Example implementation problems and solutions identified through PDSA cycles
| Problems identified | Root cause | Solutions |
|---|---|---|
| Patients potentially benefitting from preoperative clinic not being referred | Initial selection of patients using frailty screening unsuccessful | Move to open access referral on basis of perceived frailty and multimorbidity |
| CNS and surgeons did not have time to screen older patients for frailty | ||
| Insufficient outpatient clinic capacity, delays in seeing patients | Increase in referrals | Liaison with outpatient lead nurse to provide clinical space for SpR to join clinic and run parallel clinic lists |
| Inadequate information sharing | Letters not reliably incorporated into paper notes in time for surgery | Clinic letters emailed to all stakeholders and uploaded to electronic database (and subsequently electronic case notes) |
| Inpatients potentially benefitting from medical review excluded by age | Junior members of the surgical team considered only older patients for inpatient review | Clearer communication of the role of service to junior surgical doctors |
| Presence at surgical induction to explain role of service | ||
| Variable attendance of junior doctors at discharge planning MDT meeting | Timing clashed with the heaviest burden of post-ward round jobs | Timing of meeting movedSenior surgical support enlisted to emphasise importance of attendance |
CNS = clinical nurse specialist; MDT = multidisciplinary team; PDSA = ‘plan, do study, act’; SpR = specialist registrar