Karina James
Swansea Bay University Health Board
Waiting lists in the UK are at an all time high. The ageing population and increased number of patients having elective procedures even at an older age has resulted in large numbers of frail patients sitting on waiting lists for long periods of time.
During a small pilot in Swansea Bay we showed nearly 50% of patients waiting for an elective laparoscopic cholecystectomy were frail. Over 1100 patients on general surgical waiting lists are frail and many have been on the list as long as 5-6 years.
Unfortunately without any mechanism for reviewing this their frailty continues to increase without any intervention and there is no opportunity for them to revisit their decision to have an elective procedure. Many of these patients have not had the opportunity for good shared decision making and a significant number are cancelled on the day having been to multiple pre-op assessment clinics.
This is resulting in huge wasted resource and cost, not to mention poor patient care and adverse outcome such as increased length of stay and mortality. National guidance suggests patients should be screened for frailty at point of referral and we believe while waiting lists remain this lengthy this should be a continuous process to detect increasing frailty during their period on waiting lists. Our aims are
- Initiation of frailty screening at point of referral to surgical services and as listing for procedure allowing early detection of frailty and intervention.
- Initiation of yearly frailty screening either electronically (using promptly) or via phone of people on general surgical waiting list
- Upscaling of current perioperative clinic to allow increased for frailer patients, this include a ‘rapid access slot’ for patient who have been referred via USC pathway.
- Data collection to show savings and improved care thus encouraging roll out through Wales.
