Abstract
Introduction; Patients living with frailty admitted under Emergency Surgery are vulnerable to complications, longer lengths of stay and readmission. Perioperative Care of the Older Person in Surgery (POPS) services are well evidenced and recommended by many national reports. Whilst they are well established in the other home nations, our POPS pilot in Craigavon Area Hospital is the first in N.Ireland.
Method; Our POPS Pilot in the Emergency Surgical Unit aimed to identify all patients over 65 living with frailty and deliver high quality comprehensive geriatric assessment (CGA). This consists of 4 sessions/week provided by 2 Consultant Geriatricians.
Results; Since our pilot began in January 2022 we have performed CGA on 285 patients, delivered education sessions, increased Frailty awareness, supported junior staff, championed our allied-health professionals and participated in multi-disciplinary team meetings. Typical interventions include delirium prevention and management, medication review, shared decision making and discharge planning. 87.5% of patients seen receive a medication review with discontinuation of several medications. This is vital for prevention of drug adverse events and financially accounts to an approximate saving of £21,545/year in 2022. Both patient and medical staff feedback have been positive and in periods of more intense activity, there has been a promising trend towards lower lengths-of-stay. 30-day readmission rates in the over-65s have also improved, falling from 22% in May-July 2021 to 14% for the same period in 2022. This was evident despite the increased total admissions.
Conclusion; Restrictions and obstacles remain, however with a limited team we have already shown a reduction in readmission rates and made meaningful changes to patient care. With adequate resources, we hope to provide a more consistent service and meet the national CPOC/BGS guidelines to provide good quality perioperative care for people living with frailty undergoing elective and emergency surgery.