Abstract
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 review. Results were presented at departmental clinical governance meetings where the barriers that are limiting progress in this area of clinical practice were debated. In view of finite resources and funding, realistic measures, such as highlighting frailty scores during handover, were introduced during both cycles.
Results
Both cycles demonstrated that current practice within the general surgery department at PCH does not meet CPOC standards and no significant improvement was made by simple interventions. Frailty scores are not routinely assessed or utilised by clinicians, only some patients are given opportunity to undertake shared decision-making including escalation planning and a small number of patients receive a geriatrician review. Departmental discussions revealed barriers including lack of knowledge of frailty, insufficient communication within the department, and insufficient resources for specialist geriatric input.
Conclusion
This project has demonstrated the challenges of changing clinical practice on the front line. Although our results demonstrated no significant improvement in care of frail surgical patients, change has occurred in terms of engagement of general surgeons. Gold standard practice seems elusive, but small, realistic steps are being taken. Whilst there is no immediate prospect of the resources to deliver specialist geriatric input for all frail surgical patients, there is hope that progress can be made towards this so we will continue to build a case for future investment.