eP119 Improving the Management of Frailty in Emergency General Surgery at a Tertiary Centre: An Audit of Current Practice and Quality Improvement Project

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Abstract Background Frailty is present in many older patients that present as a surgical emergency. The physiological decline from frailty is associated with poorer outcomes, thus it is crucial that these patients are identified early in the surgical pathway. The National Emergency Laparotomy Audit (NELA) stipulate that patients over age 65 should have a clinical frailty score (CFS) assessment and documentation at the first encounter with the clinical team. This allows Older Person's Assessment and Liaison (OPAL) teams to be consulted early to help guide a holistic overview of care needs. This audit assesses the implementation of the NELA recommendations at a tertiary surgical centre. Methods Two audit cycles were performed (May and September 2024) assessing all emergency general surgical admissions at Manchester Royal Infirmary for patients over age 65. Electronic patient records (EPR) were used to determine whether CFS was recorded and if OPAL were consulted. Quality improvement interventions included implementation of standardised rapid-use EPR documentation templates and staff education. Results Eighty-five patients were included in the audit. Prior to interventions, no patients admitted (0/47) had a CFS recorded and 13% (6/47) were reviewed by the OPAL team during their inpatient stay. Following intervention, a second audit cycle showed an improvement of CFS documentation to 50% (19/38) and OPAL review to 34% (13/38). Conclusion This audit demonstrates the effectiveness of EPR templates and staff training to improve early frailty identification and documentation in emergency surgical patients as well as better early OPAL involvement to improve clinical outcomes.

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