3858 Quality improvement project to improve referrals for patients undergoing emergency laparotomy to ageing and complex medicine

Abstract Introduction Emergency laparotomy is associated with high risk of mortality and morbidity. NELA best practice tariff identifies Geriatrician input as a key performance indicator for all patients over 80 years of age and those who are over 65 and living with frailty. Evidence suggests geriatrician-led comprehensive geriatric assessment (CGA) may improve post-operative outcomes, but only 8% received one between 2019–2020 in our Trust (national average 27%). The aim of this project was to create a standardised referral system between general surgeons and ageing and complex medicine (ACM) team. Method This 3-cycle quality improvement project consisted of two key multi-faceted interventions, which were assessed using data from secretaries’ emails and the Health Information System (HIS). The first intervention was a standardised referral proforma and pathway, aiming to reduce inappropriate and increase NELA referrals. The second intervention involved appointing a dedicated NELA nurse (summer 2024), who undertook a digital transformation project to improve the acute abdomen pathway, including building an electronic referral process to ACM team. Results The first intervention improved referrals for NELA patients from 0 (Sept 2023-Jan 2024) to 6 (March–June 2024). Since building the digital pathway and the referral order going live in March 2025, we have received and completed 18 NELA referrals (March–June 2025). Frailty scoring was made mandatory in the surgical assessment document and referral became active automatically. Geriatricians working on the frailty session absorbed the referrals and completed CGAs for all patients. In NELA audit figures, this has improved our performance from 40% of patients having had a geriatrician review in March 2024 to 100% for the period November 2024 to January 2025. Conclusions By working together across surgical and medical specialities, and particularly by creating the digital pathway for acute abdomen, we have significantly improved the percentage of general surgery patients receiving geriatrician review.