scholarly journals Sustainability of a proactive geriatric trauma consultation service

2017 ◽  
Vol 60 (1) ◽  
pp. 14-18
Author(s):  
Camilla L Wong ◽  
Raghda Al Atia ◽  
Amanda McFarlan ◽  
Lee Holly Y ◽  
Valiaveettil Christina ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Eligible Patient ◽  
Case Series ◽  
Study Data ◽  
Geriatric Trauma ◽  
Referral Process ◽  
Consultation Service ◽  
Implementation Phase ◽  
Recommendation Adherence

Background: Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS. Methods: We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012–December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination. Results: Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home. Conclusion: Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence.

The role of the psycho-oncologist in the Comprehensive Geriatric Assessment (CGA)

2012 ◽  
Author(s):  
Mariarosa Mazzolini ◽  
Lucia Bazzo ◽  
Roberta Cascarilla ◽  
Annalisa Anni ◽  
Romina Spina ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment

A key role for comprehensive geriatric assessment in aortic valve replacement

2020 ◽  
Vol 13 (12) ◽  
pp. e237031
Author(s):  
Karim Hussien El-Shakankery ◽  
Luis Mieiro
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Small Vessel Disease ◽  
Postoperative Recovery ◽  
Medical Patients ◽  
Surgical Aortic Valve Replacement ◽  
Cardiac Amyloid

As our population ages, the demand for surgical services in older people is increasing exponentially. Shown to be indispensable in the care of medical patients, use of the comprehensive geriatric assessment (CGA) is also growing in the perioperative setting. We present the case of a previously independent 82-year-old man who underwent a standard preoperative assessment and surgical aortic valve replacement. In the 7 months that followed, prior to his death, he suffered a rapid functional decline contributed to by slow postoperative recovery, delirium and recurrent falls. Post-mortem revealed cardiac amyloid deposition and extensive small vessel disease in the brain. This case highlights the importance of the CGA in the perioperative management of older patients, especially in identification and optimisation of geriatric syndromes and consideration of less-invasive alternative treatments. We review the existing literature on CGA use in cardiothoracic and vascular surgical settings, drawing on experiences learnt from the above case.

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