Improving the Referral to Treatment Time (RTT) Pathway

MyPreOp and improving the 18 week pathway
Conventional preoperative assessment is triggered when the decision to treat is made. In some organisations a one stop preoperative assessment is done, but in many the patient goes home and then has to return to the hospital for a preoperative assessment. This often takes four weeks or more to complete meaning that by the time the To Come In (TCI) date is given it is perilously close to the 18 week limit.

MyPreOp can be used in 3 ways in the surgical 18 week pathway:-
1) Before attending the surgical outpatients – this means that for a “high conversion” rate clinic a patient would be sent
the information about MyPreOp with their outpatient appointment and invited to complete it before attending. This means their information is available to the surgeon and that any suggested tests can be actioned if appropriate in the
surgical outpatients i.e. further supporting the one stop principle.

2) MyPreOp can be completed as a part of the one stop preoperative assessment, with patients entering their data into the system on computers or tablets within the hospital after the decision to treat has been made in the surgical
outpatients.

3) The patient can go home from the outpatients knowing that they need an operation and having been given the
Ultramed blue card with their NHS number and details about how to log on and use MyPreOp. They then have 5 days in which to complete their MyPreOp and submit their data.

Using MyPreOp in this way means that for the significant majority of patients the background preoperative assessment data will have been collected by day five after the decision to treat. In the next week these are reviewed and a decision taken about which of the following action to take:-

• Green –   i.e. “good to go” and a TCI date can be given
• Amber – needs further tests which can be organised, or needs a telephone assessment to understand more fully any issues, with access to the                      patients notes or EPR
• Red –       needs a face to face assessment as identified as potentially high risk due to either the complexity of the surgery or significant co-                              morbidities

This means that within 2 weeks of the decision to treat patients either have a TCI date, or further tests organised or have a face to face appointment booked for as soon as possible.

MyPreOp is therefore able to facilitate improvements in the speed of the surgical pathway and reduce the 18 week RTT breach risk. This also means patients may get their operations quicker, potentially improving outcome and the patient experience.
Early identification of high risk patients is imperative in improving their preoperative assessment and preparation for surgery.

References
Royal College of Anaesthetists – PeriOperative Medicine
http://www.rcoa.ac.uk/perioperativemedicine