Background Perioperative services must adapt to the needs of an increasingly older surgical population. Perioperative medicine for Older People undergoing Surgery (POPS) services integrate geriatric medicine teams into surgical pathways to provide quality and cost-effective medical care. This project aims to examine value-based outcomes (clinical and financial impact) of embedding a POPS service at a district general hospital. Methods Following a period of implementation on an acute Trauma and Orthopaedic (T&O) ward, a two-week pilot was undertaken. All emergency fragility fracture admissions aged over 65 years with Clinical Frailty Scores (CFS) of ≥5 were included. Patients with hip fractures were excluded. The POPS service provided medical consultation, medicine rationalisation, proactive treatment escalation planning and shared decision making, as well as leading multidisciplinary team meetings. Outcome metrics: geriatric medicine consults, medical emergency team (MET)/cardiac arrest calls, staff/patient satisfaction and clinical coding. The REDUCE trial cost calculator was used to estimate savings. Results 35 patients were included, mean age 84 years, mean CFS score 7. Ward MET calls and cardiac arrest calls were reduced from a weekly average of 2.5 to 0, and weekly referrals to geriatric medicine reduced from 3 to 0. Experience-based design surveys identified thematic improvements relating to leadership, communication, dignity and respect. Improved quality of documentation resulted in the comorbidity score tariff increasing from £3325 to £6096 per patient. For services introduced by POPS including Comprehensive Geriatric Assessment and delirium assessments, the REDUCE trial cost calculator estimated an additional saving of £2926 per patient totalling hospital savings of £2 million per year (for an estimated 700 patients per year). Conclusion Implementation of a POPS service at a district general hospital can lead to cost savings, improved patient and staff experience, and improved clinical outcomes within a sustainable workforce model.

中文翻译：

---

2317 老年病学家主导的围手术期服务：基于价值的护理的一个例子


背景 围手术期服务必须适应日益老龄化的外科人群的需求。接受手术的老年人围手术期医学 （POPS） 服务将老年医学团队整合到手术途径中，以提供优质且具有成本效益的医疗保健。该项目旨在检查在地区综合医院嵌入 POPS 服务的基于价值的结果（临床和财务影响）。方法 在急性创伤和骨科 （T&O） 病房实施一段时间后，进行了为期两周的试点。所有年龄在 65 岁以上且临床虚弱评分 （CFS） 为 ≥5 的紧急脆性骨折入院患者均被纳入。排除髋部骨折患者。POPS 服务提供医疗咨询、药物合理化、主动治疗升级计划和共同决策，以及领导多学科团队会议。结局指标：老年医学咨询、医疗急救小组 （MET）/心脏骤停呼叫、工作人员/患者满意度和临床编码。使用 REDUCE 试用成本计算器来估算节省的费用。结果 共纳入 35 例患者，平均年龄 84 岁，平均 CFS 评分 7。病房 MET 呼叫和心脏骤停呼叫从每周平均 2.5 次减少到 0 次，每周转诊老年医学从每次 3 次减少到 0 次。基于体验的设计调查确定了与领导力、沟通、尊严和尊重相关的主题改进。文档质量的提高导致每位患者的合并症评分关税从 3325 英镑增加到 6096 英镑。 对于 POPS 推出的服务，包括综合老年病评估和谵妄评估，REDUCE 试验成本计算器估计每位患者可额外节省 2926 英镑，每年总计节省 200 万英镑的住院费用（估计每年可节省 700 名患者）。结论在地区综合医院实施 POPS 服务可以节省成本，改善患者和员工体验，并在可持续的劳动力模式下改善临床结果。