Jason Cross is an Advanced Nurse Practitioner for the Proactive Care of Older People Undergoing Surgery (POPS) team at Guy’s and St Thomas’ Hospital and is a member of the BGS POPS Special Interest Group. He Tweets at @jdcross1970
It’s been an exciting and challenging three years since I last wrote in the BGS blog, and while the messages haven’t changed much, the field of perioperative medicine continues to gather momentum.
In 2012 I wrote about the publication of An Age Old Problem (2011) and Access All Ages (2012) and how both these reports highlighted the deficiencies in surgical care for the older patient, and how geriatrician input was cited as an essential component to improving these issues.
These recommendations have been further supported by the recent publication of the new perioperative pathway vision document from the Royal College of Anaesthetists, titled Perioperative Medicine: The Pathway to Better Surgical Care. Here we note an emphasis on collaborative working with a focus on improving the outcomes and efficiency throughout the surgical pathway.
Whilst the message is clear, the challenges of implementing the recommendations set out in these reports remain. Money is tight and while we have seen the successful appointment of surgical liaison geriatricians in Salford, Oxford and Basildon, many geriatrician posts remain unfilled. What is encouraging though is that many services are looking to develop different models, or pathways of care to support the needs of the older surgical patient.
One such area of development is close to my heart: the rise of the nurse specialist. Up and down the country there is a growing cohort of highly skilled and enthusiastic nurses delivering comprehensive, collaborative and integrated surgical liaison that many of the aforementioned reports suggest is essential. Many have advanced assessment skills with the ability to prescribe and plan complex care interventions.
Maybe this is a possible solution? We know that the introduction of geriatricians into every surgical team is an ideal, but likely not workable. Going forward, we need to be creative in how we deliver the care required for our surgical population, which needs to include all members of the multidisciplinary team, at all stages of the surgical journey, to ensure it is successful.
Over the past three years we’ve seen emerging data to support the benefits of preoperative comprehensive geriatric assessment in the reduction of surgical complications, and reduction in hospital length of stay. This has only been possible with the continued collaboration of services like the ones mentioned above, slowly building a network of enthusiastic health professionals to share our data and experiences.
In March 2016 the POPS team will be running its sixth annual education event (details will be published soon on the BGS website).
Structured over the course of two days, attendees can come to hear advice and guidance regarding the perioperative management of the complex older surgical patient, whilst also hearing first-hand experiences on the setting up and running a surgical-geriatric liaison service.
Previous years have sold out, and have featured delegates from the UK, Europe and further aboard. Set again at The Wellcome Centre by Euston Station, it’s a wonderful opportunity to meet like-minded ‘perioperative enthusiasts’. It’s not just doctors too: last year we boasted a significant number of allied health professionals including OTs, physiotherapists and nurses.
Similarly, the POPS Special Interest Group (SIG) within the BGS is a further way to share experiences and news. This 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, there are exciting times ahead. I will echo the end of my previous blog: the set-up of these services may not be plain sailing, but through collaboration we can continue to build on the already enthusiastic and dedicated members of the perioperative community to cement this exciting area of 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 and come share your experiences, successes and ideas. We are keen to hear from you.