Abstract
Abstract Background Traditional consult services represent an area where the evidence-based 4Ms framework might be applied. A 4M framework Comprehensive Geriatric Assessment (CGA) consult form may help standardise the assessment of older persons outside of geriatric medicine. We aimed to incorporate a concise CGA tool based on the 4Ms within a geriatric medicine consult form. Methods Data from 100 geriatric medicine consult forms was entered onto an excel database. Each component was analysed, using descriptive statistics, for accuracy in completion, ability to contribute to referrers knowledge and a modified Delphi consensus model was used to inform the creation of a 4M framework-based concise CGA within the consult referral form. Time to completion was monitored. Results The median age of referred patients was 79 with a male:female ratio of 1:1. The average number of co-morbidities was 6, with 75% of patients having a significant vascular history, 30% a history of falls, and 16% diagnosed with delirium. 72% were on 5 or more medications. 53% had a complete Barthel index, with a median score of 12/20. What matters to the patient, clinical frailty score, mood and mental health were not well captured by the existing consult. These were incorporated, following consensus, into a ‘little g’, which takes between 4 and 15 minutes depending on user experience and patient complexity. Conclusion An evidence-based consult form, based on 4Ms, has been developed. Next steps are to introduce it to the next cohort of interns and assess efficiency and outcomes.
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