Establishing a POPS service in elective general surgery

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Dr Margaret Coakley – Consultant Anaesthetist

Dr Nia Humphry – Consultant Perioperative Geriatrician

Background

Aims & Objectives

1. Establish frailty screening in patients ≥65 attending POAC

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2. Offer a preop Comprehensive Geriatric Assessment (CGA) to those living with frailty

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3. Upskill staff in managing geriatric syndromes

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4. Inform resource required to provide a substantive service:

• throughout perioperative pathway
• across surgical specialties

Project Pathway

Patients age ≥65 with CFS ≥5, awaiting planned general surgery

(Urology / ENT / Maxillofacial surgery)

POPS NURSE 

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• Nutrition
• Cognition
• Signposting to prehabilitation
• Home adaptations

POPS DOCTOR

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• Optimise comorbidities
• Medication review
• Shared Decision Making
• Treatment Escalation Planning
• Anaesthesia liaison  

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POPS MDT

Feedback outcome:

• Referring clinician
• GP
• POAC nurse
• Responsible clinician
• Prehab

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• Multiprofessional
• Case-based learning
• ↓ anaesthetic workload
• ↓ GP workload
• ↓ specialist referral

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POAC

Surgical Consultants

Cancer CNS

Prehab

Primary Care

Project Outcomes

Did It Work?

Annual recurring saving

£41 per patient

Opportunity cost >£10K / month

Downward trend in need for Consultant Anaesthetist review

Feedback

"Keeping up to date with what "they" were doing, and why they were doing it.  Attend Anywhere (video appointment) saved travelling to Cardiff...and getting another £40 fine“

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"I was told straight - didn't go around in circles.  Told the truth and I could make the choice I wanted then."

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"Gave us information about procedure and risks, and options about doing nothing.  It was not problematic, so we decided to watch and wait"

Outputs and Accolades

What Next?

Reflections

Conclusions