Assessing the impact of proactive geriatrician review on surgical wards during a system reset on patient flow

To reduce bed pressures some health boards run fire breaks or system resets, sometimes with additional financial resources.  We wanted to see if enhanced geriatrician in-reach to surgical wards during a system reset would benefit patient flow, as part of POPS service development.  Prior to this; patients were referred to geriatric medicine by the surgical or AHP teams after surgical treatment was complete.

During the week of the system reset there were 3 geriatric medicine afternoon visits to the surgical wards.  Frail, older, patients were identified using the Health Improvement Scotland Frailty tool.  Those screening positive were reviewed by a consultant geriatrician or registrar. Data was collected at the end of the reset week and one week later.

36 frail, older adults were identified.  19% of those patients were referred via the old system.  75% of patients benefited from a face-to-face CGA, 1 patient had email advice.  One patient had no CGA benefits identified.  Other patients not reviewed was because discharge was planned within 24 hours or end of life care was initiated.  During the week of the audit 28% of patients were identified as surgically fit with discharge delayed due to medical, rehabilitation or social issues.  At the end of week one these delays were reduced by 70% and 1 week later by 90%.  74% of patients had rehabilitation and discharge planning initiated whilst surgical treatment was ongoing to reduce future delayed discharges.  We identified improvements in quality of care - 67% of patients had a reduction in harmful polypharmacy, 59% of patients had comorbidities optimised and 19% of patients had anticipatory care planning.

During a system reset, proactive geriatrician involvement in surgical wards significantly improves patient flow, with benefits in reducing discharge delays lasting longer than the system reset itself, as well as improving quality of care.