This is because older people often have other problems like heart disease or poor memory. These problems need treatment from experts called geriatricians but 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 (CGA).
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.
This project aims to evaluate the implementation, clinical and cost effectiveness of POPS services for older patients undergoing elective and emergency surgery. It 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. The economic and biostatistics theme of the ARC South London will lead on the economic evaluation, evaluating the cost-effectiveness of national implementation.
This is a mixed methods project examining implementation, clinical and cost effectiveness outcomes. Implementation will be examined through process evaluation and clinical effectiveness through quantitative methods. The economic evaluation will specifically employ modelling approaches based on data from the main clinical study to evaluate cost-effectiveness. The researchers will also carry out qualitative analysis through patient and staff interviews and focus groups.
The research team will work closely with Guys and St Thomas’ NHS Trust, Universites of Leicester, Birmingham and Belfast. The British Geriatrics Society, Centre for Perioperative Care, Royal Colleges of Physicians, Surgeons and Anesthetists. 18 NHS hospitals will be participating in the study.
In preparation for this study, the researchers worked with patients, the public and staff to find out what patients want, how many hospitals have a POPS service, what the POPS services look like and what makes it easy or hard to set up a POPS service.
Using this information the research team including patients, designed a ‘strategy’ to help set up new POPS services across the NHS. Working with patients and a team from NHS Elect, the tested the strategy in a few hospitals, finding that it worked well with good patient feedback. To make sure that all patients in the NHS get the same care, they now want to test the strategy for setting up POPS services across the NHS.
Findings of this study could reduce uncertainty about the effectiveness and cost-effectiveness of POPS delivered nationally. It could provide further evidence of using this service to improve patient health outcomes and reduce delayed discharge from acute care settings.
The study is funded by NIHR Health and Social Care Delivery Research. It was adopted by ARC South London Executive in April 2024 and will be completed by 31 January 2027.
