Abstract
Introduction
An increasing number of older people living with frailty are undergoing surgery. The Centre for Perioperative Care (CPOC) published guidelines in 2021 to improve the care of this patient group through the perioperative pathway. Whilst significant progress has been made in Cardiff and Vale in improving unscheduled surgical care for older people, there remains a dearth of services for patients undergoing elective procedures.
Method
A Perioperative Frailty team was formed to deliver a service based on Comprehensive Geriatric Assessment principles, for older people undergoing elective surgery. Support was sought from Health Education and Improvement Wales for a Leadership Fellow to help implement a pilot service, with additional funding from the Bevan Commission for nursing secondments.
Results
A standard operating procedure and uniform patient assessment proforma were compiled. Digital Transformation software was developed to enable clinical frailty scale (CFS) scores to be recorded electronically in the preoperative assessment clinic. This enabled identification of patients who are aged ≥65 with CSF ≥ 5, streamlining referrals, allowing an operational service and evaluating the impact of Perioperative care for Older Patients in the elective setting. The team have collaborated with perioperative specialties, therapies and the third sector to increase awareness of the service.
Conclusion
Planning a new hospital service presents multiple opportunities as well as many, sometimes unforeseen, challenges. Our recommendations for colleagues designing new pathways for older people are: consider the strategic plan of your organisation together with the vision of the department to guide service design and selection of outcome measurements; ensure baseline data for the pre-intervention service is available and of high quality; compile a clear project plan with realistic and achievable time frames; explore stakeholder engagement; and most critically, to continually measure and evaluate any new or modified service from the outset.