WP7.4 - A closed loop audit assessing adherence to NELA frailty guidelines in over 75’s undergoing Emergency Laparotomy

Abstract

Abstract Background and Aims The National Emergency Laparotomy Audit (NELA) 2023 recommend patients over 65 should have clinical frailty score (CFS) recorded, and, if frail or aged 80 or over, should have Care of the Elderly (COE) input. Due to the multi-morbid nature of frailty this population carry additional surgical and post-operative risk. This audit reviewed use of these recommendations at a large District General Hospital (DGH). Methods We performed a closed loop audit on all patients aged 75 and older who had an emergency laparotomy between September 2020 to December 2023. We collected data from their admissions, including CFS and if COE reviews had occurred. The data was analysed. Interventions included presentation at clinical governance, discussion with the COE consultant and a poster was developed for the surgical assessment unit. The data was again retrospectively collected to complete the audit cycle. Results A total of 94 patients were included. The initial audit found 0 patients had CFS recorded and 16% had COE review. The reaudit found significant improvement, with 92% of patients having CFS recorded and 46% having had COE review. Conclusion The second cycle audit has shown significant improvement at the DGH in recording CFS and organising COE reviews for patients over 75 having an emergency laparotomy. However, there remains scope for improvement. Suggested improvements include: a referral pathway to prompt COE reviews and the creation of the “general surgery geriatrician” similar to the ortho-geriatrician role. Organising COE reviews could improve patient outcomes and provide more holistic care.