Geriatric Perioperative Service (GPS) Improves Healthcare Outcomes

Year Submitted: 2025
Published Date: 28 November 2025

Tags: Care Process ＆ Redesign, Access To Care, Readmission Rate, Quality Improvement, Clinical Practice Improvement, Workflow Redesign, Value Based Care, Length Of Stay, Patient Satisfaction

About this Content

Aims

Reduce 30-day unplanned readmission by 30% in targeted wards from Apr 2023 to Dec 2023 amongst in-patients aged 70 years and above who are planned for surgery or post-operatively, whom also are diagnosed with delirium or have prior cognitive impairment or dementia.

Background

Delirium is a common condition in elderly in perioperative care ranging from 30 -90% of patients and is associated with adverse healthcare outcomes. Perioperative management of patients with Geriatricians is an evidence-based established practice in many countries.

Methods

Develop Geriatric Perioperative service (GPS) for perioperative care which helps to optimize care for elders going for surgery in the inpatient setting. Nursing: To undergo Delirium education, training and team building (1) Didactic sessions - detect, diagnose, and manage delirium (2) VITAL-S for team building, focusing on aspects of interprofessional education and communications (3) Early education/use of the hospital-wide 4AT. (4) Early Delirium care bundle rollout in targeted wards. Doctors: Referral letter to dedicated peri-op geriatricians.

Results

Before-after analysis with matched before-intervention controls showed significant (p .05) improved (a) 90day postoperative mortality from 22.7% to 8.0% (reduce by 64.8%) and (b) 30day readmission rates from 33.3% to 14.0% (reduce by 57.8%), this is consistent with improved intermediate outcomes such as reductions in nascent acute coronary syndromes (22.7% to 6%), arrhythmias (26.7% to 12%), congestive cardiac failure (16% to 4%), urinary tract infections (17.3% to 4%).

Acceptability and patient satisfaction data are shown in the histograms and the pie charts on the right respectively and the changes are statistically significant (p.05).

Conclusion

Geriatric Perioperative Service (GPS) improves healthcare outcomes.

Lessons Learnt

Significant improvements in work process resulted in less dehydration episodes (40% to 14%), less Nil-by-mouth orders for more than 3days (42.7% to 16.0%) and less indwelling urine catheters after 3 days (66.7% - 42.0%), and non-statistically significant albeit clinically significant reductions in overall length of stay (median LOS 17days to 12.5days) as well as less severe (4) Clavien-Dindo complications (32% -18%).

Keywords

Delirium, Geriatric, Perioperative, Nursing, Healthcare Outcomes

Innovators' Details

Connect with this contributor!

Tan Boon Hian - tan.boon.hian@singhealth.com.sg

Roshan Mahesh Lalmalani - roshan.lalmalani@singhealth.com.sg

Project Attachment

1056_SKGH_NHIP_2025_Geriatric_Perioperative_Service_GPS_Improves_Healthcare_Outcomes.pdf