Northwestern Ontario covers a geographical area the size of France, but is sparsely populated, having only around 230,000 residents.

THE PROBLEM

Thunder Bay Regional Health Sciences Center (TBRHSC) staff know that with limited health resources throughout Northwestern Ontario, it's very important they work together across all hospitals that provide surgical services to improve access to care for remote and rural patients.

PROPOSAL

"Asynchronous video technology is important to improving patient care, supporting equitable access to care, and to our hospital moving forward our strategic enabler, called 'Sustainable Future – Advance Digital Health to Improve Patient and Staff Experiences,'" said Cindy Fedell, CIO at TBRHSC. "Providing tools to empower our patients is foundational to our vision.

"We began implementing asynchronous video technology for surgery across the four hospitals of TBRHSC's Regional Surgical Services program," she continued. "The overarching goal was to optimize clinical staff time while also improving patient compliance, experience and outcomes."

The major challenges the provider organization was facing, Fedell outlined, were:

• Optimization of clinical staff time because of limited resources
• Lengthy pre-anesthetic appointments causing a bottleneck to getting patients into available operating rooms
• No standardization of pre-surgical teaching, which can reduce quality assurance
• Poor patient compliance in pre-surgical teaching resulting in no-shows to the pre-anesthetic appointment, surgery cancellations due to non-compliance, patients not understanding the importance of ambulation and same day discharge, and much more

"In surgical care, there is a lot of information that needs to be conveyed to patients and caregivers before surgery," Fedell explained. "It is vital the patient not only understands the information but also retains it and then takes appropriate action.

"While we had invested in an app to deliver this information to patients in written form, most of the pre-surgical information was delivered verbally by doctors, nurses and staff, in addition to a paper packet," she continued. "The verbal repetition was incredibly time-consuming for our clinical staff. On average, it would take an hour in the pre-anesthetic appointment to convey the redundant information."

These lengthy appointments acted as a bottleneck to getting patients into the OR. Additionally, patients would often forget the information they heard and call in with questions, and staff would repeat the information.

Asynchronous video technology made sense to the organization, and it selected vendor HCT Digital Care.

"Staff were on repeat, relaying pre-surgical information and then answering the same questions when they inevitably came in," Fedell said. "If we put it all on async video, then they don't have to be regurgitating the same information constantly.

"And the message is scripted and standardized, which is fantastic from a quality assurance standpoint," she added. "Patients can re-watch the videos as often as they need, at home with their caregivers and family, in the language they speak at home."

The technology's capabilities also were compelling to Fedell because the videos are interactive and have built-in surveys and analytics.

"So, we could encourage patients to take action, such as downloading our digital patient engagement and monitoring tool from SeamlessMD," she remarked. "And with the surveys, we could do digital teach-backs to ensure the patient understood what they just listened to. We also could get experience data back from the patients.

"Then with the video analytics we can actually see the data to make sure our patients are in fact watching and engaging with the video content," she continued. "And HCT are healthcare operations experts. They understand us and what we are trying to do."

MEETING THE CHALLENGE

TBRHSC automated the pre-op messaging for all surgeries across Northwestern Ontario surgical hospitals. It started with 10 videos that address many topics, including scheduling and consenting for surgery, downloading the app, what to expect in the pre-anesthetic appointment, general pre-op instructions, what to expect for OP and IP surgery, common misconceptions, what to expect after surgery and how to prepare the patient's home.

The videos are embedded in the organization's website and in the SeamlessMD app.

"HCT helped us build out our clinical workflows, use QR codes to promote the videos, and communicate internally to all our clinicians and staff about the launch," Fedell recalled. "Now that we are live with the videos, we regularly meet and review analytics reports where we get to see the impact we are having on our patients.

"The vendor's project management and guidance has been really impactful to our leadership team," she added.

RESULTS

To date, patients have watched more than 250 hours of video.

"That's incredible when you think about how much time we are saving for our clinical staff," Fedell said. "But further, it is time spent enhancing the surgical experience for our patients and their families."

There have been more than 9,500 video views, which means TBRHSC has standardized the pre-op messaging for thousands of surgeries. That's a big quality assurance gain.

"Another stat we know because of the analytics is that 99% of patients found the videos helpful and felt more prepared for surgery after they watched the videos," Fedell reported. "That's an A+ in patient experience. Through the analytics we can see patient comments about how the videos were educational and informative, answered their questions, calmed their anxiety and clarified expectations.

"A really incredible statistic: We have reduced inbound patient questions by a factor of 15 to 1," she continued. "For every 15 questions the nurses used to get from patients calling or writing in pre-op, now they get one. That means we are proactively answering patients' questions with the video technology and making better use of our nurse and staff time."

ADVICE FOR OTHERS

This is the future of care delivery, Fedell contended.

"Patients already are using video in their daily lives and oftentimes watching YouTube videos when trying to navigate care," she said. "We want patients to get the information from us, their trusted provider, in the best format for learning and retention. And async video technology is a way you can reach patients in the format they prefer that enhances the care we deliver. It's a win-win-win.

"Our administrators love it because it's helping them achieve their business and operational goals," Fedell concluded. "Our clinicians and staff love it because they don't want to be on verbal repeat 24/7 and they want their patients to be better prepared and engaged. And I want to thank Caroline Fanti, our director of regional surgical services, for leading the charge on these efforts at our organization."

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