Improving Referrals to an Older Adults' Inpatient Surgical Liaison service – A QI project and retrospective service review

Introduction

Frailty is associated with increased rates of postoperative complications, a quarter of adults undergoing emergency laparotomy are living with frailty. The "Care of the Elderly Surgical Liaison service" aims to provide a comprehensive geriatric assessment for surgical patients aged over 65 years old and living with frailty. The aim was to conduct a general review of the Surgical Liaison service at Royal Bolton Hospital and improve the referral process.

Method

The project was a retrospective study across a period of 3 years, from January 2023 to December 2025. A total of 730 patients were reviewed by the Surgical Liaison service within this period and data was obtained from reviewing documentation on EPR. 

Results

63% of patients reviewed by the Surgical Liaison service had a clinical frailty score of 5 or above. The focus of our quality improvement project was around the referral process. The majority of patients (60%) were reviewed on a proactive basis by the geriatric team. In the cases where patients were referred by the surgical teams, accounting for 298 patients, 72% of patients had a geriatric review within 24 hours of referral. In 82% of cases the Surgical Liaison service made an intervention or change to the patient's management, a common theme being medication changes in 62% of cases. 

Conclusion

The Care of the Elderly Surgical Liaison service offers prompt, comprehensive assessments for older patients admitted under surgical specialties. The main areas for improvement are to increase the number of patients referred from surgical specialties, earlier in a patient's admission. We have introduced a referral proforma, Surgical Liaison handbook and have displayed the referral criteria in the surgical doctors offices. We have also started presenting at surgical induction and departmental teaching in order to increase awareness of the service and how this should be utilised appropriately.