GERIATRICIAN CO-MANAGEMENT AND EDUCATION OF JUNIOR DOCTORS IMPROVE THE CARE OF HOSPITALIZED OLDER SURGICAL PATIENTS

Abstract

Abstract We evaluated changes in processes of care after the introduction of a novel model of care for older vascular surgery inpatients. This model, called Geriatrics Co-management of older vascular surgery patients (GeriCO-V) embedded a geriatrician into the vascular surgery team who provided proactive geriatrics assessment of patients and education for junior surgical doctors. A pre-post study of the GeriCO-V model comparing prospectively recruited pre-intervention (n=150) and post-intervention (n=152) cohorts of consecutively admitted vascular surgery patients aged ≥65 years at an acute care academic hospital. Education of junior surgical doctors was embedded in the new model of care and included role modelling, provision of delirium and frailty screening lanyards and mobile Apps for ‘just-in-time’ learning, and a Wiki page of tips on assessing older patients. We measured processes of care by review of medical charts. After implementing the novel geriatrician and education embedded model of care, there was a significant increase in several processes of care by the junior surgical doctor: screening for cognition (8% vs 76%, p<.001) and delirium (2% vs 69%, p<.001), documentation of functional history (34% vs 76%, p<.001), medications (53% vs 74%, p<.001) and treatment preferences (5% vs 46%, p<.001) and prescribing of pharmacological venous thromboprophylaxis (93% vs 99%, p=.03) and co-prescription of laxative with opioid (60% vs 81%, p=.002). A collaborative model of care that embeds proactive geriatrician care and education of junior surgical doctors improves the quality of care for older vascular surgical patients.