Identifying Patients for Comprehensive Geriatric Assessment: Medical Student-Led Frailty Recognition in General Surgery

Introduction 

Older people living with frailty admitted under General Surgery frequently have complex medical needs and experience poorer surgical outcomes. Comprehensive Geriatric Assessment (CGA)-based perioperative services are therefore recommended. ¹–⁴ Baseline evaluation at NHS Grampian demonstrated limited frailty recognition and no geriatrician-led reviews despite substantial unmet need and an established geriatrics liaison service. A medical student-led quality improvement project was undertaken during the wider development of a General Surgery Perioperative Medicine for Older People undergoing Surgery (POPS) service as part of the POPS-SUp programme^.5 

Method 

Baseline data were collected from emergency General Surgical admissions aged ≥75 years during December 2025. A test of change aimed to improve identification of patients most likely to benefit from CGA through Clinical Frailty Scale (CFS) screening, implementation of a clerking proforma, targeted frailty teaching, educational sessions at resident doctor changeover, ‘G-POPS Frailty Hunters’ branding and repeated weekly data collection.  Outcome measures included CFS completion, CGA reviews, numbers of treatment escalation planning (TEP) decisions and general surgical team member satisfaction. 

Results 

At baseline, only 3/28 patients (10.7%) had a documented CFS, although retrospective review identified 13/28 patients with CFS ≥5. Only 4/28 patients had a TEP and no patients had received geriatric review. Following implementation, overall CFS completion increased to 54.5%. 62 patients aged ≥65 years with CFS ≥5 were identified over six weeks, and by week six 60% had received POPS/geriatric liaison review. TEP completion increased from 23.1% to 40%. 15 surgical multidisciplinary team members completed a service evaluation survey; all rated reviews were positive, with reported perceived benefits in inpatient management, discharge planning and decision-making. 

Conclusions 

Improved identification of patients living with frailty facilitated targeted CGA, improved treatment escalation planning and was widely appreciated by the General Surgical team. This demonstrates the value of student-led quality improvement as part of service transformation. 

References  

1. NCEPOD. An Age Old Problem: A review of the care received by elderly patients undergoing surgery. London: National Confidential Enquiry into Patient Outcome and Death; 2010.

2. Dhesi JK, Swart M, Hughes C, Gillies C, Shaw RJ, Pothier DD, et al. Peri-operative care of the elderly 2014: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2014;69 Suppl 1:81-98. 

3. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489-95.

4. Partridge JSL, Harari D, Martin FC, Dhesi JK. The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review. 2014;69 Suppl 1:8-16.

5. Dhesi JK, Partridge JSL, Strasser BC, Bearne L, Hall N, Healey A, et al. Perioperative Medicine for Older People Undergoing Surgery Scale Up (POPS-SUp): study protocol. BJS Open. 2025;9(6):zraf063. doi:10.1093/bjsopen/zraf063