Digital tools in neurosurgical pathways: considerations for the future.

With aspects of neurosurgery becoming increasingly digitised, there is a need to understand both the prevalence and impact of digital tools on clinical and organisational outcomes. Consequently, we sought to evaluate evidence of the use of digital tools in neurosurgical settings. We systematically searched three public databases for relevant articles: 283 articles were screened using inclusion/exclusion criteria, with 26 selected for further analysis. Many studies reported on the use of simulation, smartphones, telemedicine and robotics in neurosurgical pathways from education through to postoperative care. Though generally beneficial for both patient and organisational outcomes, a number of considerations were highlighted. Many referred to protection of patient data, cost and requirements to ensure socially disadvantaged groups are not further excluded by the move to digital services. Fortunately, with further innovation, many of these limitations look set to dissipate over coming years, paving the way for a more streamlined neurosurgical pathway.

Patient-initiated follow up as a means of reducing pressures in secondary care.

Outpatient services, largely dedicated to routine follow up, have been under increasing pressure in recent years. The growing and ageing UK population has been a large driver of this pressure, requiring a significant increase in annual outpatient appointments. Many of these appointments, however, may be guided by organisational, rather than clinical need, and as a result, some evidence indicates patient attendance rates have fallen, demonstrating a need for more effective, patient-centred care models. One such model, patient-initiated follow up (PIFU) has shown significant promise, empowering patients while simultaneously reducing appointment numbers and increasing attendance rates. However, for PIFU to be implemented nationwide several key considerations must be made to ensure patients are appropriately engaged, and supported, in directing their own care.

Investigating consultant-led virtual review as a model for implementing 7-day cardiology services in UK clinical practice.

BACKGROUND: Disparities between weekend and weekday care, termed 'the weekend effect', have led to a UK government pledge to provide 7-day services. Despite this, poor outcomes have led to criticism of the programme. This study consequently sought to evaluate consultant-led virtual review as a model for 7-day cardiology services. METHODS: Over 4 weekends, cardiology patients underwent virtual review alongside in-person teams. Outcomes included length of stay, same-day discharge and 30-day mortality rates, as well as duration of ward rounds and change in patient management. Patients were surveyed on attitudes towards virtual review. RESULTS: Statistical analysis revealed no significant difference in clinical outcomes, while virtual review was noted to significantly decrease time taken (p<0.0001). Attitudes towards virtual review were broadly favourable. CONCLUSION: By demonstrating comparable outcomes compared with conventional review, as well as high acceptability, this study identified virtual review as an effective substitute for in-person care.