Innovator profile: Little Journey Little Journey, big success Anaesthetist Dr Chris Evans had an idea for a better way to help prepare anxious children for surgery. He explains how his digital innovation is having an international impact thanks to support from Eastern AHSN Every year, 600,000 children undergo day surgery in NHS operating theatres – and up to 75 per cent of them show signs of fear and significant anxiety, leading to worse surgical outcomes.1,2 As an anaesthetist, I’ve witnessed the impact of children feeling distressed about receiving a general anaesthetic and helped to deal with the consequences. When I discovered that they were given information leaflets designed for adults, I was determined to find another way. Particularly when the literature stated that anxious children need more analgesia, take longer to recover after surgery and face a higher risk of hospital admission. So, I devised Little Journey, an interactive smartphone app and virtual reality headset, for children to use from the comfort and safety of their own home, which aims to reduce apprehension and improve physical and mental outcomes – all while creating a rapidly scalable intervention across the NHS. Co-designed with healthcare professionals and families, the app and headset enable children to take a virtual tour of the hospital, play games and watch animations, all designed to help them understand the hospital experience. There’s tailored information for parents too. The app has transformed hospital visits for patients like three-year-old Alexander, who used to get upset even before leaving home. His delighted dad Matt says: “The effect was transformational with Launched in 2017 as part of a Hospital research study, Little Journey was successfully adopted for patients at Princess Alexandra Hospital, Harlow, and more recently at Ipswich Hospital, after an Eastern AHSN innovation exchange event, Alexander excited instead of scared for his ‘big adventure’. Little Journey meant that he was very familiar with the process of what to expect, so nothing fazed F1act “The effect was transformational, him. 2 with Alexander excited instead of scared for his ‘big “Not only did this make his experience infinitely better, but it made our experience as parents that much better seeing him happy. If there were any tears, it was when I tried to take the virtual reality headset off him!” Fact adventure’. Little Journey meant that University College London 3 he was very familiar with the process of what to expect, Fact so nothing” fazed which was designed to connect 4 innovators with experts to help him them develop and pilot their ideas. With Eastern AHSN funding this year, we have improved the app’s usability, added new functionality, including animations for children undergoing radiotherapy and become compliant with data protection requirements. To date, the app has been tailored to more than 31 UK hospitals with another 10 at different stages of set-up; been used in 29 countries; and had approximately 100,000 animations viewed. At present rates, we’ll prepare 6,000 children for operations in 2019, rising to an estimated 30,000 with hospitals adopting it for standard operating procedure and the adoption at new sites, including Addenbrooke’s Hospital, Cambridge, and Norfolk and Norwich Hospital. It has received plaudits at the highest level with Dr Jacqueline Cornish, NHS England National Clinical Director for Children, Young People and Transition to Adulthood, saying: “The Little Sparks Hospital innovations are outstanding and a perfect example of patient-centred healthcare design. Little Sparks Hospital’s goal of improving children’s experience of hospital is of paramount importance to us at NHS England.” ● Find out more about Little Journey at littlesparkshospital.com and Eastern AHSN Footnotes 1 Kain Z, Mayes L, O’Connor T, Cicchetti D Preoperative anxiety in children. Archives of Paediatric & Adolescent medicine 1996; 150: 1238-45. 2 Beringer RM, Segar P, Pearson A, Greamspet M, Kilpatrick N Observational study of perioperative behaviour changes in children having teeth extracted under general anesthesia. Paediatr Anaesth 2014; 24: 499-504. Where next on the journey? Creating a sound evidence base for new innovations like this can be challenging. As part of a PhD at University College London, Dr Chris Evans is performing a multi-centre randomised controlled trial to evaluate the effectiveness of the app at reducing anxiety before surgery. This is supported by the National Institute for Health Research and the Research for Patient Benefit scheme. He explains: “With Eastern AHSN’s support, we are also assessing if the app delivers cost savings for hospitals through reductions in on-the-day cancellations, premedication rates and unplanned admissions. “As with any innovation, finding early adopters and support, both financial and advisory, from overarching bodies is taxing. Eastern AHSN’s support has been integral to our success. Equally, being agile in development and using co-design with patients, parents and a variety of healthcare professionals has enabled an application that delivers benefit to all stakeholders.” He says he is exploring how the measurement of patient reported outcomes throughout the whole period before surgery can create a continuous loop of data that hospitals can use for quality improvement. “As such, Little Journey not only improves children’s psychological preparation for surgery, but also becomes the method by which new interventions or patient pathway changes can be evaluated,” he adds. “By harnessing machine learning, we hope to predict which children could need more support before surgery, track their recovery after discharge and ultimately tailor the app to the user. To this end we are applying for an Innovate UK grant that will enable us to apply machine learning with the aim of creating algorithms to help identify children at higher risk of anxiety. This would involve linking patient reported outcomes and psychological data collected within the app with patient demographics, physiological and process data from electronic patient records.” Matt, dad of three-year-old Alexander Fact Innovator profile: Little Journey Anaesthetist Dr Chris Evans had an idea for a better way to help prepare anxious children for surgery. He explains how his digital innovation is having an international impact thanks to support from Eastern AHSN Every year, 600,000 children undergo day surgery in NHS operating theatres – and up to 75 per cent of them show signs of fear and significant anxiety, leading to worse surgical outcomes.1,2 As an anaesthetist, I’ve witnessed the impact of children feeling distressed about receiving a general anaesthetic and helped to deal with the consequences. When I discovered that they were given information leaflets designed for adults, I was determined to find another way. Particularly when the literature stated that anxious children need more analgesia, take longer to recover after surgery and face a higher risk of hospital admission. So, I devised Little Journey, an interactive smartphone app and virtual reality headset, for children to use from the comfort and safety of their own home, which aims to reduce apprehension and improve physical and mental outcomes – all while creating a rapidly scalable intervention across the NHS. Co-designed with healthcare professionals and families, the app and headset enable children to take a virtual tour of the hospital, play games and watch animations, all designed to help them understand the hospital experience. There’s tailored information for parents too. The app has transformed hospital visits for patients like three-year-old Alexander, who used to get upset even before leaving home. His delighted dad Matt says: “The effect was transformational with Launched in 2017 as part of a Hospital research study, Little Journey was successfully adopted for patients at Princess Alexandra Hospital, Harlow, and more recently at Ipswich Hospital, after an Eastern AHSN innovation exchange event, Alexander excited instead of scared for his ‘big adventure’. Little Journey meant that he was very familiar with the process of what to expect, so nothing fazed F1act “The effect was transformational, him. 2 with Alexander excited instead of scared for his ‘big “Not only did this make his experience infinitely better, but it made our experience as parents that much better seeing him happy. If there were any tears, it was when I tried to take the virtual reality headset off him!” Fact adventure’. Little Journey meant that University College London 3 he was very familiar with the process of what to expect, Fact so nothing” fazed which was designed to connect 4 innovators with experts to help him them develop and pilot their ideas. With Eastern AHSN funding this year, we have improved the app’s usability, added new functionality, including animations for children undergoing radiotherapy and become compliant with data protection requirements. To date, the app has been tailored to more than 31 UK hospitals with another 10 at different stages of set-up; been used in 29 countries; and had approximately 100,000 animations viewed. At present rates, we’ll prepare 6,000 children for operations in 2019, rising to an estimated 30,000 with hospitals adopting it for standard operating procedure and the adoption at new sites, including Addenbrooke’s Hospital, Cambridge, and Norfolk and Norwich Hospital. It has received plaudits at the highest level with Dr Jacqueline Cornish, NHS England National Clinical Director for Children, Young People and Transition to Adulthood, saying: “The Little Sparks Hospital innovations are outstanding and a perfect example of patient-centred healthcare design. Little Sparks Hospital’s goal of improving children’s experience of hospital is of paramount importance to us at NHS England.” ● Find out more about Little Journey at littlesparkshospital.com and Eastern AHSN Footnotes 1 Kain Z, Mayes L, O’Connor T, Cicchetti D Preoperative anxiety in children. Archives of Paediatric & Adolescent medicine 1996; 150: 1238-45. 2 Beringer RM, Segar P, Pearson A, Greamspet M, Kilpatrick N Observational study of perioperative behaviour changes in children having teeth extracted under general anesthesia. Paediatr Anaesth 2014; 24: 499-504. Where next on the journey? Creating a sound evidence base for new innovations like this can be challenging. As part of a PhD at University College London, Dr Chris Evans is performing a multi-centre randomised controlled trial to evaluate the effectiveness of the app at reducing anxiety before surgery. This is supported by the National Institute for Health Research and the Research for Patient Benefit scheme. He explains: “With Eastern AHSN’s support, we are also assessing if the app delivers cost savings for hospitals through reductions in on-the-day cancellations, premedication rates and unplanned admissions. “As with any innovation, finding early adopters and support, both financial and advisory, from overarching bodies is taxing. Eastern AHSN’s support has been integral to our success. Equally, being agile in development and using co-design with patients, parents and a variety of healthcare professionals has enabled an application that delivers benefit to all stakeholders.” He says he is exploring how the measurement of patient reported outcomes throughout the whole period before surgery can create a continuous loop of data that hospitals can use for quality improvement. “As such, Little Journey not only improves children’s psychological preparation for surgery, but also becomes the method by which new interventions or patient pathway changes can be evaluated,” he adds. “By harnessing machine learning, we hope to predict which children could need more support before surgery, track their recovery after discharge and ultimately tailor the app to the user. To this end we are applying for an Innovate UK grant that will enable us to apply machine learning with the aim of creating algorithms to help identify children at higher risk of anxiety. This would involve linking patient reported outcomes and psychological data collected within the app with patient demographics, physiological and process data from electronic patient records.” Matt, dad of three-year-old Alexander Fact Little Journey, big success 600,000 children undergo day surgery every year in UK hospitals 75 per cent show signs of fear and significant anxiety App tailored to 31 UK hospitals so far, with another 10 being set up Spread internationally to be used in 29 countries to date