1121 Comprehensive Care for Geriatric and Frail Surgical Patients: A Multi-Cycle Audit and Review of Outcomes

Aim A National Confidential Enquiry of Patient Outcome and Death 2010 report highlighted deficiencies in care for elderly surgical patients, recommending routine geriatrician input. This audit, conducted in a district general hospital’s general surgery department, aims for 95% of eligible emergency laparotomy patients to receive geriatric review and compares 30-day mortality and average length of stay (LOS) to national averages. Method A multi-cycle audit with three periods of data collection, analysed patients aged ≥80 or ≥65 and frail undergoing emergency abdominal surgery. Data sources included patient notes, electronic referrals, and the NELA database. Results 2017/18: 13 patients, 15.4% 30-day average mortality, 23% geriatric review. A liaison consultant was employed as a result. 2020/21: 14 patients, 15.8% mortality, 17.7-day average LOS, 64.3% geriatric review. Following this, an eReferral system was introduced, but the liaison role became vacant. 2023/24: 26 patients, 3.8% mortality, 23.2-day average LOS, 4.2% geriatric review. Conclusions Despite initial improvements, the department remains noncompliant with national standards. The department is underperforming compared to national averages for LOS (11 days) and geriatric review (33.2%) but a better 30-day mortality (9.0%). The department remains noncompliant with national standards. Dedicated time in geriatricians’ job plans is needed for consistent reviews, but reliance on a single individual creates vulnerabilities. A multidisciplinary team approach is essential for reliability. Following this audit cycle, the liaison role was re-established. Recommendations include mandatory clinical frailty scoring on admission, appointing a 'geriatric lead' surgeon and integrating geriatric care into resident inductions, with summary posters present in the doctors’ office.