ELLSA Geriatrician Review - Setting Up a Service at the Glasgow Royal Infirmary

1.Introduction

The Emergency Laparotomy and Laparoscopy Scottish Audit (ELLSA) commenced in 2019. This partly considers whether a geriatrician has reviewed patients undergoing emergency laparotomy aged over 65 with frailty or over 80.

The ELLSA 2024 report showed the national average geriatrician review was 32.3% (target 75%).

Glasgow Royal Infirmary had no dedicated laparotomy in-reach geriatrician process; therefore, we started developing a service.

2. Method

Commencing January 2026, a spreadsheet of all patients over 75 for geriatrician review was made. Referral was placed by a dedicated ELLSA nurse.

One geriatrics registrar and consultant carried out comprehensive geriatric assessment (CGA) in spare time and in addition to the pre-existing surgical-frailty MDT. 

3. Results

In a 6-month cycle, 65% of 23 referred patients were reviewed.

In the 6 months prior to this service, 33% of 18 patients were reviewed. 

The mean time to review post-laparotomy was 16 days and mean length of stay was 25 days.

Of those assessed, 93% required at least one CGA intervention and 40% required 3 or more.

The main intervention was polypharmacy advice followed by optimisation of medical conditions.

30-day mortality was 7.6% vs. national average 9.2% (excluding those within 1 month of surgery).

4. Conclusions

We have improved access to service by doubling the number of patients receiving CGA in 6 months however still falls short of the national target of 75%. The fact 93% needed CGA intervention, shows there is need to meet this target for equitable care.

Length of stay is longer than the national average of 12 days, however this compares our frail group with all ages. 

In the next 6 months we aim to improve reviews to 75% and extend to the national audit specifications for age and frailty as we develop frailty screening for surgical patients.