Posters

Introduction Orthopaedic surgery is an important treatment for musculoskeletal (MSK) conditions. In the NHS, 25% of all surgical interventions are for MSK conditions and account for 16.1% of the total cost of surgery. Complications following joint surgery include venous thromboembolism, infection, stroke, myocardial infarction, falls and delirium. Remote ischaemic conditioning (RIC) is a technique which induces intermittent ischaemia of a limb, through inflating a tourniquet above systolic blood pressure for intervals that avoid physical injury but trigger several intrinsic protective

Introduction Hip fracture is the most common fracture in adults over 60 years, affecting approximately 70,000 people in the UK in 2019. Mortality after hip fracture continues to be high and the cost of hip fracture is estimated at £1.1 billion per year for the NHS. It has been shown that there are key clinical indicators which can improve patient outcomes. These are monitored annually in the UK by the national hip fracture database (NHFD). Methods Our aim was to look at the demographics and clinical codes for patients admitted with hip fracture, codes when they are readmitted and cause of

Hip fractures tend to affect older, frailer people and are associated with high morbidity and mortality. The Best Practice Tariff (B PT) was introduced to recognise gold standard care. Features of the BPT include prompt surgical and orthogeriatric input, with multidisciplinary working throughout. Subsequent service changes have led to the creation of specialist hip fracture wards. However, it is not always possible to admit patients with a fractured neck of femur to a specialist hip fracture ward. We reviewed data for 691 patients admitted with a primary neck of femur fracture to a district

AimsTo reduce the burden of inappropriate CPR with surgical specialties and to improve the conversations we are having with patient’s and their relatives around CPR. Methods Data collection was done one one day in March, June and September 2024 across three surgical wards. Patients were included over the age of 65 and with a Rockwood Clinical frailty score over 5. A retrospective review of whether discussions with patient and/or next of kin was done. Below is the table demographics. Results Following teaching intervention to junior doctors and discussion with geriatric medicine surgical

Introduction: Chronic limb-threatening ischemia (CLTI) is defined by presence of peripheral artery disease, rest pain, and/or gangrene or ulceration.1 Management of CLTI often involves a major amputation which has a 30-day in-hospital mortality of 6.6%. Despite improvements in secondary risk management, 5-year mortality remains high.1 Understanding how comorbidity affects amputation survival may help support patient optimisation and shared decision-making. Methods: This audit assessed the outcomes of patients who were reviewed by the POPS team using a comprehensive geriatric assessment (CGA)

Following COVID and an aging population waiting lists in Swansea Bay for elective procedures along with the rest of the UK had reached an all time high. Many patients have become frailer over time and may no longer be suitable or keen for surgery. There was not an efficient mechanism in place for screening these patients and many were being cancelled on the day or having pre-op assessments close to the time of surgery and found to be unsuitable. As part screening our elective surgical waiting lists for frailty we used a number of mechanisms including a electronically screening questionnaire

Introduction Prompted by observation and directed by The Centre for Perioperative Care (CPOC) guidelines, two quality improvement cycles were carried out during 2021-2023 seeking to improve the identification and care of frail patients admitted emergently to the general surgery department at Peterborough City Hospital (PCH), a busy district general hospital with over 40 general surgical beds. Method Two Plan-Do-Study-Act cycles were undertaken. The medical records of patients 65+ years were interrogated for documentation of frailty assessment, evidence of escalation planning and geriatrician

Introduction Surgical intervention may not be appropriate in frail patients with new or recurrent bladder cancer. To ensure that their care is aligned to the principles of ‘Realistic Medicine’, we developed a structured programme of joint management between our Peri-Operative care of Older People undergoing Surgery (POPS), Anaesthetic and Urology teams. This analysis examines our experience. Method Patients listed for surgery and deemed to be frail at initial screening, underwent Comprehensive Geriatric Assessment, an anaesthetic review (if indicated) and surgical evaluations. Validated

Introduction: It’s estimated that 52% of elective vascular patients are frail, with predictions by 2030, one-fifth of surgical procedures will involve patients over 75. This project aimed to evaluate current practices around frailty recognition and documentation at the South-East Wales Vascular Network's regional surgical centre. Objectives: Assess the proportion of patients >65 years with documented frailty assessments using the Clinical Frailty Scale (CFS). Assess healthcare workers' understanding of frailty and familiarity with the CFS. Identify barriers to recognising and undertaking

Introduction: The prevalence of older patients with Colorectal Cancer (CRC) is increasing. While surgery can offer benefits, older patients living with frailty undergoing Colorectal Surgery are more at risk of postoperative mortality and complications. The literature suggests comprehensive geriatric assessment (CGA) pre-operatively enhances shared decision making (SDM), equity of access to surgery, length of stay (LOS) and mortality. Our aim is to evaluate how a joint Geriatrician/Anaesthetic pre-assessment clinic would impact outcomes for elective colorectal surgery in older patients. Method

Introduction: Within our hospital, the Surgical Acute Frailty Team (SAFT) delivers perioperative care to the older emergency surgical population. SAFT focuses on early identification of frailty using the Clinical Frailty Scale and subsequent comprehensive geriatric assessment delivery. The most common referral reason to the team is delirium therefore widespread awareness and timely management is essential. Given the challenging clinical environment, SAFT decided to implement a blended teaching programme to support with delivering frailty education to the surgical multidisciplinary team. The

Introduction The Frailty Network, initiated in November 2023, aims to enhance care for frail patients through multidisciplinary collaboration across acute and community settings. By fostering partnerships with Health and Social Care teams, GPs, district nurses, and third sector organisations, the Network strives to provide realistic and patient-centric improvements in Lanarkshire. The initiative focuses on proactive, personalised, and coordinated support to help frail older adults maintain independence and well-being. Methods The Frailty Network is supporting multiple teams to implement new

Introduction Hospital-at-Home (HaH) is an innovative care model delivering hospital-level care to community patients. A key priority for Bromley HaH has been to streamline strategies, providing integrated, individualised care for patients with heart failure (HF). Our study revealed that our length of stay (LOS) exceeded the 7-day target, and readmission rates surpassed the 0-10% target. Recognising the complexities of managing HF in the community, we evaluated the impact of a new HF bundle to enhance clinician confidence, reduce LOS, and improve outcomes and service capacity. Method An adapted

Introduction: Prevalence of aortic stenosis and comorbidity burden correlates with advancing age. The Charlson Comorbidity Index (CCI) is a widely validated tool that predicts outcomes in a range of conditions and settings. Methods: We analysed 38 eligible patients referred for CT TAVI at our institution between August 21 - December 22 and calculated their CCI score to study its impact on symptoms, procedural complications and mortality at 30-days, 6-months and 1-year post TAVI. Evidence of frailty screening was determined using retrospective case note review. Results: Thirty-eight patients

Introduction: Completing a comprehensive geriatric comprehensive assessment (CGA) should be standard practice (Stuck & Lliffe, 2011). Studies have shown some improvement in CFS status following completion of a CGA (Chia-Ming et al., 2010). However, the evidence of community based completed CGA’s in improving health outcomes is limited (Sum et al., 2022). Background:In November 2023, with the creation of Porth Preseli (PP), members of the frailty pathway joined PP as a pilot, working within an integrated care team (ICT) to provide an Multidisciplinary approach (MDT). No additional resources

Introduction Introduction of the medical examiner (ME) service has changed the process in which the Medical Certificate of Cause of Death (MCCD) is completed across South Wales. In a tertiary hospital we endeavoured to improve team ownership of medical cause of death decisions, senior involvement, and communication of this to the medical examiner service, through development of a new process and communication form. Methods Two PDSA cycles have been completed. With stakeholder involvement we produced a process map and developed a Proposed Cause of Death form. In 2022 medical teams on 2 wards (A

Introduction It is estimated that by 2030, 1 in 5 people undergoing surgery will be over the age of 75. These patients are often frail with a higher risk of post-operative complications including delirium. They are also more likely to have multiple co-morbidities and an increased anticholinergic burden due to polypharmacy. Anticholinergics are often linked with an increased risk of dementia, delirium, and falls. Methods This retrospective cohort study analysed anonymised data from 50 emergency general surgery patients the POPS team reviewed between December 2023 and February 2024 at the

Introduction Venous thromboembolism (VTE) risk following acute stroke is high. Current guidelines recommended intermittent pneumatic compression (IPC) stockings for up to 30 days in those who are immobile following acute stroke. The concern post-stroke is haemorrhagic complications when using low molecular weight heparin (LMWH). The CLOTS3 trial favoured IPC for safety in the first 30 days. However, in many cases, doses suitable for VTE prophylaxis can be used but with caution if IPC cannot be used. Method A spot audit of patients current VTE prophylaxis was undertaken in a stroke

Introduction In today's healthcare practice, many patients live longer with multiple health issues, often in a frail or terminally ill state. Their quality of life doesn't necessarily improve. These patients require optimal supportive care that respects their dignity. Advanced Care Plans (ACPs) are crucial here, facilitating person-centered discussions about future care preferences while the patients have the mental capacity for meaningful participation. We aim in this study to assess how many patients in General Internal Medicine department would benefit from ACP and compare that to our

An 80 year old man living independently with his wife presented with progressive unsteadiness, generalised weakness and muscle aches over 2 months, following a short episode of flu-like symptoms. Systems review revealed shortness of breath, a hoarse voice, 2kg weight loss and occasional non-drenching night sweats. Bloods showed elevated WCC, CRP and ESR. He was started on 20mg of prednisolone for a working diagnosis of polymyalgia rheumatica. These symptoms did not improve, even after this increased to 30mg. He was admitted to hospital after he developed left leg weakness evolving over the