Abstract
Introduction
The NHS backlog in Elective Surgery are a subject of societal concern and political pressure. Over 6,400 patients >65 yrs are currently awaiting surgery at Swansea Bay. What role, if any, can geriatricians play in improving patient and organisational outcomes? Intervention We wrote to all 258 patients on the Cholecystectomy waiting list > 65 yrs with a letter explaining the project and a patient experience questionnaire. An attempt to contact all patients by telephone was made with an intention to ask questions about their health, activities of daily living and frailty and complete a CRANE questionnaire. Patients who were identified as frail either by the CFS or HFRS, with complex co-morbidities and any concerns raised by the CRANE questionnaire were offered a clinic appointment. Clinic outcomes were prospectively recorded. Patients who attended clinic were asked about their experience through another questionnaire and focus groups. Results from phase A (January 2023) The waiting list had 258 patients, 193 (75%) patients spoken to on telephone. 32 of these have been seen clinic to date with another 11 due to attend. These clinics have identified spinal wedge fractures, abdominal aortic aneurysm requiring surveillance, potential malignancy (referred for imaging), possible new diagnosis of RA, optimisation of cardiac drugs (5 patients), polypharmacy management, hyponatraemia; amongst others with several patients referred to other frailty or specialist services. This process was able to reduce the waiting list by 36 patients or 14% of those >65yrs on the waiting list. The focus groups and questionnaires showed patients valued the service.
Conclusion
This project demonstrates that proactive management can yield a substantial benefit, both in optimising patients experience and health outcomes and by producing an organisational benefit by reducing the overall waiting list size and allowing anaesthetic led perioperative clinics to function more efficiently.