Europe, including Finland and the UK. The Buddy Healthcare platform and patient app streamline the traditional surgical pathway and automate manual, paper-heavy processes so clinical teams can optimise waiting list management, save time for patients, and improve perioperative procedures.

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    Transforming waiting to preparation