Addressing the surgical waiting list through comprehensive geriatric assessment.

Area of Science:

• Geriatric Medicine
• Surgical Patient Care
• Healthcare Management

Background:

• Surgical waiting lists are growing, disproportionately impacting older adults and those in deprived areas.
• Poor shared decision-making (SDM) contributes to healthcare costs and litigation.
• The perioperative care for the older person undergoing surgery (POPS) model offers potential solutions.

Purpose of the Study:

• To integrate POPS principles into routine care for older surgical patients with minimal staffing.
• To profile the cholecystectomy waiting list and patient experiences.
• To provide SDM through comprehensive geriatric assessment for frail individuals.

Main Methods:

• A two-tier triage system (post and telephone) for patients over 64 awaiting cholecystectomy.
• Multidisciplinary team discussions for all patients.
• Clinic appointments offered to patients identified with frailty (CFS>5).
• Prospective data collection on diagnoses, interventions, and screening methods.

Main Results:

• Median wait time for patients over 65 was 101.7 weeks.
• 98 patients surveyed reported health deterioration while waiting.
• 32.8% met frailty criteria; 44 were offered clinic appointments.
• 51 patients (19.9%) were removed from the waiting list via triage.
• Over half of removed patients were identified through simple interventions by non-clinical staff.

Conclusions:

• A triaged approach effectively reduced waiting lists for older adults awaiting cholecystectomy.
• Simple interventions and non-clinical staff involvement can significantly impact waiting list numbers.
• This model has substantial implications for managing long surgical waiting lists, particularly for at-risk older populations.
• Novel approaches can enhance sustainability, patient care, and outcomes in surgical services.