Abstract
Introduction:
Some institutions have established Perioperative Medicine for Older Persons undergoing Surgery (POPS) services, demonstrating clinical benefits for frail and multimorbid patients over 65 years-old. As part of a national upscale (POPS-SUp), University Hospitals of Leicester geriatricians piloted a vascular-liaison service for those with a clinical frailty score (CFS) of five or more and lower limb pathology. We aimed to improve CFS accuracy by the vascular team and enhance their confidence in identifying and managing geriatric syndromes.
Methods:
We conducted a mixed-methods evaluation, comprising two PDSA cycles. In cycle one, we delivered a six-week teaching programme, covering geriatric syndromes and post-operative complications. In cycle two, we disseminated educational resources, encouraging the use of an existing CFS app. We performed Bland-Altman analysis and measured percentage accuracy of CFS between the vascular team and geriatricians after each cycle. Reflexive thematic analysis of qualitative feedback for the teaching was undertaken.
Results:
At baseline, the vascular team underestimated frailty score compared to geriatricians by 0.7 points on average (n=104), reducing to 0.2 (n=48) and 0.3 (n=26) after each cycle, respectively. Percentage CFS accuracy rose to 50% (cycle one) and 58% (cycle two) from 35% pre-intervention. Confidence in identifying and managing geriatric syndromes improved in all domains, with the largest impact in addressing delirium. Thematic analysis of responses revealed perceived benefits in patient safety, integration between medicine and surgery, and managing complexity.
Conclusion:
In this pilot, targeted education on frailty and geriatric syndromes refined CFS accuracy by a vascular team compared to geriatricians, improving accurate identification of patients to access comprehensive geriatric assessment. This may have clinical significance in improving perioperative outcomes, which is currently being determined. Training and education within host surgical teams is therefore imperative in POPS service development, though the long-term impact of short-term interventions is to be elucidated.
Comments
Fully agree with surgeons being made more familiar with CFS
As a geriatric medicine registrar with a special interest in POPS I have come across many vascular patients who have significant co-morbidities that need managing alongside their primary surgical pathology. By improving the education of vascular doctors in the management of elderly patients this should improve morbidity and mortality. By educating them on CFS they will be more aware of which of their patients would benefit from a geriatrician review and would therefore refer in a more timely and appropriate manner.
Hi Sophie, Lovely to hear…
Hi Sophie,
Lovely to hear you are interested in POPS.
Thanks for taking the time to view our poster and for your supportive comments, much appreciated!
Do you have a formal POPS service where you're based and what's the setup like?
Best wishes,
Neil