TU6.3 Limited geriatrician input is better than none: Geriatrician led team meetings improve understanding of frailty and medical management of older general surgical patients, meeting NELA standards of care

Abstract

Aims General surgical teams are treating an increasing number of frail, older patients.1 Geriatrician involvement has shown improvement in length of stay.2 We sought to demonstrate that even with limited geriatrician involvement we could meet NELA targets of completing frailty scores, increasing frequency of geriatrician reviews and improving team education. Methods We introduced twice-weekly geriatrician-led team meetings followed by selected patient reviews to best optimise the care of older patients. Surgical trainees, nurses and allied health staff attended each meeting. The team was educated by the geriatrician about geriatric medicine and the importance of recognising frailty. They were also supported in performing independent frailty assessments. We measured frequency of frailty score recorded and geriatrician involvement pre- and post-set up of this limited service. We also conducted semi structured interviews of staff pre- and post-intervention related to educational impact. Results 94% (29/31) of patients aged over 65 had a clinical frailty score recorded post intervention compared to 9% (3/35) originally. All 31 had geriatrician involvement. Comments from the surgical team included: ‘pro-active approach to identifying frailty’, ‘early identification of barriers to discharging complex patients' and ‘improvement in understanding of geriatric giants’. Conclusions The Emergency Laparotomy and Frailty (ELF) study recognised that frailer individuals were vulnerable to adverse outcomes and longer hospital stays.3 Our limited geriatrician-led service supported surgical doctors and the MDT in understanding frailty and considering its impact. Within a short space of time we aligned with NELA recommendations, improved patient outcomes and improved MDT understanding of geriatric medicine.