Background Perioperative management of diabetes is a strong predictor of post-operative outcomes for patients undergoing major elective surgery. The national confidential enquiry into patient outcome and death (NCEPOD) has specific recommendations for diabetes care in the perioperative phase. We aimed to audit current practice in East Sussex Healthcare Trust (ESHT) against these recommendations prior to the introduction of a recognised programme designed to improve the perioperative pathway for patients with diabetes (IP3D). Methods A retrospective audit of 30 patients with diabetes who
Introduction Orthopaedic surgery is an important treatment for musculoskeletal (MSK) conditions. In the NHS, 25% of all surgical interventions are for MSK conditions and account for 16.1% of the total cost of surgery. Complications following joint surgery include venous thromboembolism, infection, stroke, myocardial infarction, falls and delirium. Remote ischaemic conditioning (RIC) is a technique which induces intermittent ischaemia of a limb, through inflating a tourniquet above systolic blood pressure for intervals that avoid physical injury but trigger several intrinsic protective
Introduction Hip fracture is the most common fracture in adults over 60 years, affecting approximately 70,000 people in the UK in 2019. Mortality after hip fracture continues to be high and the cost of hip fracture is estimated at £1.1 billion per year for the NHS. It has been shown that there are key clinical indicators which can improve patient outcomes. These are monitored annually in the UK by the national hip fracture database (NHFD). Methods Our aim was to look at the demographics and clinical codes for patients admitted with hip fracture, codes when they are readmitted and cause of
Hip fractures tend to affect older, frailer people and are associated with high morbidity and mortality. The Best Practice Tariff (B PT) was introduced to recognise gold standard care. Features of the BPT include prompt surgical and orthogeriatric input, with multidisciplinary working throughout. Subsequent service changes have led to the creation of specialist hip fracture wards. However, it is not always possible to admit patients with a fractured neck of femur to a specialist hip fracture ward. We reviewed data for 691 patients admitted with a primary neck of femur fracture to a district
AimsTo reduce the burden of inappropriate CPR with surgical specialties and to improve the conversations we are having with patient’s and their relatives around CPR. Methods Data collection was done one one day in March, June and September 2024 across three surgical wards. Patients were included over the age of 65 and with a Rockwood Clinical frailty score over 5. A retrospective review of whether discussions with patient and/or next of kin was done. Below is the table demographics. Results Following teaching intervention to junior doctors and discussion with geriatric medicine surgical
Introduction: Chronic limb-threatening ischemia (CLTI) is defined by presence of peripheral artery disease, rest pain, and/or gangrene or ulceration.1 Management of CLTI often involves a major amputation which has a 30-day in-hospital mortality of 6.6%. Despite improvements in secondary risk management, 5-year mortality remains high.1 Understanding how comorbidity affects amputation survival may help support patient optimisation and shared decision-making. Methods: This audit assessed the outcomes of patients who were reviewed by the POPS team using a comprehensive geriatric assessment (CGA)
Following COVID and an aging population waiting lists in Swansea Bay for elective procedures along with the rest of the UK had reached an all time high. Many patients have become frailer over time and may no longer be suitable or keen for surgery. There was not an efficient mechanism in place for screening these patients and many were being cancelled on the day or having pre-op assessments close to the time of surgery and found to be unsuitable. As part screening our elective surgical waiting lists for frailty we used a number of mechanisms including a electronically screening questionnaire
Introduction Prompted by observation and directed by The Centre for Perioperative Care (CPOC) guidelines, two quality improvement cycles were carried out during 2021-2023 seeking to improve the identification and care of frail patients admitted emergently to the general surgery department at Peterborough City Hospital (PCH), a busy district general hospital with over 40 general surgical beds. Method Two Plan-Do-Study-Act cycles were undertaken. The medical records of patients 65+ years were interrogated for documentation of frailty assessment, evidence of escalation planning and geriatrician
Introduction Surgical intervention may not be appropriate in frail patients with new or recurrent bladder cancer. To ensure that their care is aligned to the principles of ‘Realistic Medicine’, we developed a structured programme of joint management between our Peri-Operative care of Older People undergoing Surgery (POPS), Anaesthetic and Urology teams. This analysis examines our experience. Method Patients listed for surgery and deemed to be frail at initial screening, underwent Comprehensive Geriatric Assessment, an anaesthetic review (if indicated) and surgical evaluations. Validated
Introduction: It’s estimated that 52% of elective vascular patients are frail, with predictions by 2030, one-fifth of surgical procedures will involve patients over 75. This project aimed to evaluate current practices around frailty recognition and documentation at the South-East Wales Vascular Network's regional surgical centre. Objectives: Assess the proportion of patients >65 years with documented frailty assessments using the Clinical Frailty Scale (CFS). Assess healthcare workers' understanding of frailty and familiarity with the CFS. Identify barriers to recognising and undertaking
Introduction: The prevalence of older patients with Colorectal Cancer (CRC) is increasing. While surgery can offer benefits, older patients living with frailty undergoing Colorectal Surgery are more at risk of postoperative mortality and complications. The literature suggests comprehensive geriatric assessment (CGA) pre-operatively enhances shared decision making (SDM), equity of access to surgery, length of stay (LOS) and mortality. Our aim is to evaluate how a joint Geriatrician/Anaesthetic pre-assessment clinic would impact outcomes for elective colorectal surgery in older patients. Method
Introduction: Within our hospital, the Surgical Acute Frailty Team (SAFT) delivers perioperative care to the older emergency surgical population. SAFT focuses on early identification of frailty using the Clinical Frailty Scale and subsequent comprehensive geriatric assessment delivery. The most common referral reason to the team is delirium therefore widespread awareness and timely management is essential. Given the challenging clinical environment, SAFT decided to implement a blended teaching programme to support with delivering frailty education to the surgical multidisciplinary team. The
There is unequivocal evidence to support Perioperative care for the Older Person Undergoing Surgery (POPS) services. However, POPS services are not available in all Trusts offering surgery, including Royal Surrey Foundation Trust (RSFT). The necessity for POPS services will continue to grow with increasing numbers of older people undergoing elective and emergency surgery due to: changing demographics, surgical and anaesthetic advancements, shifts in culture and patients’ expectation of healthcare (1). A RSFT POPS steering group was convened to explore the current orthopaedic elective pathway
Introduction Shared decision making (SDM) is a vital element in ensuring a more personalised approach to care. The Peri-operative Care of Older People in Surgery (POPS) Team adopts enhanced SDM in frail patients referred for elective urological or colorectal surgery using the BRAN (benefits, risks, alternatives, nothing) approach. In frail populations, there is a complex balance between providing appropriate access to surgery and minimising exposure to potentially harmful procedures. SDM can help to negotiate this balance. This study aimed to evaluate the patient perception of the SDM process
Introduction NELA (National Emergency Laparotomy Audit) and British Geriatric Society guidance states patients aged ≥ 80 years, or ≥ 65 years and frail, should have a comprehensive geriatric assessment (CGA) from a perioperative frailty team within 72 hours of admission or critical care step-down. Patients aged ≥ 65 years represented 55.3% of those undergoing emergency laparotomy; and frailty doubled the mortality rate in this group, but post-operative geriatrician review was associated with reduced mortality (NELA project team, RCoA, 2023). Method The Perioperative Care of Older People
Introduction Surgical interventions for older adults are increasing as the population ages. This demographic has a higher perioperative risk. Perioperative care through virtual wards (VWs) is a new service, allowing patients to remain at home. We compared operational and clinical metrics between two age groups (65+ and <65 years) receiving surgical inpatient care through a VW service to evaluate safety and efficacy. Methods The VW service at Wrightington Wigan and Leigh (WWL) NHS Foundation Trust cared for patients at home using the Current Health (CH) platform for medical and surgical
BACKGROUND: At Sheffield Teaching Hospitals, an Older Surgical Patients Pathway (OSPP) began in 2014, introducing a Consultant Geriatrician working in a liaison role within General Surgery. BGS reports in its 'Case for more Geriatricians' that the number of people aged over 85 is set to double by 2045. An increase in patient age and complexity is already being seen across a range of services including admissions to general surgery. We look to characterise this increase to make the case for an expansion of the OSPP service. METHODS: We identified patients aged over 75 admitted under General
Introduction Patients living with dementia are more likely to experience delirium and adverse outcomes when admitted to hospital (Dementia UK, 2022). The General Surgery directorate at Cardiff and Vale University Health Board secured funding for a Memory Link Worker (MLW) in the emergency stream. The aim of the MLW is to improve the hospital experience for patients living with cognitive impairment or anyone experiencing delirium. The MLW should also increase awareness and completion rates of “Read About Me” (RAM). Method Eligible patients are identified by ward staff or the Perioperative care
Introduction: Polypharmacy is commonly defined as the concomitant use of five or more medications. This is a common problem in frail elderly patients and more so on the surgical inpatients where it is not regularly reviewed by the surgical team. Methods: We reviewed retrospectively the data on vascular inpatients from 2015-2016 and after the set-up of the perioperative services in 2022-23. Patients above 65 years of age with a clinical frailty score of 4 or more or with two or more co-morbidities were selected from both groups. In total 130 patients were selected from each group and their
Introduction Malnutrition is common in patients with hip fractures. Early post-operative ONS (oral nutritional supplements) have been shown to reduce the length of stay in hospital and improve post-operative outcomes. The aim of this audit is to determine the number of people within the Royal Victoria Hospital Fracture Unit with NOF (neck of femur) fractures who are receiving ONS; it also determined the reasons for doses missed. Additionally, it covers if baseline refeeding bloods were done as per Trust Guidelines. Method A two cycle audit was completed on the use of ONS in patients with NOF