Dr Margaret Coakley – Consultant Anaesthetist
Dr Nia Humphry – Consultant Perioperative Geriatrician
Cardiff and Vale University Health Board
Greater numbers of older patients are undergoing surgery. There is increasing evidence that patients who are frail or have cognitive impairment are particularly vulnerable to increased morbidity and mortality. Such patients would benefit from comprehensive geriatric assessment. Comprehensive Geriatric Assessment (CGA) is a geriatrician led multidisciplinary process to establish a care plan to identify and meet any medical, social and functional needs. CGA for patients undergoing elective surgery leads to reductions in length of hospital stay, postoperative morbidity and mortality, and patients are more likely to be discharged to their original place of residence. This approach has become known as POPS – perioperative care of the older patient undergoing surgery. With limited staff resource we need to explore novel ways of delivering CGA to our frail patients.
Aim
To establish a POPS service in our elective surgery stream, to demonstrate it’s effectiveness and to capture data to inform a business case to sustain and expand the service. A Band 6 frailty nurse and band 2 frailty support worker will be working with us for 12 months to establish routine and accurate frailty screening in all our patients over 65 attending our preoperative assessment clinic. CGA will be offered to those who are frail, and findings shared with the relevant therapy staff (physio, occupational therapy and dietetics) prior to admission. Patients will also be signposted to resources to aid their preoperative prehabilitation. This proactive identification of a patient’s needs will optimise the use of current resources and highlight any unmet need. During the admission the frailty nurses will attend ward board rounds and liaise with therapists to progress care. The team will also work to upskill our perioperative colleagues developing and delivering education in common geriatric syndromes. There will be a focus on delerium anticipation and management in our ward teaching.
We hope that upskilling staff will improve recognition of older patients at high risk of perioperative complications and facilitate earlier appropriate intervention to reduce their incidence. Improving quality of care will reduce length of stay and benefit patient experience. We also hope to see decreased readmission rates and need for change of discharge residence to higher care.
What Next
- Embed service
- Expand surgical specialities
- Wider MDT involvement
- Post op geriatrician input
- Patient involvement
- National tool kit
- Promote wider adoption
