A survey of the workload generated by older surgical patients referred to on-call medical registrars—SNAP-3

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.