Many of you will have heard of and worked alongside Perioperative medicine for Older People undergoing Surgery (POPS) services. Since its inception in 2003, POPS has been translated successfully into multiple NHS trusts and has demonstrated improved outcomes for patients and healthcare systems.1,2,3 Still, not all hospitals in the UK have established POPS services… yet! 4

Over the years we have heard from teams thinking about introducing similar services who aren’t sure of how to get started, who may be struggling to get their own service off the ground, or who wish to expand a pre-existing perioperative service for older people.

Established in 2021, the POPS Network provides support, guidance and lots of useful tools for teams looking to start or develop Comprehensive Geriatric Assessment (CGA)-based perioperative services for their local context.

What is the POPS Network?

The POPS Network is a six-month quality improvement (QI) programme that has been built in partnership with NHS Elect. NHS Elect is a national organisation run by experienced NHS colleagues that delivers improvement networks such as the Acute Frailty Network and Specialist Clinical Frailty Network.

The programme uses a trimodal approach of expert mentoring and coaching, access to an online toolkit of resource and guidance on measurement for improvement that is tailored to the needs of individual teams and hospitals.

What is offered during the POPS Network programme?

  1. Expert mentoring and coaching

The programme starts with a virtual site visit to share ideas and discuss local barriers and potential solutions to effect change. Following this, an allocated QI associate meets with the local team on a two weekly basis to help design the local service and adapt the POPS model to the local population, workforce and context. In addition, structured, monthly, core events, webinars and masterclasses are provided to address questions raised by the network members and offer opportunities for networking between sites, shared learning and building a lasting community of practice.

  1. Access to a toolkit of POPS resources

The POPS toolkit contains essential resources for establishing a local POPS service including clinical materials (such as guidelines, and letter templates), education and training materials (such as teaching programmes, slide sets), and business materials (such as core outcome sets, job descriptions and adverts, business plans and annual reports).

  1. Guidance in measurement for improvement and data analysis 

Sites are supported by data analysts to identify key measurements for local improvement and how to efficiently collect and present patient reported, clinician reported and process-related measures such as length of stay and readmission rates.

So far, thirteen NHS Trusts across England and Wales have completed the programme since June 2021, embedding new or expanded POPS services into their pathways. Similar work is underway at international sites including Australia, Singapore and Qatar.

Why join the POPS network?

The need for cost- and clinically-effective models of care is more pressing than ever as the NHS faces Covid-19 pandemic recovery, with long waiting lists and delays to surgical treatment. Addressing this challenge requires new and innovative approaches to perioperative care.

The whole pathway approach of POPS services can help address this in a number of ways:

  • Holistic POPS clinic assessment facilitates early preoperative assessment and one stop optimisation. This reduces the need for multiple preoperative appointments and onward specialty referrals (eg anaemia clinic, GP review of hypertension) and in turn avoids the patient being on multiple waiting lists. Additionally, early medical optimisation and prehabilitation (through lifestyle modification, exercise, nutrition, and psychological preparation) reframes waiting lists as preparation lists.
  • Better optimisation reduces late cancellations of surgery and facilitates day surgery for patients who may not otherwise have been considered for day surgery.
  • Shared decision making discussions facilitated by POPS help patients to choose the care that is best for them. Following POPS clinic assessment, 1 in 7 patients opt for alternative management and to be removed from the surgical list.5 This ensures patient centred care with access to appropriate alternative treatments but also reduces unnecessary cost.
  • The POPS approach helps flow through primary, secondary and community services. Early decision making around the need for level 2 and 3 care is facilitated, and reductions are demonstrated in length of stay, readmissions and cancellations of surgery.2,6,7 Effective use of community services allows timely, safe discharge.

If your team is interested in joining the POPS Network and establishing or expanding a local service, please do get in touch:

NHS Elect - networksinfo@nhselect.org.uk

Professor Jugdeep Dhesi - jugdeep.dhesi@gstt.nhs.uk

POPS@GSTT - gst-tr.popsgstt@nhs.net

Websites:

NHS Elect -www.nhselect.nhs.uk

POPS Network website - www.popsolderpeople.org

Professor Jugdeep Dhesi - Talking about the POPS Network

References

  1. Partridge, J. S. L., Healey, A., Modarai, B., Harari, D., Martin, F. C., & Dhesi, J. K. (2021). Preoperative comprehensive geriatric assessment and optimisation prior to elective arterial vascular surgery: a health economic analysis. Age and ageing, 50(5), 1770–1777.
  2. Partridge, J. S., Harari, D., Martin, F. C., Peacock, J. L., Bell, R., Mohammed, A., & Dhesi, J. K. (2017). Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. The British journal of surgery, 104(6), 679–687.
  3. De Las Casas, R., Meilak, C., Whittle, A., Partridge, J. S. L, Adamek, J., Sadler, E., Sevdalis, N. and Dhesi, J. K. (2021) Establishing a perioperative medicine for older people undergoing surgery service for general surgical patients at a district general hospital. Clinical Medicine, 21(6), e608-e614.
  4. Joughin, A. L., Partridge, J. S. L., O'Halloran, T., & Dhesi, J. K. (2019). Where are we now in perioperative medicine? Results from a repeated UK survey of geriatric medicine delivered services for older people. Age and ageing, 48 (3), 458–462.
  5. Shahab, R., Lochrie, N., Moppett, I. K., Dasgupta, P., Partridge, J. S. L. and Dhesi, J.K. (2022) A description of interventions prompted by preoperative comprehensive geriatric assessment and optimization in older elective noncardiac surgical patients. J Am Med Dir Assoc, 23(12), 1948-1954.
  6. Braude P, Goodman A, Elias T, et al. Evaluation and establishment of a ward-based geriatric liaison service for older urological surgical patients: POPS-Urology (Proactive Care of Older People Undergoing Surgery). BJU Int 2017;120:123-129.
  7. Partridge J S, Moonesinghe S R, Lees N and Dhesi J K. Perioperative care for older people. Age Ageing 2022;51:afac194