A survey of the workload generated by older surgical patients referred to on-call medical registrars—SNAP-3
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Older surgical patients who develop medical problems are commonly referred to medical teams, which can be proactive physician-led teams or through reactive referral to the on-call medical registrar.
Methods
A cross-sectional survey of on-call medical registrars who received referrals from surgical teams was conducted in March–June 2022 at 140 NHS hospitals. It focused on the workload derived from referrals of older surgical patients to on-call medical registrars, excluding referrals to existing services such as perioperative medicine, orthogeriatric, or medical specialty teams. To minimise recall bias, completion of the survey was encouraged regardless of whether a registrar had received a referral. The aim of this survey was to estimate the unplanned, acute workload generated by older surgical patients requiring referral to on-call medical registrars. The survey also aimed to estimate the prevalence and nature of training in perioperative medicine amongst medical registrars.
Results
During an on-call shift, 41.3% (266/644) of medical registrars received at least one referral regarding an older surgical patient. The commonest indications were arrhythmia, acute respiratory problems, electrolyte abnormalities, suspected myocardial infarction, sepsis, and delirium. Three-quarters of registrars reported not receiving training in perioperative management of older patients.
Conclusions
The findings highlight the significant workload and training gaps faced by medical registrars in managing older surgical patients. Bridging the gap between national recommendations and local services may reduce demands on on-call registrars and improve care.
Older surgical patients who develop medical problems are commonly referred to medical teams, which can be proactive physician-led teams or through reactive referral to the on-call medical registrar.
Methods
A cross-sectional survey of on-call medical registrars who received referrals from surgical teams was conducted in March–June 2022 at 140 NHS hospitals. It focused on the workload derived from referrals of older surgical patients to on-call medical registrars, excluding referrals to existing services such as perioperative medicine, orthogeriatric, or medical specialty teams. To minimise recall bias, completion of the survey was encouraged regardless of whether a registrar had received a referral. The aim of this survey was to estimate the unplanned, acute workload generated by older surgical patients requiring referral to on-call medical registrars. The survey also aimed to estimate the prevalence and nature of training in perioperative medicine amongst medical registrars.
Results
During an on-call shift, 41.3% (266/644) of medical registrars received at least one referral regarding an older surgical patient. The commonest indications were arrhythmia, acute respiratory problems, electrolyte abnormalities, suspected myocardial infarction, sepsis, and delirium. Three-quarters of registrars reported not receiving training in perioperative management of older patients.
Conclusions
The findings highlight the significant workload and training gaps faced by medical registrars in managing older surgical patients. Bridging the gap between national recommendations and local services may reduce demands on on-call registrars and improve care.
Date Issued
2025-09-01
Date Acceptance
2025-02-17
Citation
BJA Open, 2025, 15
ISSN
2772-6096
Publisher
Elsevier BV
Journal / Book Title
BJA Open
Volume
15
Copyright Statement
© 2025 The Authors. Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). For Permissions, please email: permissions@elsevier.com
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41049423
PII: S2772-6096(25)00018-8
Subjects
ageing
and services
geriatric
geriatric medicine
health service
health services research
healthcare facilities
internal medicine
manpower
perioperative care
surgery
Publication Status
Published
Coverage Spatial
England
Article Number
100394
Date Publish Online
2025-05-19