A quality improvement initiative utilising digital questionnaires to identify people living with frailty on general surgical waiting lists

Background: Patients living with frailty have an increased vulnerability to external stressors and experience worse outcomes from surgery compared to older individuals without frailty syndromes. Routine frailty screening is recommended at point of referral to surgical pathways but is not standard practice. This can make identifying people living with frailty a challenge whilst lengthy waiting lists can mean people become increasingly frail while waiting. Our aim was to trial a digital questionnaire for people to self-screen for frailty to allow early intervention.

Approach: In SBUHB, a digital questionnaire was developed in collaboration with the Rockwood Clinical Frailty Score (CFS). Using a digital platform, Promptly Collect, all individuals >65 years old on general surgical waiting lists in October 2024 were contacted. Patients selected their own frailty score based on a modified CFS as well as a Comprehensive Risk Assessment and Needs Evaluation (CRANE) and were rated red, amber or green on a digital dashboard.

 

To alleviate digital bias patients were contacted via telephone if unable to complete digitally. Patients living with frailty could then be seen in a Geriatrician led perioperative frailty clinic, allowing for early identification of frailty, optimisation and shared decision making.

 

Results: A total of 58.2% responded on the online platform. Previous telephone contacts took on average 20 minutes per patient, where patients were able to complete digitally this took an average of 3 minutes to review. Time savings equated to 125.56 hours which is a significant cost saving. Increasing efficiency of the service allows a far larger number of patients to be contacted and a more equitable service.

 

Of those that responded to the satisfaction questionnaire, 88.8% strongly or mostly agreed that the questionnaire was easy to complete and 84.6% strongly or mostly agreed they would be satisfied using digital questionnaires as part of future routine care. The total respondents identifying themselves with a CFS ≥5 was 26.2%. This is a significant proportion of the surgical waiting list.

 

 

Implications: These findings demonstrate the promising potential for the use of digital questionnaires to screen perioperative patients for frailty. It highlights a means of identifying those individuals that would benefit from early optimisation and planning, including comprehensive geriatric review, in a way that is both time and cost effective.