How to provide a cost effective geriatric peri-operative service within general surgery in line with NELA BPT

Introduction: More than 50% of patients undergoing emergency general surgery are > 65
years. The Emergency Laparotomy and Frailty (ELF) study showed strong associations
between frailty (CFS ≥ 5) and increased mortality, risks of complications, and length of
hospital stay.

Methods: For nearly 10 years, we have had geriatric liaison input for general surgery and
colorectal patients in a tertiary teaching centre. This has transformed into a fully embedded
service involving consultant geriatrician, registrars and senior house offices, providing 3-day
a week medical input. NELA best practice tariff (BPT) April 2023 emphasises perioperative
Geriatric team involvement in frail patients aged 65 and above. The main metrics include
CFS, an MDT-based risk assessment, treatment escalation decision making and
perioperative geriatrician involvement.

Results: The service has previously demonstrated significant improvement in patient care
and holistic management including reducing the length of stay in hospital (average decrease
of 5.5 days). Simple job planning, use of current resources and efficiency can mean Trusts
can incorporate geriatricians with essential skills to improve patient management and reach
NELA BPT.

Conclusion: Changes in NELA BPT emphasise the importance of comprehensive geriatric
assessment in the management of older laparotomy patients. Introducing a
multidisciplinary geriatric liaison service into the general surgical department can achieve
high levels of compliance with national guidelines, resulting in better outcomes for patients
as well as financial benefits for Trusts. This is particularly pertinent given the financial
constraints on many services across the NHS, this is an opportunity to increase revenue and
build a geriatric workforce.