Assess the staggered implementation of a permanent surgical geriatric service embedded within emergency and surgery.

The intervention phase involves implementing a Geriatric Perioperative Care Service (GPS) at John Hunter Hospital to enhance the care of older surgical patients through proactive, integrated geriatric consultation. Unlike the current reactive care model, where general medical or geriatric consultation is ad hoc and based on surgical team referrals, the GPS offers systematic and early involvement of a geriatrician and a Clinical Nurse Consultant (CNC). Patients aged 75 or older (55+ for Aboriginal or Torres Strait Islander individuals) and those with an expected hospital stay of more than 48 hours will be automatically reviewed. Those aged 65-74 (45-54 if Aboriginal or Torres Strait Islander) will either be referred by the surgical team or proactively screened by the geriatrics team. Elective surgical patients at high risk will be identified in the perioperative clinic for preoperative optimization. The GPS team will provide daily rounds and aim to review eligible patients within 24 to 72hours of admission. They will conduct a Comprehensive Geriatric Assessment (CGA) to address comorbidities, medications, frailty, and postoperative risks. The geriatric team will collaborate with the surgical team, which remains in charge of major treatment decisions, but the GPS will assist in managing geriatric syndromes, facilitating shared decision-making, discharge planning, and coordinating with other medical services. Staffing will include geriatricians and CNCs, and research staff will oversee data collection for the study. The staggered implementation trial will start with Emergency general surgery and eventually extend to other departments like elective general surgery, vascular, and urology. After the trial, the GPS will continue as a permanent service, though data collection will cease. The trial aims to assess health service delivery, implementation outcomes, and patient-related outcomes, contributing to the evidence for future geriatric perioperative care models. The frequency pf the intervention, provided by the embedded Geriatrician/ Clinical Nurse Consultant (GPS), will be a proactive co-management service with daily rounds from Monday to Friday and availability for review within 0800 to 1630. Strategies applied for adherence to the intervention are outlined in the design. Proactive screening by the geriatrics team, geriatrician review and screening in perioperative clinic, and dedicated research staff will be used to identify patients. Operating lists, electronic records and admission lists will be utilised. Data will be collected over 3 time-periods: 6-months prior to service implementation (baseline period); during a 6-month period of active service implementation (intervention phase) and the following 6-months of sustained service but without active attention to implementation (sustained phase).