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Clinica Medtech Ventures: Encare

This article was originally published in Clinica

Executive Summary

Specialty area(s): Web-based audit system to improve hospital compliance and enhance patient recovery

Based in: Kista, Sweden

Founded in: 2009

No. of employees: 4

Total investment received to date: SEK6m ($0.8m) plus research grants

Investors: STING, Almi Invest and private investors

About 270 million major surgeries are performed annually in the Western world, but around 3,000 people in Sweden alone are killed each year due to some form of malpractice before, during and after the surgical procedure. To put it into perspective, this death toll, says Magnus Stafsing, CEO of Swedish company Encare, is equivalent to a major plane crash every month. “In the aviation industry, pilots use a checklist to minimize the risk of a plane crash. Yet in the healthcare field, surgeons and the perioperative team don’t use a checklist to minimize the risk of post-surgical complications,” he tells Clinica.

Encare’s solution to reducing the risk of malpractice is its ERAS Interactive Audit System (EIAS), an internet-based data entry and analysis system designed to ensure best practice based on a perioperative protocol developed by the ERAS (Enhanced Recovery After Surgery) Society. The protocol describes the perioperative care pathway (ie the patient’s journey from admission to discharge), and comprises a checklist of around 20 recommendations for patient care at various steps in the perioperative process.

Each patient undergoing an operation would be registered in the ERAS system, then the surgeon and perioperative team would audit their actions against the EIAS. EIAS records the level of compliance to the ERAS protocol, and also registers the level of post-surgical complications. The data analysis function then illustrates in graphs how the level of compliance is actually impacting patient outcomes.

“Often, you think you’re doing things the right way, but you can never be sure until you audit,” says Mr Stafsing. He cites one hospital in Lausanne, Switzerland – the Centre Hospitalier Universitaire Vaudois (CHUV) – which implemented the ERAS system for colorectal surgery in 2011. A study compared two groups of 50 patients and their outcomes; the control group was operated on in 2010 before EIAS was installed, while the other, post-ERAS-audit group was operated on in 2011. An analysis found that in the control group, where the level of compliance to the ERAS protocol was 36%, 19 patients had Grade I-II complications within 30 days of surgery and 10 patients had more severe Grade IIIa-IVb complications. In the post-ERAS-audit group, where the level of compliance to the ERAS protocol was 71%, 24 patients had Grade I-II complications within 30 days of surgery but only 6 had severe Grade IIIa-IVb complications.

More importantly, the length of hospital stay in the post-ERAS-audit group was 5-12 days, significantly shorter than in the control group (7-18 days). Also significant were the findings from an analysis of the total cost of care for these patients: the mean cost per patient (including pre-, intra- and post-operative costs) in the control group was €26,970 ($32,869), while the mean cost per patient in the post-ERAS-audit group was €25,319, representing a saving of €1,651 per patient.

“CHUV found that it has already paid off its first year’s investment in the ERAS system after 20 operations,” says Mr Stafsing, adding that the hospital is currently planning to implement the system in its urology, gynecology and orthopedics departments as well.

Encare’s pricing model includes a fee of €17,500 to train a team of six to implement ERAS, and then a subscription fee of €95 per patient to start using the interactive audit system.

When asked whether the audit system has met with any resistance from hospital staff who might feel that having to record their actions against this checklist is simply making their workload heavier, Mr Stafsing said that staff are actually “motivated when they see the level of complications go down, as compliance goes up.” He added: “Also, when you have more than one team using the audit system, they start to compete against each other to see who has better performance outcomes.” Rather than adding to their workload, the ERAS system helps to reduce it for hospital staff and has “a large cost saving potential,” he continues.

Encare has exclusive rights to commercialize the present, as well as all future, surgical protocols developed by the ERAS Society. According to Mr Stafsing, the company now has over 50 hospitals using the EIAS – in Sweden, France, Spain, Poland, UK, Norway, Switzerland and Canada.

The firm is looking to accelerate the roll-out of ERAS globally and is currently in negotiations with “big industry partners”. It is also working on the fourth version of the EIAS, which is due to be released in the first quarter of 2015, and will also be compatible with mobile platforms such as tablet devices.

Magnus Stafsing, CEO. Tel: +46 706 55 93 12. Email: magnus.stafsing@encaregroup.com

Encare. Isafjordsgatan 39B, 164 40 Kista, Sweden.

www.eras.pro

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