University Hospitals Coventry and Warwickshire NHS Trust Case Study
Pre-operative anxiety affects 50-75% of children and is associated with worse physical and mental outcomes for the patient. Fifty percent of children develop negative post-hospital behavioural changes, such as separation anxiety and bed-wetting; 8% of these changes are on-going at one year post-procedure. Additionally, there are financial implications for the hospital and wider society, for example due to cancelled operations or ongoing medical costs due to treatment non-adherence. Research demonstrates that psychological preparation before healthcare intervention improves outcomes. Currently, this is predominantly provided via paper leaflets and a single face to face meeting pre-admission; it is thus limited by cost and time. Coronavirus has further restricted the accessibility of these meetings.
Little Journey is a digital health company that psychologically prepares and supports children and their families undergoing a healthcare procedure. The aim is to modify patient behaviours and decrease patient anxiety to improve health outcomes. Little Journey can be downloaded as a free smartphone app by patients and their families; it provides immersive and interactive content that can be tailored to the end user. Support can therefore be accessed anytime, anywhere. The app includes familiarisation of the healthcare setting and staff, coping skills education and parent information articles. The content can be adjusted according to age and is timetabled to be delivered at certain timelines on the patient’s journey. Alongside the app is a web-based hospital portal. This gives real-time control to the healthcare professionals to control the application and modify the patient pathway, to monitor key performance indicators and to review patient feedback.
Patients using Little Journey at University Hospitals Coventry and Warwickshire NHS trust reported favourably on the app. Alex, aged 10 said, “I really like it. It’s good to know what it will look like when I come in and I’m less worried now”. Izzy, aged 11 said, “I really loved the app and it’s really good, literally, seriously, and I think that all the other children will like it too”.
Parents of a younger patient, Freddie (aged 5) spoke of how the app empowered them to be able to explain the procedure to him: “We think the app is a really good idea. We hadn’t really discussed the operation with Freddie yet as we weren’t quite sure what to say or how best to go about it, so the app really helps with that”. Regarding preparation for the day: “The app helped as he was very relaxed. It helped seeing where he would sleep. We could have a look before the day and we felt ready. It helped reduce the stress of coming to hospital as we were unsure how to prepare our son for what was going to happen and it helped encourage him to talk about it. Freddie particularly liked the games including the bit where you can dress up the doctors and nurses in various costumes. He was a bit disappointed though when his surgeon on the day wasn’t a rhino wearing a pink tutu!”
Dr Joseph Hardwicke, a Clinical Innovation Lead at UHCW NHS Trust, described how the app can be easily implemented within the trust. He said, “The Little Journey App has provided an easily adoptable solution to enhance the patient experience for children and their parents when they are visiting hospital for a planned procedure. It aligns well with our Trust’s mission here at the University Hospitals of Coventry and Warwickshire to Care, Achieve and Innovate.”
Mr Christopher Hill, Consultant Paediatric Orthopaedic Surgeon at UHCW NHS trust spoke about the benefits of the virtual reality tour of the unit. He said, “Coming to hospital for surgery can be a worrying time for anyone, but especially for a child. The Little Journey app is fantastic as it allows a child and their family to go on a virtual walkthrough of the hospital areas they will visit, so they know what to expect ahead of time. This helps allay many of their concerns and keeps them more relaxed on the day of surgery. It gives parents a way of talking through aspects of the surgery/admission with their child, which can otherwise be a challenging topic to broach, and utilises fun games and characters which children respond positively to. It is a great, innovative app that is significantly improving the patient (and parent) experience here at the University Hospital of Coventry and Warwickshire.”
Little Journey plans to expand into new areas of healthcare and clinical research. It is easily scalable and aims to become a world leading healthcare information tool for clinical and research trial procedures, in the process, improving the mental and physical health outcomes of children following any healthcare intervention whether as part of routine care or a clinical trial.
Moving forward, Little Journey aims to better understand children’s and their parent’s information preferences and underlying health behaviours. By combining this understanding with in-app behaviours data and patient reported outcomes, Little Journey can better learn how to identify and modify specific behavioural traits to improve health outcomes. In this way it can enable rapid improvements to patient pathways and facilitate further tailoring of support to children and their families.
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