Table 1 Geriatrics perioperative models of care that are currently being developed or implemented
From: Geriatrician perspectives on perioperative care: a qualitative study
INPATIENT MODELS OF CARE | ||||
Models of perioperative care | Setting | Referral process for geriatrician input | Leadership | Team members |
Traditional reactive model | Inpatient surgical ward | Review on request | Surgeon | Surgeon-led multidisciplinary nursing and allied health team +/− other specialist reviews as requested |
Geriatrician on the ward | Inpatient surgical ward | Geriatrician present on the ward regularly e.g. weekly ward rounds | Surgeon | Surgeon-led multidisciplinary nursing and allied health team PLUS Geriatrician and/or an aged care trained allied health professional or nurse |
Screening-based referral for Geriatrician review | Inpatient surgical ward +/− Emergency department | Non-geriatrician screens patients (e.g. frailty screening) and if specified criteria met referral made for Geriatrician review | Surgeon | Surgeon-led multidisciplinary nursing and allied health team PLUS Screening by nurse/allied health professional/anaesthetist +/− Geriatrician review if screening criteria met |
Proactive case-finding by Geriatrician | Inpatient surgical ward +/− Emergency department | Geriatrician or aged care nurse attends ED, board meetings or case conferences to identify patients for Geriatrician review | Surgeon | Surgeon-led multidisciplinary nursing and allied health team +/− Geriatrician and/or aged care nurse review |
Geriatrician Co-management | Inpatient surgical ward | Blanket referral and involvement from admission to discharge | Surgeon and Geriatrician | Surgeon and Geriatrician Co-management within a shared multidisciplinary team |
OUTPATIENT MODELS OF CARE | ||||
Models of perioperative care | Setting | Referral process for geriatrician input | Leadership | Team members |
Traditional reactive model | Outpatient preadmission clinic | Non existent | Surgeon and/or Anaesthetist | Surgeon, anaesthetist and clinic nurse |
Screening-based referral for Geriatrician review | Outpatient preadmission clinic +/− Inpatient surgical ward | Anaesthetist screens patients (e.g. frailty screening or presence of multimorbidity) and if specified criteria met referral made for Geriatrician review | Anaesthetist | Surgeon, anaesthetist and clinic nurse +/− Geriatrician and/or Aged Care nurse preoperative clinic review +/− Geriatrician and/or Aged Care nurse postoperative review on the ward |
Joint preoperative clinic | Outpatient preoperative clinic +/− Inpatient surgical ward | Blanket referral | Geriatrician and Surgeon/Anaesthetist | Surgeon, geriatrician, anaesthetist and clinic nurse +/− Geriatrician postoperative review on the ward |