SERVICES
Comprehensive geriatric assessment
Services
- Comprehensive geriatric assessment
- Diagnosing and managing memory disorders and dementias
- Falls risk assessment and management
- Managing complex and multiple comorbidities in the elderly
- Managing polypharmacy and medication optimisation
- Frailty assessments and management
- Peri-operative & ortho-geriatric services
General medical assessments (Physician)
Perioperative and ortho-geriatrics services
Conventionally pre-operative care is delivered by a surgical lead, with anaesthetic and nursing support. In the majority of patients after a decision to operate is made, assessment by an Anaesthetist is undertaken.
Furthermore, Surgeons may not have had training in peri-operative medicine and are therefore not familiar with evidence-based interventions to reduce peri-operative risk.
There can be a lack of emphasis on the optimisation of health and social issues in order to reduce adverse post-operative outcomes. Abnormalities found on assessment are often referred to single-organ specialists or back to primary care, which may delay surgery.
Our goal is to assist our surgical and anaesthetic colleagues to provide – coordinated, ‘patient centric’ pre-operative optimisation, post-operative medical care and discharge planning for you.
We will endeavour to do this in the following ways:
- To assess risk, optimise and manage the elective surgical patient throughout the surgical pathway.
- Risk assessment of peri-operative morbidity and mortality (including use of told and investigations as required).
- Attempt to modify risk factors which include the use of organ specific national and international guidelines.
- Medication optimisation – addressing poly pharmacy (where relevant).
- Use of inter-disciplinary and cross-specialty interventions to improve post-operative outcome.
- Clinical assessment with appropriate use of investigations and tools to preoperatively risk assess for peri-operative morbidity and mortality.
- Communication of risks with other health professionals involved and patients/relatives.
- Timely optimisation of medical co-morbid conditions (and geriatric syndromes, where relevant).
- Appropriate allocation of post-operative resources.
- Decision making regards rehabilitation, and timely and effective discharge pertinent to the surgical patient.
- Liaison with patients, Anaesthetists and Surgeons to ensure shared decision making.
- Liaison work on surgical wards in hospital – working in conjunction with the Surgeon in the post-operative journey and aid in managing post-operative medical complications (if needed, Eg. pain, constipation, nausea etc).
- Attend surgical ward multidisciplinary team meetings – liaise with physiotherapists, nurses and discharge planners to plan appropriate discharge pathways.
- Appropriate and timely communication with the GP concerned with regard to outcomes, medications changes and other issues which occur, or had occurred, during the journey.
- Peri-operative assessments (30—60mins) use the document for peri-op service that we had created to transcribe here.