Abstract
A National Confidential Enquiry of Patient Outcome and Death (NCEPOD) report ‘An Age Old Problem’ in 2010 highlighted the failure of the NHS in providing good quality clinical care for elderly patients undergoing surgery. This report generated important guidelines aimed at improving the perioperative care of elderly patients. NCEPOD standards state 95% of elderly patients receiving a geriatric review as part of their perioperative care.
A closed loop audit with two completed cycles in 2018 and 2021 and an ongoing cycle in 2022 looks at the compliance of Barnsley Hospital NHS Foundation Trust (BHNFT) general surgery wards with NCEPOD standards for geriatric review. Also considered were mortality rates, length of stay and complication rates of emergency laparotomy patients in the target patient group.
In 2018, the department was found to be non-compliant with NCEPOD standards, with 23% of target patients having as geriatric review. Numerous recommendations were made and in response, a geriatric liaison consultant was employed and the introduction of a pathway for geriatric emergency surgery patients .
A further cycle in 2021 found a greater than 40% improvement in percentage of patients that have a geriatric review but was still below the 95% target. No significant difference was seen in mortality. Since this cycle, a geriatric liaison consultant is no longer employed in the department and actions have been suggested to involve the multidisciplinary team in identifying these patients for timely review.
Comments
Thank you Alice for your poster and presentation. And lovely to see your cat!
I was wondering whether you had any data on age, frailty or co-morbidities in your sample to enable you to perform some between group analysis for patients seen by a geriatrician compared to those not seen by a geriatrician. This may help to explain the increased length of stay and increased complications seen in the group seen by a geriatrician, along with the factors that you mention.
Thank you so much for your comment.
Fortunately, I have data collected for patient ages and frailty score, although not individual co-morbidities and I have looked into these further based on your suggestions.
There was no correlation between increasing age or frailty score and length of stay. Across frailty scores, length of stay was longer for ever score (range of 0 - 6) for those reviewed by a geriatrician. I feel it also suggests that patients that could still benefit from a geriatrician review based on their age and frailty score were not receiving this service at all. Hopefully further review of the patient notes will help to evidence if it truly is delayed review that is the issue or not enough patients being referred at all, which would help with current plans to develop a new process for identifying and reviewing these patients.