A Case Study from the POPS-SUp Trial

This is the authors' abstract. We don't add key points for this paper.

Introduction Older patients presenting with surgical pathology are the biggest growing population undergoing surgery. Geriatrician led care called Perioperative care for Older People undergoing Surgery (POPS) improves patients’ outcomes through a model of Comprehensive Geriatric Assessment (CGA) and Optimisation and Shared Decision Making (SDM). Aim: To improve care for frail older persons requiring emergency vascular surgery using CGA and SDM. This project was unfunded and part of the national POPS-SUp trial. Methods POPS team (2 geriatric consultants, 2 geriatric SpRs and geriatric ANP) attended the vascular ward 4 days per week to assess patients. Patients aged ≥ 65 presenting with lower limb vascular pathology and CFS ≥ 5 were reviewed using a CGA model. Patients were identified via board round, MDT and direct referral. Alongside daily clinical work: A POPS proforma was implemented. POPS cases were presented at the vascular morbidity and mortality meetings. Quality improvement work was undertaken. A new pain management working group was set up. An MDT teaching programme was implemented. Results 76% of patients required a one off review. On average, 2 new problems identified per POPS review. Reduction in mortality in patients living with frailty (7.5% from 10.6%). Reduction in emergency readmissions (12% from 32%). Improved identification of delirium. Improved accuracy of Clinical frailty score (58% from 35%). End of pilot survey: Staff said POPS delivered holistic care with good communication. Conclusions Overall the service showed individual patient and wider trust benefits; however the service does not have any substantive funding. Next steps include developing a business case and sharing outcomes with the trust board to facilitate continuation of this service.