Improving Planned Care in the Frail at Morriston (IPCF Morriston)
Swansea Bay University Health Board
A record number of patients are currently awaiting elective care across the UK. A large number of patients in Swansea were waiting over the recommended 36 weeks for an elective procedure, with some waiting up to six years for a cholecystectomy (gall bladder removal), partly as a result of the pandemic.
Sponsorship was gained from the Bevan commission to review all patients on the waiting list for a laparoscopic cholecystectomy to assess their appropriateness for this operation, in order to remove those who no longer need the procedure and optimise those who had some frailty syndromes preoperatively.
Of the 750 total patients on the cholecystectomy list, 256 patients fit the selection criteria of being aged 65 or over. Patients were contacted via post to explain the project and asked to complete a patient satisfaction survey regarding their waiting list experience so far. They were then contacted for a phone consultation and assessed for frailty using the clinical frailty score (CFS). Any patients with high CFS scores or concerning questionnaire results were invited to a clinic for a comprehensive geriatric assessment with a consultant geriatrician.
Over 20% of patients were removed from the waiting list following the intervention, leading to an opportunistic cost calculation of around £250,000 in saved surgical time alone, excluding the benefits of directly reviewing the patients and ordering tests during clinic. The majority of patients felt that their health had deteriorated whilst on the waiting list, with the themes from the focus group displaying a lot of frustration and anger towards waiting for extended periods, and many felt forgotten. There was a consensus from patients that, whilst they understood the pressure the NHS was under, the communication prior to the project was poor. The phone call was a positive intervention as it felt like a ‘check-up’, did not require much time and reassured them they were still on the waiting list.
