Developing a POPS Service Within Existing Resources: Data From the First 100 Arthroplasty Patients

Introduction

The NHS is under unprecedented financial pressure, and emerging perioperative services for older people undergoing surgery are often difficult to fund, even where economic modelling suggests potential savings. After securing Royal Surrey Charity funding to join Cohort 4 of the NHS Elect POPS Improvement Collaborative, it became clear that funding for a new proactive POPS service would not be available. The team therefore explored what could be achieved within existing funded services for patients living with frailty who were referred for hip or knee arthroplasty.

Method

Quality improvement methodology was used to compare current service provision with an ideal POPS model. A gap analysis identified key barriers and opportunities. A series of small-scale projects were undertaken to develop a self-completion Clinical Frailty Scale (CFS) tool, create a referral pathway, establish a weekly Teams-based multidisciplinary team (MDT) meeting, and design a structured CGA-POPS template. Patients with frailty referred for comprehensive geriatric assessment, who were also awaiting hip or knee arthroplasty, were reviewed using these new processes.

Results

The self-completion CFS tool was evaluated, refined and is now being rolled out in frailty clinics, with excellent user satisfaction. Review of the first 100 CGA-POPS patients demonstrated that many patients living with frailty, often alongside multi-joint arthritis, had expectations of surgery that did not align with likely risks or benefits. Following detailed, individualised discussions, a number chose not to proceed with surgery. Patients also benefited from comprehensive geriatric assessment, including structured medication review, advance care planning and onward referral to community therapy services.

Conclusions

A CGA-POPS clinic and MDT can be developed within existing resources. This model avoids unnecessary investigations and reduces demand on pre-operative assessment and high-risk anaesthetic clinics, while ensuring that patient priorities, shared decision-making and future care planning are addressed.