Abstract:
Introduction:
Some institutions have establised Perioperative medicine for Older People Undergoing Surgery (POPS) services, demonstrating clinical benefits for frail and multimorbid patients (1). Geriatricians in Leicester piloted a vascular-liaison service, delivering comprehensive geriatric assessment (CGA) and optimisation for those with a clinical frailty score (CFS) ≥ 5 and lower limb pathology. We aimed to improve CFS accuracy by the vascular team compared to geriatricians through a structured teaching programme and use of a mobile application.
Methods:
We conducted a mixed-methods quality improvement project, comprising two PDSA cycles: (a) a six-week teaching programme on frailty and geriatric syndromes, and (b) use of a mobile application, endorsed by the British Geriatrics Society, to score frailty. We compared percentage CFS accuracy and assessed inter-rater agreement between the vascular team and geriatricians using the kappa statistic, with p<0.05 as significant. We conducted a reflexive thematic analysis of free-text qualitative feedback on post-teaching surveys.
Results:
Percentage CFS accuracy rose from 35% at baseline to 58% post-interventions. Inter-rater agreement improved from borderline-fair pre-intervention (ĸ=0.21, p<0.001) to moderate (ĸ=0.47, p<0.001) after cycle two. We found a reduction in mortality in patients with frailty (7.5% from 10.6%) and a reduction in emergency readmissions (12% from 32%). Thematic analysis of post-teaching feedback produced three themes: (a) improved self-reported ability in managing complexity in older patients with multimorbidity; (b) improved integration between medicine and surgery; (c) perceived improvements in patient safety attributable to the training.
Conclusion:
In this pilot, targeted education on frailty and geriatric syndromes refined CFS accuracy by non-geriatricians on the vascular ward, improving accurate identification of patients to refer to the POPS service for CGA. Subsequently, geriatrician-led input for identified patients improved mortality and emergency readmission rates. Training and education within host surgical teams to identify suitable patients is therefore imperative for POPS service development.
