Staff Perceptions and Impact of a Spinal POPS Service in a Major Trauma Centre - a Qualitative and Quantitative Evaluation.

Background 

Older spinal surgery patients often exhibit multi-morbidity and frailty syndromes. Hence, they are high risk for adverse outcomes and prolonged hospital admissions.  POPS models have demonstrated efficacy in other surgical specialties. Data from dedicated spinal surgery units on staff perceptions of POPS services remains sparse. 

Objective 

To evaluate multi-disciplinary staff perceptions regarding the utility, clinical benefit, and impact of a Spinal Surgery POPS weekly in-reach service. 

Methods 

A pilot POPS service was established at a Major Trauma Centre (Leeds General Infirmary, UK), providing weekly comprehensive geriatric assessments for spinal surgery inpatients aged ≥75 years. Following a 3-month trial, an anonymized survey was distributed to the spinal surgery multi-disciplinary team (MDT). Quantitative metrics were collated using a 5-point Likert scale alongside qualitative free-text thematic analysis. 

Results 

Survey responses (n=13) were completed by a range of professionals (consultants, resident doctors, advanced clinical practitioners, nurses, discharge coordinator, occupational therapist): 

92.3% agreed/strongly agreed there was an unmet need for specialist geriatrician support prior to the pilot. 92.3% agreed/strongly agreed the service provided distinct clinical benefit to older patients. 92.3% agreed/strongly agreed the service actively benefitted discharge planning and improved patient flow. 100% advocated for continuation of the service.  

A thematic analysis of qualitative data highlighted themes of service value and future service improvement. 

Service value: Clinicians highly valued geriatricians' medical support and diagnostic input. The ward MDT highly valued geriatricians' input in expediting discharges.  

Service improvement: the most prominent theme was the support to expand the service to twice weekly and permanently embed the POPS service into the department. Senior clinicians suggested expanding the criteria to include cranial neurosurgery patients and lower the age threshold to 70 years.  

Conclusion 

The implementation of a Spinal Surgery POPS service achieved universal staff endorsement and demonstrated a perception of high clinical and operational value.