Geriatric co-management of older vascular surgical patients in hospital

Delivery of proactive comprehensive geriatric assessment and management (CGA) of patients aged 65 years and over admitted under the vascular surgery service with an expected length of stay > 2 days. The geriatrician and senior vascular nurse will work as a team to undertake CGA at admission, make management recommendations, and follow-through till hospital discharge (i.e. the intervention is delivered from admission up until hospital discharge). The geriatrician will round twice weekly and will liaise with the vascular CNC on other weekdays to implement CGA. There will be no service provision on weekends. A multidisciplinary team meeting will occur weekly with attendance by the geriatrician that focuses on discharge planning. Provision of education and training in CGA and delirium for nursing staff as part of in-service education on the ward; this will be delivered by the geriatrician, vascular clinical nurse consultant, vascular clinical nurse educator, and falls and delirium clinical nurse consultant. Patient and carer education regarding delirium and falls, and strategies to prevent these with distribution of consumer information pamphlets which are available from the Agency for Clinical Innovation. This is anticipated to be an ongoing service. Patient recruitment in the post-implementation phase will conclude after 8 months. Intervention fidelity will be assessed as the proportion of patients who received comprehensive geriatric assessment and management by the geriatrician and/or vascular CNC.