393 Towards Sustainable Care Pathways: A Review of Outpatient Appointments for Elderly Patients Under Fast-Track Discharge from Surgical Specialties
Year: 2024
Type: article
Abstract: Aim To conduct a multi-cycle QI project to review outpatient appointments and evaluate the effectiveness of a junior doctor discharge checklist for elderly patients under Fast-Track discharge from surgical wards at a tertiary hospital. Method A pilot questionnaire survey was sent to consultants and junior doctors, followed by dissimilation of a peer-reviewed FT discharge checklist to junior doctors. A retrospective review of surgical patients under FT discharge between July 22 to April 23 was carried out. Inclusion criteria were discharged with palliative care injectables and not deceased prior to discharge. Results 21 responses were received with 95% agreed that OP appointments review was essential and 76% reported that no routine review of OP appointments was carried out. Prior to intervention (checklist), 54% (6/11) of patients from colorectal, orthopaedics and vascular wards have OP appointments including face-to-face (F2F) thrombosis and rheumatology clinics with transport. 3 patients were deceased within 2 months. Post intervention, over two cycles, 3 out of 16 patients had appointments, with fewer F2F follow-up, but increase in telephone-led care. Conclusions In light of the Royal College of Surgeons report in Sustainability in Surgery in 2022, this study featuring a short checklist revealed gaps in care pathways for co-morbid FT surgical patients. This could entail unnecessary care burden to patients, inappropriate surgical service distribution and sustainability including carbon emission. Akin to medication rationalisation, there is a need for qualitative studies involving patients and carers and in other centres to raise awareness for more holistic and sustainable post-surgical end of life care.
Source: British journal of surgery
Authors: J Yiu, T Ernst
Institution: Guy's and St Thomas' NHS Foundation Trust
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4402004458