Dr David Burberry
Dr Karina James
Dr Duncan Soppitt
Dr Greg Taylor
Dr Jugdeep Dhesi
Swansea Bay University Health Board
Background
We have a growing ageing population, coupled with increasing numbers of patients awaiting operations for longer periods of time. Older and frailer patients are more complex and are associated with longer lengths of stay and worse outcomes postoperatively, making the ability to process the ever growing waiting list more difficult.
Aim
We know that early intervention by geriatricians improves outcomes, with reduced post-operative complications and improved patients outcomes, and with improved utilization of services. However we do not know who will benefit.
Objectives
- Assess the demand for perioperative geriatric services
- Assess the cost benefit of the service
- Identify a screening tool that can be used electronically to identify patients that would benefit from geriatric review
- Map out additional benefits in improving patient care
- Develop the service with robust patient involvement and feedback
The Approach
- Written questionnaire sent to all (256) patients over 65 years on the laparoscopic cholecystectomy (LC) list
- Telephone contact to do clinical frailty risk score, hospital frailty risk score and CRANE questionnaire
- MDT discussion to determine whether patient would benefit from clinical review
Outcome / Benefits
- Waiting list reduction
- 15% of patients over 65 years old removed from LC list
- 40% of patients seen in hernia clinic removed from list
- £250,000 LC savings/ cost avoidance
- Patient centred care with excellent feedback
- Patients medically optimised
- Reduced single specialist referrals
- Reduced medicines cost
- Supports waiting list screening
