TH5.10 Results of a pilot programme of Care of the Elderly inreach in Emergency General Surgery patients

Abstract

Abstract Introduction Due to adverse outcomes in patients age >65years who undergo emergency laparotomy NELA suggests surgical units engage with care of the elderly inreach services. This twelve week pilot programme ran during the summer of 2021. Aim To assess the feasibility and benefits of elderly care review of acute general surgical patients aged >65 years. Methods Surgical team identified elderly patients requiring medical input which were reviewed by the elderly care team. Outputs of consultations were recorded and standard proforma developed. Results 129 reviews (male- 63, female- 66) of 121 patients, aged 65–94, were seen between 1st June and 31st August 2021. There were 13 patients more than 90 years old. 54 patients had undergone an emergency operation and 36 had bilio-pancreatic disease. 23 patients needed modification of medications for management of heart failure, fluid balance and Parkinson's disease. Further medical investigations for pre-existing medical conditions were arranged and acted upon. There was significant help in managing patients with delirium and in organizing follow up in memory clinic. SNPs were trained in comprehensive review of elderly patients including clinical frailty score and delirium wheel app to aid in assessment. Conclusion There was evidence that review by the elderly care team helped in preventing call out to the on call medical team and in optimisation of medical comorbidities in complex older patients. Referral criteria to elderly care around medical optimisation and polypharmacy for complex pre-existing disease, management of delirium, discharge planning and end of life care have been developed.