273 Improving frail care—is there a role for the geriatrician in elective waiting lists?

Abstract

Abstract Background The perfect storm of an ageing population and recent pandemic has hugely impacted waiting lists. There is evidence for frailty assessment at point of referral as per the traditional Peri-Operative Care of Older People undergoing Surgery (POPS) model however our concern was for all those patients already on lengthy waiting lists. We obtained funding via the Bevan commission to look at whether a geriatrician had a role in reviewing need for surgery, intervening in medical issues and the best way to select the patients who would benefit. Methods We chose the cholecystectomy list to start as the ‘least frail’. We contacted all patients completing a modified CRANE (Comprehensive Risk Assessment and Needs Evaluation) questionnaire and frailty scoring. We offered a clinic appointment to any patient with a CFS (Clinical Frailty Score) over 4 or who triggered for frailty. Primary outcome was patients removed from the list, secondary outcomes included cost savings through avoiding further outpatient tests and consults, diagnoses made and patient feedback collected. Results Over 20% of patients were removed from the waiting list with a cost saving of around £250,000. 54 patients were offered clinic appointments, over 25 tests were ordered minimising delays in pre-operative assessment and diagnoses including dementia and hyponatraemia were made. Patient feedback was excellent. They felt there was an improvement in the health and social care needs being met following an outpatient appointment and raised the importance of good communication whilst waiting a procedure. The HFRS (Hospital Frailty Risk Score) showed the greatest specificity in selecting patients for clinic while the CRANE questionnaire was more sensitive. Conclusion Clearly geriatricians have a huge role to play in perioperative medicine. We have suggested a modified POPS model with a six monthly CFS score and CRANE questionnaire to identify patients who are becoming frailer while waiting. The project shows cost savings and decreased waits but more importantly improvement in patient care and satisfaction.