Improving care for older patients undergoing vascular surgery

Quality Improvement Poster Download

Background & Problem

I was offered the opportunity to work on vascular surgery for a year with the very wide remit of improving the medical care of patients on the vascular unit. My initial aim was to focus on frail older people to provide comprehensive geriatric assessment (CGA). There is a substantial body of national data showing the deficiencies of care received by older patients admitted under surgical teams. There is also published data showing benefits of CGA and proactive medical intervention to reduce length of stay and complications.

Aim

Original aim: By August 2017 ≥ 75% of patients aged ≥ 65 with a Rockwood frailty score of ≥ 5, admitted to the vascular unit (excluding emergency AAA rupture) will have an assessment based on the principles of CGA within 72 hours of admission.

Method

• Frailty scoring using the Rockwood frailty score.
• Collaborative joint ward rounds.
• CGA undertaken using OPAL CGA proforma initially then subsequently switched to documenting in medical notes.
• Attempted to set-up MDT board rounds and meetings.

Results

After 3 months no clear consistent improvement in length of stay or number of delayed discharge days. Change in aim to allow targeting of the most complex group – emergency admissions due to lower limb peripheral vascular disease or diabetic foot complications.

Implications

• Very wide remit – difficulties in ascertaining the exact problems and the scope of what is achievable to improve
• How do you measure the quality of care?
• Time limited due to other clinical commitments/on-call commitments
• Lack of sustainability once I leave
• Narrowing down the scope to start MUCH smaller and build up rather than the other way round: ‘The creation of an amputee care pathway in line with best practice standards set-out by the Vascular Society’.