Jason Cross is a Clinical Nurse Specialist for the Proactive Care of Older People (POPS) team at Guys and St Thomas Hospitals and is a member of the BGS Proactive care of Older People undergoing Surgery (POPS) special interest group. He Tweets at @jdcross1970
Following the publication of the National Confidential Enquiry into Patient outcome and Death (NCEPOD) report An age old Problem 2011 and the Royal College of Surgeons (RCS) report Access all ages 2012, interest in the specialist area of perioperative medicine for the older surgical patient is gathering momentum. As a result, clinicians, commissioners and patients are recognising there is a need to have geriatrician input in surgical pathways for older people.
But is it that easy? Will the rapid introduction of geriatricians into complex and often resistant surgical teams throughout the NHS solve the myriad of issues, far too many to list in this short blog, detailed in recently published national reports?
The answer to this question is very likely no. We are faced with a problem. We feel intuitively that surgical geriatric-liaison works, but outside of the realm of orthogeriatrics, the evidence is somewhat sparse. We also know that when purse strings are tight, making the case for funding to develop new services without robust evidence can be difficult.
But, it’s not all bad news. As with all good ideas, we have a small but growing group of dedicated clinicians, from geriatric medicine, surgery and anaesthetics, driving the agenda forward, developing services and gathering evidence for the effectiveness of structured elderly medicine input into elective and emergency surgical care pathways for older people.
Established services such as SCOPES (Nottingham), and POPS (London) are slowly building a network of similarly minded professionals with the aim of sharing experiences, both positive and negative of negotiating the potential minefield of service development, medical management of the surgical patient, staffing issues and true ingratiation into surgical teams.
One such forum has been the POPS (Proactive care of the Older Patient undergoing Surgery) education days. In June we saw this annual event run at capacity for the third year. Aimed at all members of the MDT, it wasn’t just enthusiastic geriatric medicine trainees and consultants filling the seats. Nurses, occupational therapists, anaesthetists, surgeons and psychiatrists attended and participated in the lively discussions. Structured over the course of two days, delegates from all over the UK, Europe and further afield attended to glean practical advice and guidance regarding the perioperative management of the complex older surgical patient, whilst also hearing first hand experiences and advice on the set up and day to day running of a surgical-geriatric liaison service.
Similarly, the POPS Special interest group (SIG) within the BGS is also a new way to share experiences and news. This tripartite forum is easily accessed via the BGS website and has been set up to help disseminate new ideas and research to like-minded colleagues, whilst also providing structured support through sessions at conferences nationally.
In summary, whilst it is still early days, and the set-up of these services may not be plain sailing, through collaboration we can build on the already enthusiastic and dedicated members of the elderly care community. This will help cement this exciting area of geriatric medicine into our work places and improve the care of our older surgical population.
Interested in hearing more? Just drop us an email, or why not join the POPS SIG Come and share your experiences, successes and ideas. We are keen to hear from you.
The POPS team are anonymously surveying current geriatric medicine provision to older surgical patients (excluding hip fracture patients). We would be grateful if you could complete this short survey or forward to the relevant consultant in your department. Please note: in completing this survey please do not refer to orthogeriatric services.