Vasculogeriatrics: embracing shared care with our colleagues in geriatric medicine should not be a threat

• DOI: 10.1111/ans.17785
• Publication Date: 2022-09-13T06:30:51Z
• Authors: Shirley Jansen; Christopher Wilson; Emily Jasper; Kien Chan
• Keywords: Geriatric Care

Devas and colleagues are credited with pioneering orthogeriatric care in the 1950s Hastings, United Kingdom.1 He described need to carefully consider all patient's circumstances when planning their care.2 This approach remains highly relevant 70 years on. Shared models of now well recognized specialties like orthopaedics where benefits mortality, morbidity reduced length stay have been shown mainly hip fracture surgery.3-8 Other disciplines slow replicating this model, perhaps due lack evidence across other procedures, conflicting demands, funding barriers or perhaps, a perceived threat loss control over perioperative care. Reluctance may also stem from prying eyes physician into our decision making outcomes, possibly anticipating delays surgery medical incursions. Perhaps it is simply understanding possible frameworks potential gains? We were offered chance emulate orthopaedic model similar initiative at Sir Charles Gairdner Hospital Perth 2014, securing for 0.1 FTE consultant geriatrics 0.4 geriatric registrar, equating one led ward round per week weekday rounds by registrar.8 Over time, has evolved twice-weekly geriatrician registrar support 6 days week. Whilst did involve vascular juniors, took place after early morning surgical so as not interfere patient flow, theatre discharge deadlines. The juniors quick express appreciation slower paced opportunity learn medicine pertains elderly, frail co-morbid—a skill base essential many career pathways. surprise came team who astonished that we had routinely managing some highest risk patients hospital years. One major hurdles prior service, was facilitating transfer frail, co-morbid an appropriate downstream facility rehabilitation ongoing rapidly appreciate expertise expediting optimisation discharges rather than weeks. Having ‘in-house’ created further time savings within stay, including reduction number specialty consultations required. With helping manage period, there requirement external advice consequent delay. helped reduce further, enabling us admit higher volumes urgent problems through limited beds any time.9 ability geriatricians documented.3, 10, 11 In surgery, catheter-based interventions norm endovascular possibilities ever-expanding, regularly faced risk/benefit judgement calls. involvement prognostication complex facing intervention become valuable assisting best decisions patients. Although centres Physician- assisted input, Geriatricians expert cognitive impairment dementia improving quality these patients.12, 13 include centred improvements management syndromes (such delirium, frailty polypharmacy), enhanced communication patients, relatives allied health outside fast- round.10, 14-17 An unexpected gain emergence productive research group involving geriatrics, anaesthesia, renal medicine, podiatry nursing. delivered several QI projects, student projects audits. Outcomes changes unit practice, example use myocardial perfusion scans preoperative assessment, increased iron transfusion measurement sarcopenia, presented meetings. delivery engagement motivated individuals change can be exponentially beneficial unit. It satisfying see come away knowledge collaborations this, presentation paper two. As population ages conditions such diabetes obesity increase, procedural cohorts will only get higher. By sharing goals perspective experts mitigate streamline flow without compromising way work, personal preferences, schedules control.18-20 clear benefit shared geriatricians, reported outcomes strengthen case aside cost-effectiveness life greater importance quantity. practical implementation could provide framework units wish work together way. Emily Jasper: Writing – review editing. Kien Chan: Conceptualization; supervision; validation; writing Shirley Jansen: project administration; original draft; Christopher Wilson: Open access publishing facilitated Curtin University, part Wiley - University agreement via Council Australian Librarians.