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IntroductionOlder patients undergoing cancer surgery are at increased risk of post-operative complications, prolonged hospital stay, and mortality. Identification of frailty can help predict patients at high risk of peri-operative complications and allow a collaborative, multidisciplinary team approach to their care. A survey was conducted to assess the confidence and knowledge of trainees in obstetrics and gynecology regarding identification and management of peri-operative issues encountered in frail gynecological oncology patients.MethodsA web-based survey was distributed via the Audit and Research in Gynaecological Oncology (ARGO) collaborative and UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) . The survey on the management of frail peri-operative patients was disseminated to doctors-in-training (trainees) working in obstetrics and gynecology in the United Kingdom (UK) and Ireland. Specialty (ST1–7), subspecialty, and general practice trainees, non-training grade doctors, and foundation year doctors currently working in obstetrics and gynecology were eligible. Consultants were excluded. Study data were collected using REDCAP software hosted at the University of Manchester. Responses were collected over a 6-week period between January and February 2020.ResultsOf the 666 trainees who participated, 67% (425/666) reported inadequate training in peri-operative management of frail patients. Validated frailty assessment tools were used by only 9% (59/638) of trainees and less than 1% (4/613) were able to correctly identify all the diagnostic features of frailty. Common misconceptions included the use of chronological age and gender in frailty assessments. The majority of trainees (76.5%, 448/586) correctly answered a series of questions relating to mental capacity; however, only 6% (36/606) were able to correctly identify all three diagnostic features of delirium. A total of 87% (495/571) of trainees supported closer collaboration with geriatricians and a multidisciplinary approach.ConclusionsObstetrics and gynecology trainees reported inadequate training in the peri-operative care of frail gynecological oncology patients, and overwhelmingly favored input from geriatricians. Routine use of validated frailty assessment tools may aid diagnosis of frailty in the peri-operative setting. There is an unmet need for formal education in the management of frail surgical patients within the UK and Irish obstetrics and gynecology curriculum.

Introduction Sepsis is the leading cause of direct maternal mortality, resulting in 27 deaths in the UK between 2006 and 2008:1 in 70% of these cases, CMACE identified substandard care.1 The Surviving Sepsis campaign supports early recognition and treatment of sepsis, and improved survival by implementing six evidence based management steps in non-pregnant populations.2 However, this is not widely used in obstetric care. We aimed to develop and implement a tool utilizing the physiological and biochemical parameters of pregnancy, whilst identifying the clinical features that should raise suspicion of sepsis in this vulnerable group of patients. Methods Using a trust-wide Sepsis Screening tool, we developed a maternity specific tool. We implemented this throughout our department, and refined it using Plan-Do-Study-Act (PDSA) cycles. Multi-professional education sessions were provided, underlining the importance of prompt management. A retrospective monitoring checklist was devised to audit compliance. Results Initiation of the bundle between November 2012 and November 2013, improved from 38.5% (5/13 patients) to 100% (13/13 patients). At the beginning of the study only 1/5 women (20%) received the complete bundle within 1 h1 hour, compared to 9/13 (69.2%) in November 2013. Conclusion The use of a maternity specific sepsis tool prompts early recognition and treatment. We believe our proforma, and ongoing monitoring tool, has raised the profile and awareness of sepsis within our department, resulting in a reduction in time for instigation of the complete bundle. This should result in a reduction in morbidity and mortality in the pregnant population. References Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the UK. BJOG 2011;118 (Suppl. 1):1–203 Society of Critical Care Medicine. Surviving Sepsis Campaign. [Online] Available from: [Accessed 10thJanuary 2014]

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