Abstract
Introduction
It is predicted that over 4,000,000 patients will be on an elective waiting list in England by 2030 (1) with increased demand, age and frailty following COVID (2). The importance of early assessment of frailty and geriatrician input to allow optimisation and shared decision making is key. A Geriatrician led perioperative clinic was established in Swansea Bay for patients on elective general surgical waiting lists in September 2023.
Method
Using an electronic Power Business Intelligence frailty flag, we highlighted patients and screened either electronically or via telephone using a combination of CFS and CRANE questionnaire. Covering a number of areas including continence, falls and cognition. The outcomes are reviewed by a geriatrician and directed to appropriate avenues such as face-to-face perioperative clinic, continence services or virtual wards. All patients who decide to continue on their journey to surgery are given advice r.e. operative risk, diet and fitness along with optimisation of medications and tests such as echo to minimize delays going forward.
Results
Over 250 patients >65 have been screened to date-either Digitally/Paper/Telephone. Digital responders have an average CFS of 4.48. Over 20 patients have been seen per month since initiating the service with a variety of outcomes. Over 50 (~20%) have decided against surgery following shared decision making demonstrating cost savings of approx. £200,000. There are a number of new diagnoses including dementia and incontinence. Over 20 patients have accepted referral to continence services.
Conclusion
Formalising a perioperative clinic has allowed improvements in patient care and cost savings. We have now completed an initial screen on all general surgical patients who have been on the waiting list over 1 year and have initiated ongoing screening to detect changes in frailty going forward. The next step is initiation of frailty screening at point of referral on WCCG referral.