King's College London

Implementation of Comprehensive Geriatric Assessment based perioperative medicine services to improve clinical outcomes for older patients undergoing elective and emergency surgery with cost effectiveness

Older people have more operations than younger people and also have more complications after surgery, such as chest infections, kidney problems, slow recovery and longer hospital stay. This is because older people often have other problems like heart disease or poor memory. These problems need treatment from experts called geriatricians. Having geriatricians care for older people who need operations is not standard in the NHS right now. A service called Perioperative medicine for Older People undergoing Surgery (POPS) was set up at one NHS hospital by geriatricians to help older people get better outcomes after operations. POPS was set up together with patients, carers, surgeons, anaesthetists, nurses, therapists and managers. It uses a method of care called Comprehensive Geriatric Assessment. Studies show that using Comprehensive Geriatric Assessment as part of POPS services can reduce complications after surgery, help people leave hospital sooner and save the NHS money. Some NHS hospitals have now set up POPS services, but not all, meaning not all NHS patients get the same quality of care. We know that setting up POPS services can be hard but our work has shown this can be done. Our research will test how POPS services can be set up in more NHS hospitals to improve care for older patients having operations and save money for the NHS.

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Patient and Public Involvement and Engagement:

From its conception, the POPS model has actively involved patients and service users in codesign and coproduction to inform research and service design. Through collaboration with PPIE groups, we have continuously gathered feedback to help shape our POPS service and research.

Three stakeholder groups have been established to work with us throughout the study, meeting biannually to allow participants to help shape the study as it progresses:

• PPIE1: Public advisory group of patients and carers with lived experience
• PPIE2: Community of practice/network comprising clinicians delivering NHS POPS services
• PPIE3: Multidisciplinary professional stakeholder group comprising clinicians, professional bodies, charity representatives, decisions makers

Effective PPIE has directly informed the POPS-SUp research question, the use of a hybrid effectiveness-implementation study design, the use of co-primary outcome measures and the dissemination strategy. Furthermore, conversations with patients have provided valuable insights into what matters most to them. It prompted a focus on the inclusion of a shared decision-making approach, ensuring ‘no decision about me, without me’ and a sub-study exploring the impact of mental health issues on perioperative shared decision making. Patients also told us they want to know about delirium and functional recovery with some people eager to hear updates about POPS-SUp in written form.

This PPIE approach to codesign and coproduction of research has been acknowledged by the Royal College of Anaesthetists, Patient Voices Gold Award which we are proud to announce that the GSTT POPS team won earlier this year. We continue to share our learning through PPIE newsletters and recently published a blog with The Patient’s Association:  Improving care for older people having surgery through meaningful patient involvement | The Patients Association

Our ongoing commitment to PPIE work continues to guide how POPS is delivered and expanded nationally, ensuring that patient voices remain central to our research and service development.

Internal Steering Committee Members: