Optimising Emergency Urological Care in the Older Patient – Impact of a Dedicated Perioperative Care for Older People undergoing Surgery (POPS) Platform
BAUS ePoster online library. Yao M. 06/22/21; 319019; p11-10
Disclosure(s): nil to disclose
Mr. Mark Yao
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Abstract
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Introduction
The number of older urology patients admitted in the acute setting continues to increase. These patients have multiple co-morbidities, concomitant frailty and are at risk of poor health outcomes and experience. We present our experience of a dedicated consultant led Perioperative care for Older People undergoing Surgery (POPS) Platform in the acute urology setting.
Patients and methods
Prospective data was collected over 3months following introduction of the POPS Platform (PP) and compared to 3months' retrospective data of the previous standard of no POPS Platform (NPP). Staff questionnaires were analysed.
Results
We assessed 197 patients [PP(n=141)/NPP(n=56)]. Mean age NPP=78yrs Vs. PP 84yrs. Range of length of stay (LOS) decreased from NPP(1-80days) to PP(1-25days). Thirty day readmission rates for 'medical reasons' were NPP[41% (17/41)] and PP[0% (0/15)] and 'urological reasons' NPP[59% (24/41)] to PP[100% (15/15)], p=0.002. Mortality rates on readmission improved from NPP[20%(8/41)] to PP[0% (0/15)]. Patients transferred to other speciality teams were halved. This cohort had mean Rockwood (frailty) score 6 (moderately frail), and mean of 7 co-morbidities. Increase in prevalence of fast-track, hospice discharge, and patients achieving end of life at-home was seen. 69% (42/61) of PP cohort returned to usual residence. Recognition and management of delirium and anaemia improved. Questionnaires revealed 100% approval by staff.
Conclusion
A dedicated POPS team optimises emergency urological care in the older patient with improved recognition and management of medical complications, end of life care/discharge planning, 30-day readmission rates, LOS and in-hospital mortality. Introduction of similar platforms in urology departments is recommended.
The number of older urology patients admitted in the acute setting continues to increase. These patients have multiple co-morbidities, concomitant frailty and are at risk of poor health outcomes and experience. We present our experience of a dedicated consultant led Perioperative care for Older People undergoing Surgery (POPS) Platform in the acute urology setting.
Patients and methods
Prospective data was collected over 3months following introduction of the POPS Platform (PP) and compared to 3months' retrospective data of the previous standard of no POPS Platform (NPP). Staff questionnaires were analysed.
Results
We assessed 197 patients [PP(n=141)/NPP(n=56)]. Mean age NPP=78yrs Vs. PP 84yrs. Range of length of stay (LOS) decreased from NPP(1-80days) to PP(1-25days). Thirty day readmission rates for 'medical reasons' were NPP[41% (17/41)] and PP[0% (0/15)] and 'urological reasons' NPP[59% (24/41)] to PP[100% (15/15)], p=0.002. Mortality rates on readmission improved from NPP[20%(8/41)] to PP[0% (0/15)]. Patients transferred to other speciality teams were halved. This cohort had mean Rockwood (frailty) score 6 (moderately frail), and mean of 7 co-morbidities. Increase in prevalence of fast-track, hospice discharge, and patients achieving end of life at-home was seen. 69% (42/61) of PP cohort returned to usual residence. Recognition and management of delirium and anaemia improved. Questionnaires revealed 100% approval by staff.
Conclusion
A dedicated POPS team optimises emergency urological care in the older patient with improved recognition and management of medical complications, end of life care/discharge planning, 30-day readmission rates, LOS and in-hospital mortality. Introduction of similar platforms in urology departments is recommended.
Introduction
The number of older urology patients admitted in the acute setting continues to increase. These patients have multiple co-morbidities, concomitant frailty and are at risk of poor health outcomes and experience. We present our experience of a dedicated consultant led Perioperative care for Older People undergoing Surgery (POPS) Platform in the acute urology setting.
Patients and methods
Prospective data was collected over 3months following introduction of the POPS Platform (PP) and compared to 3months' retrospective data of the previous standard of no POPS Platform (NPP). Staff questionnaires were analysed.
Results
We assessed 197 patients [PP(n=141)/NPP(n=56)]. Mean age NPP=78yrs Vs. PP 84yrs. Range of length of stay (LOS) decreased from NPP(1-80days) to PP(1-25days). Thirty day readmission rates for 'medical reasons' were NPP[41% (17/41)] and PP[0% (0/15)] and 'urological reasons' NPP[59% (24/41)] to PP[100% (15/15)], p=0.002. Mortality rates on readmission improved from NPP[20%(8/41)] to PP[0% (0/15)]. Patients transferred to other speciality teams were halved. This cohort had mean Rockwood (frailty) score 6 (moderately frail), and mean of 7 co-morbidities. Increase in prevalence of fast-track, hospice discharge, and patients achieving end of life at-home was seen. 69% (42/61) of PP cohort returned to usual residence. Recognition and management of delirium and anaemia improved. Questionnaires revealed 100% approval by staff.
Conclusion
A dedicated POPS team optimises emergency urological care in the older patient with improved recognition and management of medical complications, end of life care/discharge planning, 30-day readmission rates, LOS and in-hospital mortality. Introduction of similar platforms in urology departments is recommended.
The number of older urology patients admitted in the acute setting continues to increase. These patients have multiple co-morbidities, concomitant frailty and are at risk of poor health outcomes and experience. We present our experience of a dedicated consultant led Perioperative care for Older People undergoing Surgery (POPS) Platform in the acute urology setting.
Patients and methods
Prospective data was collected over 3months following introduction of the POPS Platform (PP) and compared to 3months' retrospective data of the previous standard of no POPS Platform (NPP). Staff questionnaires were analysed.
Results
We assessed 197 patients [PP(n=141)/NPP(n=56)]. Mean age NPP=78yrs Vs. PP 84yrs. Range of length of stay (LOS) decreased from NPP(1-80days) to PP(1-25days). Thirty day readmission rates for 'medical reasons' were NPP[41% (17/41)] and PP[0% (0/15)] and 'urological reasons' NPP[59% (24/41)] to PP[100% (15/15)], p=0.002. Mortality rates on readmission improved from NPP[20%(8/41)] to PP[0% (0/15)]. Patients transferred to other speciality teams were halved. This cohort had mean Rockwood (frailty) score 6 (moderately frail), and mean of 7 co-morbidities. Increase in prevalence of fast-track, hospice discharge, and patients achieving end of life at-home was seen. 69% (42/61) of PP cohort returned to usual residence. Recognition and management of delirium and anaemia improved. Questionnaires revealed 100% approval by staff.
Conclusion
A dedicated POPS team optimises emergency urological care in the older patient with improved recognition and management of medical complications, end of life care/discharge planning, 30-day readmission rates, LOS and in-hospital mortality. Introduction of similar platforms in urology departments is recommended.
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