About Torbay Charts
Torbay Charts is an innovative interactive patient decision aid (PDA) tool conceived and developed by Mr Raju Ramesh, Consultant Trauma and Orthopaedic surgeon at Torbay and South Devon NHS Foundation Trust, in order to overcome the recognised limitations of existing PDA’s.
It is unique in that it presents information in a multi-layered approach:
Layer 1: An overview of disease progression and the treatment options appropriate at each stage.
Layer 2: Presents a concise description of each treatment including an indication of the impact on the patient vs potential benefit. Information is presented through a combination of text, infographics and video.
Layer 3: Allows user driven interactive comparisons of treatment options with results displayed as a table or comparative infographics
The information provided for each treatment is based on the expert collation of published evidence and guidelines eg NICE
Torbay Charts is presented as a web-based interactive platform (www.torbaycharts.co.uk) with a hard copy version of the first layer of information available to support face-to-face consultations.
The benefits Torbay Charts offer include
- Supports embedding shared decision making into care pathways – a key priority of the NHS Long Term Plan Personalised Care agenda
- Ability to configure to local policies and guidelines
- Model applicable across range of surgical and medical pathways
- Can be used across both the primary and secondary care settings
- Presents information in range of formats and styles (text / infographics / video) suiting range of learning styles
- Ability to signpost to other resources supporting patients to manage their condition
Mr Ramesh has presented Torbay Charts to national and international experts on shared decision making and PDA’s who have affirmed its uniqueness of concept and encouraged its wider spread and adoption. Following a competitive application Torbay Charts was awarded a place on the SW Academic Health Science Network Spread Academy programme.
In a pilot of Torbay Charts at Torbay and South Devon NHS Foundation Trust (107 patients)
- Over 93% rated Torbay Charts as ‘good’ or ‘excellent’
- The majority felt that its use helped with their shared decision-making conversation
- 5% of patients, although expecting to be referred for surgery, opted for non-surgical
interventions and attributed this decision to the use of the Torbay Charts*.
Staff reported that the charts are intuitive to use, easy to adopt into practice and enabled them to have a more focussed conversation with patients (with no increase in consultation reported).
* This is consistent with the wider evidence base that the use of PDA’s is associated with a reduction in patients opting for operative treatments. A King’s Fund Review by Angela Coulter and Prof Alf Collins (Making Shared Decision Making a Reality: No decision about me, without me documented rates of surgery were 24 per cent lower among patients who used decision aids. Arterburn (2012) showed that when PDA was introduced in their practice, there was 26% fewer hips and 38% fewer knee replacements. Sepucha (2017) showed that when PDA is used in hip and knee arthritis, 15.4% fewer patients with hip and knee arthritis chose surgical options when compared to control group. Stacey and Trenamen (2017-2020) have published evidence confirming that fewer patients opted for surgical interventions and that this reduction in demand was sustained over a 7 year follow up period ie use of a PDA is not simply a delaying tactic.