Using Artificial Intelligence enabled technology to telephone patients on the elective care waiting list

Optimising new ways of working through the use of digital technology as outlined in the NHS England Operating Framework, will support the recovery of elective services and productivity and transform the NHS for the future which are key priorities for the NHS for 2023/24.

Remote consultations, e.g. telephone/video appointments, increased significantly during the pandemic and continue to be an effective and efficient way to manage patients’ consultations.

Situation

In March 2022, at University Hospitals of Leicester NHS Trust:

• 453 patients were waiting for a spinal procedure, of which 211 adult patients were waiting more than 52 weeks.
• 3,588 patients were waiting for an orthopaedic surgical procedure.
• These were increasing month on month and many patients were exceeding the Referral to Treatment (RTT) 18 weeks standard.

Aspiration

• The Trust needed to improve the way it validated and managed the increasing number of patients on the waiting list, as well as ensure that there was good communication with patients and that their expectations were being met.
• Patients who no longer wished to have treatment and/or had received their treatment elsewhere could potentially be removed from the waiting list.
• This validation would enable the Trust to gain a better understanding of capacity and demand, thereby improving service planning and delivery.

Solution and impact

Developed by Ufonia, Dora is a UK Conformity Assessed (UKCA) marked class 1 artificial intelligence clinical assistant that can telephone patients and have a routine clinical conversation with them with the aim of providing a standardised, high quality and efficient patient experience.

Dora calls patients on the orthopaedic and spinal surgical waiting list to:

• check on a patient’s condition and establish any additional risk factors.
• understand the patient’s wishes regarding treatment and if they have had treatment elsewhere.
• provide regular updates on waiting times from the My Planned Care platform.

Impact

• The artificial intelligence clinical assistant contacted 211 adult spinal patients and 1,805 adult orthopaedic patients waiting over 52 weeks for a procedure.
• 161 spinal and 1,170 orthopaedic calls were completed, i.e. patients answered the phone and there were no technical failures.
• 141 spinal and 1,057 orthopaedic patients wished to remain on the waiting list and were satisfied with having been provided with information: “It’s great to have a phone call to update you on the status” and “keeps me in the loop”.
• 12% of spinal and 10% of orthopaedic patients could potentially be removed from the waiting list as they reported they:
  • had surgery elsewhere,
  • no longer wanted the surgery, or
  • had a major health event that precluded surgery
• The artificial intelligence clinical assistant can be used to replace routine healthcare calls, releasing clinical and administrative staff, whilst delivering a reliable, consistent and safe service for patients.

Functionality

• Patients receive a text message alerting them to their telephone appointment date and time.
• Patients receive a phone call on a landline or mobile phone from the artificial intelligence clinical assistant.
• Patients can talk to the artificial intelligence assistant as if it’s a real person
• Dora has been specially trained using Artificial Intelligence and Machine Learning models to conduct these calls.

Capabilities

• Able to contact large numbers of patients at a single time point which makes this convenient for patients, providing consistent information, and an efficient way of collecting information for the service.
• If the call is not answered or the patient is temporarily unavailable, it will reattempt the call after 10 minutes, up to three attempts, using both the landline and/or mobile phone number provided.

Scope

• Used to contact any patients who have been seen by a clinician and listed for a procedure that has not yet taken place.

Key learning points

• In response to patient feedback and concerns that the calls might be a scam, the calls were highlighted to patients via the Trust website.
• Ufonia and the Trust collaborated closely to ensure that patients were sent text messages highlighting the date and time of their upcoming call to increase the pickup and call completion rate.
• The Trust’s business intelligence team ensured that timely and accurate data could be provided to Ufonia for the calls. Further improvements to be made include regular death checks and validating patient phone numbers.

Digital equalities

The artificial intelligence assistant is highly accessible and, importantly, no special technology or training is needed for patients to have a conversation with it.

For patients unable to have a telephone call, (e.g. due to deafness, cognitive impairment and/or non-English speaking), the usual trust process is followed by sending the patient a letter confirming their appointment date and time.

By supporting routine healthcare calls, the artificial intelligence assistant can:

• make it easier for individuals with disabilities who may find travelling to an appointment challenging to engage with healthcare services.
• reduce the stress that can be associated with attending a face-to-face appointment for those who no longer wish to have treatment and/or have received their treatment elsewhere and can potentially be removed from waiting lists through validation.
• save people time and money, and reduce the disruption to their day, for those who will not need to travel to an appointment.
• build individuals trust and confidence in using digital health interventions.

Key figures/quotes

• 2,249 patients on the orthopaedic and spinal surgery waiting lists were contacted over four months. 11% of these patients could potentially be removed from the waiting list.
• Simon Pizzy, Head of Strategy and Planning at University Hospitals of Leicester NHS Trust said: “Dora has transformed the way we communicate with our patients, freeing up clinicians’ time to focus on more urgent patient care. Feedback from staff and patients has been really positive”.
• Patient acceptability is extremely important and patients were asked about their experience of the call with comments such as: “It’s great to have a phone call to update you on the status” and “It's very easy to answer the questions and give you the information”.

Find out more

Read more about Home - Ufonia

Key contact

Simon Pizzy, Head of Strategy and Planning, University Hospitals of Leicester NHS Trust

Nick de Pennington, CEO and Founder, Ufonia

info@ufonia.com