Rajni Lal

Geriatrician | Periop Care Physician | POPS | ANZCA POM geriatric rep| Shared Decision Making | Frailty | Social prescribing 💪🏽

[Rajni Lal @SDM_doc]

@GongGasGirl That’s a winner! LoveSydney

[Australian & New Zealand Hip Fracture Registry @ANZHFR]

⏱️ Time to surgery matters — and this study proves it.

In Chile’s public health system, a new protocol for immediate admission to surgical hospitals after a hip fracture cut time to surgery by 5 days.

Why does that matter?
🔹 Faster surgery = less time spent in hospital beds
🔹 21% drop in total hospital stay
🔹 70% reduction in direct hospital costs
🔹 Fewer risky transfers between hospitals

By prioritising fast-track surgical care and recovery times, overall patient outcomes can be significantly improved.

🔗 Read more: https://t.co/1v5ZgzmBDp

#ANZHFR #HipFractureCare

[Alasdair MacLullich @A_MacLullich]

Infographic on #delirium prevention and management from the American College of Chest Physicians

[JAGS @AGSJournal]

Deprescribing of sedatives was associated with a 62% reduction in odds of an adverse drug event, whereas new sedative use at discharge was associated with an increased risk of falls. #geriatrics https://t.co/zaSPmn3cjR

[Centre for Perioperative Care @CPOC_News]

At our CPOC Advisory Group Webinar CPOC Deputy Director @scarlettmcnally reinforces the clear evidence for perioperative care.

➡️Preoperative optimisation reduces complications by up 50%
➡️ 3% of patients account for 45% of hospital costs
➡️12% of operations have complications

[JAGS @AGSJournal]

Frailty Matters—Why Isn't It Guiding Clinical Decisions? #geriatrics https://t.co/ph4OQq1gPY

[Alasdair MacLullich @A_MacLullich]

New Research: Delirium in Hip Fracture Patients Associated with Doubled Mortality Risk

I'm pleased to share our new study on delirium and hip fracture, led by @rosespenfold.

91% of all hip fracture patients attending Scottish hospitals had a 4AT delirium assessment tool performed at presentation (N=16,476 ). N=3,386 (21%) had delirium.

Key findings:
- Delirium was associated with important adverse outcomes including 2-fold higher mortality risks as an inpatient and at one year, and a lower likelihood of returning home following hospital admission.

Key implications:
- Delirium assessment on initial presentation is feasible at national scale.
- Delirium assessment should be performed on presentation of hip fracture.
- Hip fracture care without delirium assessment is deficient care.

***Background***
Previous studies have focused primarily on postoperative delirium. This is the first large scale study using routine data to examine delirium ascertained directly with a real-time clinical assessment at the time of hospital admission.

***Methods***
We analysed data from the Scottish Hip Fracture Audit, which covers over 99% of people aged 50+ years hospitalized with acute hip fracture in Scotland.

Delirium assessment: 4AT (https://t.co/XMJpy4ZmOx), which is embedded into routine care and performed by clinical staff.

***Results***
Delirium was present 21% of patients.

Patients with delirium were older (mean age 85 vs. 78 years), more likely to be in care homes, and had higher ASA grades.

After adjusting for age, sex, pre-fracture residence, and ASA grade, patients with delirium had a 2-fold increased risk of inpatient mortality (adjusted OR 2.26, 95% CI 1.79 to 2.84).The same pattern was observed for one-year mortality (adjusted OR 2.05, 95% CI 1.83 to 2.29).

Patients with delirium were less likely to return to their original residence within 30 days (adjusted OR 0.27, 95% CI 0.24 to 0.30)

***Conclusions***
Delirium at hip fracture presentation is a powerful prognostic indicator that can inform shared decision-making with patients and families. Identifying delirium early allows clinicians to address potentially reversible causes and implement appropriate management strategies. Recognition of delirium can help in planning post-acute care needs.

Another crucial implication is that we have definitively demonstrated that delirium testing using a validated tool is *feasible in routine practice* in this population.

Hip fracture patients must have delirium assessments, and these must be done pre-operatively as well as post-operatively.

***Call to action***
Let's move forward and make good delirium care the norm in hip fracture patients.

Let's make system-wide groupthink that it is okay to neglect delirium a thing of the past.

Study: https://t.co/itCy5o4zoF

#delirium #hipfracture

[Andrew Clegg @drandyclegg]

Big day today!! Our @NIHR_ARC_YH eFI2 study published in @Age_and_Ageing https://t.co/4755yBOTmJ

National implementation will support proactive care for older people to maximise independence https://t.co/NlyiE6hbi6 Fab team @AUASResearch @CAPS_UCL @LeedsBRC @HDR_UK @GeriSoc

[healthandcare.scot @hacscot]

The national rollout of specialist frailty services across all 30 of Scotland’s A&E departments is set to reduce the length of hospital stays and eventually bring down waiting lists, says Scotland’s Health Secretary.

@neilcgray @NHSResearchScot @RCollEM
https://t.co/Nh7mPaqEB7

[Rajni Lal @SDM_doc]

@MagdaSbai @GSTTnhs @POPS_GSTT Love this. All the best to @POPS_GSTT hope you win…totally deserve it.

[SipTilSend @SipTilSend]

👏🏼

[SipTilSend @SipTilSend]

Maybe you want to know more about our #siptilsend journey! Have a look at our 5 W’s! 🌍💙

[Rajni Lal @SDM_doc]

@anzsgm_poc

[Australian & New Zealand Hip Fracture Registry @ANZHFR]

🦴A new study using #ANZHFR registry data, co-authored by our very own @DrLaraHarvey, explores how different types of anaesthetics impact post-surgical delirium in older adults undergoing acute hip fracture surgery. 🏥🧠

📖 Read more: https://t.co/gwkYJ0zWya

#HipFracture #Anaesthesia #Delirium

[Rajni Lal @SDM_doc]

@drandyclegg @NIHRresearch @LeedsMedHealth @BTHFT @NIHR_ARC_YH @HDR_UK Amazing. Well done.

[Rajni Lal @SDM_doc]

Perfect! We don’t have to create our own now! Thanks so much. 💪🏽 #Prehab

[Centre for Perioperative Care @CPOC_News]

Exercising before surgery can boost recovery post op. True for everyone but particularly for older patients.

@thebodycoach Joe Wicks talks to @JKDhesi - Deputy Director of @CPOC_News - about the importance of fitness before surgery.
👇
https://t.co/Au6zlSfDtx @GeriSoc @GSTTnhs

[Rajni Lal @SDM_doc]

What an amazing week for our Periop Team @Blacktown Hosp. Team work. 💪🏽🌟 @PuneetRanote @WestSydHealth @SipTilSend @ANZCA @anzsgm_poc @DrDanetteW #Frailty#SDM @RACSurgeons @jenhelenmar

[Rajni Lal @SDM_doc]

DOACs can be safely interrupted for elective procedures without bridging. Don’t forget to resume them post-procedure! #PeriSIG24 @ANZCA @jdfvan6

[Rajni Lal @SDM_doc]

The ANZCA POM SIG kicks off tomorrow in Melb! 🚀 Incredible speakers, global insights, and big ideas to elevate periop care. Ready to be inspired! 💪🏽😎#PeriSIG24 #SDM @ANZCA @CPOC_News @anzsgm_poc @WestSydHealth @isdmsociety @PeriOpQI @DrDanetteW @jdfvan6

[Rajni Lal @SDM_doc]

Listening to ⁦@RachelMAitken⁩ talk about TOPS. Fantastic work being done at RMH. ⁦@anzsgm_poc⁩ ⁦

[National Institute for Health and Care Research @NIHRresearch]

Frailty impacts healthcare use and costs. Can we improve support and care in the community and in hospital?

🔗 Discover the latest research on this topic: https://t.co/I5PD8S5Nt6

@sheffielddoc @steesdementia @brunning_adam #NIHRevidence