Improving outcomes in older patients undergoing surgery Surgery
Conditions
Interventions
Overview of methods and justification
POPS-SUp is a hybrid implementation-effectiveness interrupted time series multicentre study using mixed methods to examine the use of a coproduced implementation
Sponsors
Guy's and St Thomas' NHS Foundation Trust
Eligibility
Sex/Gender
All
Age
50 Years to 120 Years
Inclusion criteria
Inclusion criteria: Inclusion criteria at the hospital site level: 1. Hospital site in the UK that provides general and/or orthopaedic and/or urological and /or vascular surgery in elective and/or emergency settings 2. Geriatrician (consultant, speciality and specialist doctors, SAS) with allocated time to support implementation 3. Hospital executive board member who will sponsor support for participation Inclusion criteria at the NHS staff level: NHS staff employed at the participating site involved in implementation of POPS intervention and/or delivery of perioperative care Inclusion criteria at the patient participant level: Patients aged over 50 years undergoing general and/or orthopaedic and/or urological and /or vascular surgical care who have received input from a POPS service at participating hospitals
Exclusion criteria
Exclusion criteria: Exclusion criteria at the hospital site level: No healthcare professional with expertise in CGA available to participate in the NHS Elect POPS programme Exclusion criteria at the NHS staff level: None Exclusion criteria at the patient participant level: 1. Prisoners 2. Dementia or delirium so severe as to preclude completion of Shared Decision Making Q9/EQ 5D 5L / Decisional regret scale / No capacity to consent to study (in the individually consented group only)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| In keeping with the MRC framework for complex interventions POPS-SUp will use the following coprimary outcome measures: 1. Reach to assess implementation will be measured using data collected in case note records at onetime point via: 1.1. The number of patients seen by POPS 1.2. The number of patients eligible for POPS review, defined according to which surgical specialty the service is being established in e.g. EGS/urology etc and which patients will be seen e.g. >65 years/frailty CFS 5/multimorbidity etc 2. Length of hospital stay in days to assess clinical and cost-effectiveness measured using data collected in case note records at one timepoint | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Fidelity to clinical components of perioperative CGA measured using a case note review of all patients seen by the POPS services to establish fidelity to the core components checklist for CGA at one timepoint 2. Fidelity to core components of POPS services measured against POPS logic model core components which will be adjusted according to the service being established eg some teams may not be providing postoperative care will be measured through process evaluation ie staff members will be interviewed/observed/surveys at one timepoint 3. Acceptability and feasibility of the implementation strategy will be assessed through process evaluation. Acceptability – staff and patient interviews - through process evaluation at one timepoint . Feasibility – staff and patient interviews in addition to questions on how long the clinic takes/whether there is enough space / sufficient staff etc - through process evaluation at one timepoint Secondary effectiveness outcomes include: 1. 30-day readmission measured using Hospital Episode Statistics (HES) data linkage at one timepoint 2. Postoperative complications retrospectively measured using predefined characteristics at one timepoint close to date of discharge 3. Post-operative delirium recorded through 4AT through retrospective notes review at one timepoint close to the date of discharge according to SNAP 3 methodology 4. Same-day cancellation measured using data collected from clinical records at one timepoint 5. Return to the preoperative place of residence measured using data collected in the clinical record at one timepoint 6. Days alive and out of hospital 90 days measured using HES data linkage and eDRIS data linkage at one timepoint 7. 90-day and 12-month mortality measured using HES data linkage and eDRIS data linkage at one timepoint 8. Operative or nonoperative management measured using data collected in the clinical record at one timepoint 9. Was the initially suggested procedure undertaken or did the pa | — |
Countries
England, Northern Ireland, Scotland, United Kingdom, Wales
Contacts
Public ContactClive Stubbs
Outcome results
None listed