Mubeena Mistry, BSc(HON)1, Camilla L. Wong, MD, MHSc2,3, Sarah Wei-Ping Chan, MD4, Daniel I. McIsaac, MD, MPH5, Rachel G. Khadaroo, MD, PhD6, Bonnie Cheung, MD1
1Temerty Faculty of Medicine, University of Toronto, Toronto
2Department of Medicine, Temerty Faculty of Medicine, University of Toronto, ON
3Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON
4Faculty of Medicine, University of Ottawa, Ottawa, ON
5Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON
6Department of Surgery, University of Alberta, Edmonton, AB, Canada
DOI: https://doi.org/10.5770/cgj.26.673
ABSTRACT
Background
Best practice recommendations support the implementation of perioperative geriatric care models that tailor to the specific needs of older adults undergoing surgery. The objective of this study was to describe the current proactive perioperative geriatric programs and pathways in Canadian hospitals.
Methods
A survey of geriatricians, surgeons, and anesthesiologists practicing in Canada combined with phone interviews of a subset of participants were used to determine characteristics of perioperative geriatric pathways or programs including eligibility, team composition, and intervention elements.
Results
Analysis of 132 survey respondents and 24 interviews showed 47% (40 out of 85) of hospitals described had elements of a perioperative geriatrics program and 20% had two or more elements. Eleven themes emerged including: how perioperative geriatric care programs built geriatric competencies in other health-care providers; geriatric assessment identified risks not captured in standard perioperative risk assessment; perceived value for patients and the health-care team; delirium prevention was addressed; most programs were reactive; most programs were informal; virtual care may be used to meet demand; successful implementation required system buy-in with collaboration across subspecialties; mechanisms to drive improvement were accountability and data evaluation; few clinicians with geriatric expertise; and other priorities limited program implementation.
Conclusions
There were few hospitals in Canada with perioperative geriatric care models and even fewer with elements spanning the entire perioperative pathway. Strengths, weaknesses, opportunities, and threats to inform the implementation and sustainability of perioperative geriatric care in the Canadian context were identified in this national environmental scan.
Key words: perioperative, geriatrics, survey
The rate of aging worldwide is increasing.(1) Canada will soon become a “super-aged” society, with more than 20% of its population over the age of 65 by 2024.(2) The average patient undergoing elective and emergency surgery has become older and more likely to live with frailty over time.(3) However, older patients living with frailty experience more adverse post-operative outcomes, with odds ratios ranging from 1.5 to 4.8 compared with younger patients.(4,5) Multiple factors underlie this age-related risk. Patient-level factors include physiological changes of aging, multi-morbidity, and frailty and other geriatric syndromes.(5–8) System factors also contribute, as traditional reactive models of surgical care may not be tailored to deliver for older adults.(9) Very few ‘whole-pathway’ approaches to older age-friendly surgical care, that is, multicomponent and multidisciplinary intervention with integration across community and social care that starts preoperatively and continues through to proactive discharge planning with follow-up services, have been implemented.(10,11)
Comprehensive geriatric assessment (CGA) is the cornerstone of geriatric medicine that is a multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s medical, psychological, and functional capability in order to develop a coordinated and integrated plan for treatment and long-term follow-up.(12) A systematic review of randomized trials comparing CGA to standard care found that older people undergoing surgery who received a CGA had a lower risk of mortality and were more likely to return to their preoperative residence (RR 0.71, 95% CI 0.55 to 0.92).(13) Perioperative geriatric care models in orthopaedics, vascular surgery, urology, trauma, general surgery, cancer surgery, and spine surgery have demonstrated improved clinical outcomes, including reductions in delirium, postoperative complications, length of stay, mortality, and discharge to higher level of care.(14–19) Based on this increasing body of evidence, the American College of Surgeons has published standards for geriatric surgery which address institutional investment (securing administrative and leadership support to establish geriatric surgical care as a priority), clinical practice (shared decision making, geriatric specific assessment, interdisciplinary collaboration), and programmatic infrastructure (standardized protocols across the perioperative pathway integrated into institutional operations).(20)
The current landscape of geriatric models of perioperative care is well-described in the United Kingdom (UK) and Australasia; both regions describe an appetite for geriatric surgical care, but identify barriers including funding and workforce shortage challenges.(21,22) Conversely, there is no comprehensive data on how perioperative geriatric care is delivered in Canada. The objective of this study was to conduct a systematic national environmental scan of the presence of structured perioperative geriatric programs and pathways in hospitals across Canada. We aimed to describe current proactive perioperative geriatric programs and pathways in Canadian hospitals; eligibility criteria, components, and providers of these perioperative geriatric programs and pathways; and to provide guidance on operationalizing perioperative geriatric care in Canada. Four principles differentiate ‘proactive’ from reactive models: “1) systematic case finding, 2) early involvement, 3) focus on evidence-based strategies to prevent geriatric syndromes including delirium, falls, functional decline, incontinence, and 4) direct implementation of recommendations.”(23) To the best of our knowledge, this is first-ever data on the state of proactive perioperative geriatric models/pathways.
This study was a cross-sectional electronic survey followed by one-on-one semi-structured phone interviews for a subset of participants to provide further qualitative data regarding existing programs and pathways. This study is reported using the Checklist for Reporting Results of Internet E-Surveys (CHERRIES)(24) (Appendix A1).
Geriatricians, anesthesiologists, and general surgeons practicing in Canada who are on the email distribution lists from the Canadian Geriatrics Society, Canadian Anesthesiologists’ Society, and/or Canadian Association of General Surgery were identified. Additional physician emails were identified through public domain directories. Two reminder emails were sent at two weeks after the initial recruitment email and then at 30 days after the first reminder.(25) The survey link was also distributed via Twitter. We used snowball recruitment whereby survey respondents were encouraged to forward the survey to colleagues. Study participants were also asked to participate in a one-on-one semi-structured phone interview for more detailed qualitative data acquisition. The option to enter a draw for a gift card was used to incentivize study participation.
Development of individual questionnaire items was guided by standard methods of survey research,(26) review of best practice guidelines on perioperative geriatrics from the American College of Surgeons and American Geriatrics Society,(20) as well as similar national surveys of perioperative geriatric care models conducted in the UK and Australasia.(21,22) The final survey comprised of 24 questions exploring the existence of established pathways or programs for proactive perioperative geriatric care. If such a pathway or program existed, further information was gathered regarding hospital and province of location, type of surgery, patient eligibility criteria, program elements (an element was defined as any preoperative, intraoperative or postoperative intervention option listed in questions 11, 12, 17, 21), assessment and management stratified by stage of perioperative course (preoperative, intraoperative, postoperative), and team composition. The survey used a combination of up to 20 multiple choice and four open-ended questions. The content of the survey was peer-reviewed by geriatricians and surgeons for face validity and clarity (n = 3). Feedback from testing was used iteratively to construct the final questionnaire. Test-retest reliability was conducted by administering the final questionnaire twice at two weeks apart to three participants fulfilling the inclusion criteria, consisting of one geriatrician and two surgeons. Out of all the questions, one rater had three questions with differing responses, another rater had all the same responses, and the third rater had two questions with differing responses.
The final self-administered questionnaire (Appendix A2) was administered using Google Forms (Google Inc., Mountain View, CA) between September and December 2019. Information on study participation was presented prior to the questionnaire and consent was implied by completing the questionnaire.
A follow-up invitation was sent to those survey respondents who indicated an interest in participating in a 15-minute phone interview. A reminder email was sent two weeks after the follow-up invitation. A series of pre-planned questions were used to conduct a semi-structured interview (Appendix A3). Phone interviews were conducted, recorded, and transcribed by one of two study authors (BC and MM). If the participant reported to be working at a hospital with a structured perioperative geriatrics pathway or program, four questions exploring the pathway or program’s benefit to patients, benefit to the health-care team, areas for improvement, and details including postoperative team composition were discussed. If the participant did not work in a hospital with a pathway or program, two questions exploring potential expected benefits of establishing a pathway or program and resources needed to create a pathway or program at their hospital were discussed. Further questions were asked throughout the interview for clarification and additional details.
Multiple choice responses were reported as frequencies and proportions. In scenarios of discrepancies between respondents from the same hospital, the more inclusive response was accepted, with the recognition that one or more of the respondents from the same hospital may not have been aware of all the initiatives/protocols in place at their institution. Free text responses and verbal responses from the phone interview were transcribed and analyzed using an inductive approach to identify themes. Qualitative data were coded by key features and collated into themes using an inductive approach by two study authors (MM and CW) independently, such that themes were generated from the data rather than using a pre-existing theoretical framework, until saturation of themes was attained. Theme saturation was determined as the point at which no new themes were emerging from the interviews and agreed by both coders, setting a minimum of 17 interviews as informed by the literature.(27) Pair debriefing to check for congruence with the original data was used to minimize the influence of researcher subjectivity. Disagreements were resolved with consultation with a third study author (BC).
Themes were categorized using a SWOT (strengths, weaknesses, opportunities, threats) framework by two authors (MM and CW) independently. The SWOT framework was chosen as it helps to inform decision-making for service delivery based on internal (strengths and weaknesses) and external (opportunities and threats) factors gathered from surveys.(28) Applying the SWOT analysis traditionally used in competition and business strategy to the present study, strengths were defined as “internally-relating facets of perioperative geriatric programs/pathways lending them an advantage over other interventions,” weaknesses were defined as “internally-relating characteristics of perioperative geriatric programs/pathways which lead them to have a relative disadvantage against other alternatives,” opportunities were defined as “externally-related realities within the greater environment that can be leveraged to enable and/or promote the implementation/sustainment of perioperative geriatric programs/pathways,” and threats were defined as “externally-related realities within the greater environment which might pose as barriers to and/or hinder the implementation or sustainment of perioperative geriatrics programs/pathways”.(29) Differences in categorization of themes were resolved through discussion. The framework was used in this study to understand, analyze, and inform strategy related to perioperative geriatric models of care.
The study protocol was approved by the University of Toronto Health Sciences Research Ethics Board (Protocol #: 00038096).
There were 132 survey respondents, comprising 104 (79%) geriatricians, 14 (11%) general surgeons, 9 (7%) anaesthesiologists, and 5 (4%) ‘other’. The respondents were from 85 hospitals (15 hospitals with <200 beds) with representation from all provinces (Appendix A4). Eighty-one (61%) survey respondents reported working in an academic hospital and 70 (53%) reported working in a hospital with a geriatric-specific surgical program or care pathway. Forty of 85 (47%) hospitals had elements of a perioperative geriatric program, though 17 (20%) had two or more elements. Of the 40 hospitals with a perioperative geriatrics program or pathway, half were academic hospitals. Fifteen, five, and 30 programs targeted the pre-operative, intraoperative, and postoperative stages, respectively. Orthopedic surgery was the most common surgical service targeted (Table 1).
TABLE 1 Types of surgical services with geriatric surgical programs or pathways, by perioperative stage, in the 85 hospitals associated with survey participants
Of the 15 hospitals with a preoperative geriatric surgical program or pathway, age was the most commonly used eligibility criteria. All but one of the hospital programs with a preoperative geriatrics pathway included a geriatrician (93%) in the care delivery. Almost all of the preoperative geriatrics programs had delirium counselling (93%) and medication review (93%) as part of preoperative optimization, and used the comprehensive geriatric assessment (87%) to inform risk assessment. See Table 2 for other characteristics of preoperative geriatrics programs.
TABLE 2 Characteristics of pre-operative geriatrics programs/pathways among the 15 Canadian hospitals with pre-operative geriatrics programs/pathways
Five hospitals were described as having an intraoperative component to geriatric surgical care. Components of these intraoperative geriatric care pathways included peripheral nerve blocks, geriatric-specific management (e.g., dose-adjustments and/or drug choices), geriatric-specific IV fluid protocols, and sedation depth monitoring protocols in two, two, one, and one, programs, respectively.
Thirty hospitals were described as having a postoperative geriatrics care pathway or program, with age being the most common eligibility criteria. Common elements included the use of geriatric-specific order sets in 19 (63%), geriatric-surgery co-management models in 16 (54%), and geriatrics consultation in 15 (50%). See Table 3 for other characteristics of postoperative geriatrics programs.
TABLE 3 Characteristics of post-operative geriatrics programs/pathways among the 30 Canadian hospitals with post-operative geriatrics programs/pathways
There were six non-geriatrician respondents, for all of whom there was a geriatrician respondent from the same hospital. The non-free text answers provided by anesthesiologists and surgeons were captured by the themes from the corresponding geriatrician respondent from the same hospital. The themes in the non-free text answers were captured within the interviews.
Of the 132 survey respondents, 24 agreed to the phone interview of which 22 (92%) were geriatricians and 2 (8%) were general surgeons, with representation from all provinces except Newfoundland and Labrador, and Saskatchewan (Appendix A4). The 24 interviewees worked at 24 different hospitals, 15 (63%) of which were academic hospitals. Fourteen (59%) of the interviewees reported working at a hospital that had a geriatric-specific program or care pathway for surgical patients. Saturation of themes was achieved before the last interview. Eleven themes were identified and categorized into the SWOT analysis framework as follows (see Figure 1): four strengths, two weaknesses, three opportunities and two threats.
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FIGURE 1 Perioperative geriatric models of care in Canada
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Strengths of perioperative geriatric care programs include building geriatric competencies in other health-care providers; geriatric assessment identifies risks that are not captured in standard perioperative risk assessment; there is perceived value for patients and the health-care team; and delirium prevention is addressed. Weaknesses identified included the reactive rather than proactive nature of programs and the lack of formal program recognition. Opportunities included the identification of elements of successful implementation (system buy-in, integration, coordination across space and time, collaboration with other specialties, and partnerships), mechanisms to drive improvement (accountability, data collection, and evaluation), and leveraging virtual care to meet demand. Threats to the implementation of perioperative geriatric programs include limited clinicians with geriatric expertise—including geriatricians, but also physicians with additional training in geriatrics and/or advanced practice nurses with specialization in geriatrics—and other priorities such as the COVID-19 pandemic response.
See Table 4 for details with supportive participant quotes. Thematic analysis of the two surgeon participants overlapped with the themes identified from the geriatrician participants’ interview data.
TABLE 4 SWOT analysis of themes from phone interviews on perioperative geriatric models of care in Canada with representative quotations (n = 24)
In a national environmental scan of perioperative geriatric services in Canada, based on quantitative and qualitative methods, we found that implementation of whole pathway approaches to perioperative care for older adults(10) remains low relative to the UK and Australasia. Similar to other jurisdictions, existing perioperative geriatric care models tend to focus on orthopedic surgery and processes are structured reactively, despite impressions that proactive care may be optimal. As evidence and guidelines support perioperative models of comprehensive geriatric care, future efforts are required to develop, implement, and evaluate proactive perioperative geriatric care in Canada.
While surveys of perioperative geriatric models have been conducted in the UK and Australasia, to our knowledge no such data exist in the Canadian context. Therefore, our data provide novel insights in Canada. While we found orthopaedics to be the most common surgical discipline to incorporate geriatric pathways, the uptake in Canada appears to be comparatively lower than other countries(10) such as in Australia, where 92% of older adults with hip fracture receive a geriatric review. Canada also lags behind the National Health Service (NHS) health-care trusts in the UK where 53% of trusts provided geriatric medicine services for older surgical patients.(21) Our data are consistent with existing Canadian data using physician billing claims that demonstrate that fewer than 10% of hip fracture patients, and fewer than 3% of older elective surgery patients, receive care from a geriatrician.(30,31) A further challenge in Canada is the widening geriatrician-supply gap; using the benchmark ratio of 1.25 specialists/10,000 population over 65, there was already a shortfall of 471.7 geriatricians in 2019.(32) Similar to the UK, most models in Canada are reactive rather than proactive,(21) which is contrary to best practice recommendations that suggest geriatric-led multidisciplinary care should be initiated before surgery.(11,20)
The themes identified in this study are similar to other qualitative studies in this space. System barriers limiting clinicians with geriatric expertise and the opportunity for collaboration are themes reflected in the present Canadian study and in Australasia.(33) A similar study from the UK also evaluated their system as being reactive and cited a lack of evidence.(34) The need for proactive approaches to perioperative geriatrics and for data collection are recognized across all aforementioned jurisdictions.(33,34)
While harnessing strengths and addressing weaknesses intrinsic to perioperative geriatrics, next steps would be to leverage opportunities to implement/sustain proactive perioperative geriatric programs/pathways in Canada, in addition to mitigating threats that may pose a barrier to overall implementation success. The SWOT analysis can be applied by looking to the British Geriatrics Society’s whole pathway approach and the American College of Surgeons’ Geriatric Surgery Verification Program Standards.(20,35) Successful proactive ‘whole pathway’ perioperative geriatrics models are already implemented elsewhere, including the NHS Proactive Care of Older People undergoing Surgery (POPS) service.(35,36) POPS involves a team of geriatricians, clinical nurse specialists, and allied health and incorporates preoperative CGA and optimization, and postoperative monitoring for early detection and treatment of complications, including delirium. As perspectives from Canada align with those from other jurisdictions, adoption of international solutions including POPS may be tweaked to fit the Canadian context, leveraging opportunities for multispecialty collaboration, data collection, and adaptations based on resource and geographic constraints. This highlights the need for system leaders, health advocates, and policymakers to recognize the added value of perioperative geriatrics, potentially paving the way for a national guideline.
Limitations of this study include the large number of geriatrician respondents in both the survey and phone interviews. Surgeons and anesthesiologists who participated in the study were more likely to be interested in perioperative geriatrics. Surgeon recruitment only focused on the general surgical specialty, though perioperative geriatric care seemed most common in orthopaedics. The study only focused on proactive, and not reactive, consultation. The study was conducted only in the English language and may have under-represented the experience of Francophone jurisdictions. The environmental scan represented only the physician perspective and did not capture health system managers or patient data. Lastly, the findings may be subject to reporting bias with likely over-representation from respondents interested in or involved in perioperative geriatric care, and the extent of the response bias is uncertain given the ambiguous sampling frame.
This study defined the current landscape of perioperative geriatrics care in Canada and identified the strengths, weaknesses, opportunities, and threats to inform the elements necessary for the implementation and sustainability of perioperative geriatric care in the Canadian context. The findings are similar to those found in other international surveys of models of perioperative geriatrics care including resource allocation gap, competing clinical priorities, role of data in driving change, importance of stakeholder engagement, need for evolving from reactive to proactive care delivery, joint development by different specialties, and the integral role of the geriatrician.(10) The adoption and spread of perioperative geriatric care models can be addressed using implementation science. Next steps include the establishment of multispecialty perioperative groups to engage policy makers and managers to develop surgical systems that embrace whole pathway care for the older person undergoing surgery, including a national guideline.(32)
The authors would like to thank Drs. Sharon Straus, Tyler Chesney, Karen D’Silva, Tricia Woo, Karen Ng, Barbara Haas, Fernando Angarita, Ian Randall, and Sarah Ward for their contributions in the pilot-testing and intra-rater reliability testing of the survey.
We have read and understood the Canadian Geriatrics Journal’s policy on conflicts of interest disclosure and declare there are none.
This research did not receive external funding.
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*This work was presented in part at the 2022 Annual Scientific Meeting of the Canadian Geriatrics Society. ( Return to Text )
For this survey, the perioperative period will be divided into three distinct phases of a surgical procedure:
Preoperative phase (time from decision to pursue surgery to the beginning of the surgical procedure);
Intraoperative phase (time from the beginning of the surgical procedure to transfer to the post-anesthesia care unit);
Postoperative phase (time from end of care in the post-anesthesia care unit to discharge from hospital).
1. (G1) What is your specialty of expertise?
Geriatric Medicine
Anesthesiology
General Surgery
Orthopedic Surgery
Other (prompt free text field)
2. (G2) In which province do you practice?
Province names presented as dropdown options.
3. (G3) What is the name of the main hospital where you practice?
Free text field.
4. (G4) What city/town is your hospital located in?
Free text field.
5. (G5) In what type of hospital do you mainly practice? Definition: An academic hospital is fully affiliated with a university sharing the academic mission of conducting research, teaching and providing clinical care.
Fully academically affiliated
Community
6. (G6) Does your hospital have any geriatric-specific programs or pathways of care for surgical patients such as: geriatric-specific order sets, geriatrics-surgery co-management model, automatic referrals for geriatrics consultation, specially designed elder-friendly ward, etc?
Yes
No
Don’t know
If yes, then prompts Question 7.
If no, then proceed to Final Questions (#22–23) portion of the survey.
If don’t know, then proceed to Final Questions (#22–23) portion of the survey.
Preoperative phase (time from decision to pursue surgery to the beginning of the surgical procedure)
7. (S1) In your hospital, does a PRE-operative geriatrics program/pathway exist?
Yes
No
Don’t know
If yes, then prompts PRE-operative Questions #8–14.
If no, then prompts Question #15.
If don’t know, then prompts Question #15.
Preoperative phase: time from decision to pursue surgery to the beginning of the surgical procedure
8. (Pr1) Your hospital’s PRE-operative geriatrics/pathway program includes which types of surgery? Select all that apply. (If the PRE-operative geriatrics pathway/program only applies to a subgroup of patients within a type of surgery, provide more details under “other”).
Cardiac Surgery
General Surgery
Neurosurgery
Orthopaedic Surgery
Otolaryngology
Plastic Surgery
Trauma Service
Urology
Vascular Surgery
Don’t know
Other (prompt free text field)
9. (Pr2) Your hospital’s PRE-operative geriatrics/pathway program is delivered to what urgency of surgery?
Elective surgical patients only
Urgent/emergent surgical patients only
Both
Don’t know
10. (Pr3) Eligibility for your hospital’s PRE-operative geriatrics/pathway program is based on which of the following characteristics? Select all that apply. If not applicable, leave blank.
If responded “other” in previous question, provide additional comments here. (free text field)
11. (Pr4) What type of geriatric-specific optimization interventions are offered in your hospital’s PRE-operative geriatrics pathway/program? Select all that apply.
Delirium counseling
Medication review
Nutritional supplements
Prehabilitation program (e.g., physiotherapy program prior to surgery)
Geriatric-specific preoperative order set
Interdisciplinary case review
Automatic referral for geriatrics consultation
Don’t know
Other (prompt free text field)
12. (Pr5) In your hospital’s PRE-operative geriatrics pathway/program, how is geriatric risk determined? Select all that apply.
A frailty screening tool
A functional measure (e.g. ADLs, IADLs, Timed-Up-and-Go)
A cognitive screening tool (e.g. Mini-Cog, Mini Mental State Examination)
Comprehensive Geriatric Assessment (CGA)
None
Don’t know
Other (prompt free text field)
13. (Pr6) In your hospital’s PRE-operative geriatrics pathway/program, which of the following domains are routinely assessed? Select all that apply.
Cognitive impairment
Decision-Making Capacity
Depression
Delirium risk
Alcohol/substance misuse
Cardiac evaluation
Pulmonary evaluation
Functional status
Frailty
Nutritional status
Medication management
Don’t know
Other (prompt free text field)
14. (Pr7) Which health care providers are involved in the geriatric risk assessment and/or geriatric-specific optimization interventions in your hospital’s PRE-operative geriatrics pathway/program? Select all that apply.
Geriatrician
Anesthesiologist
Surgeon
Nurse
Physiotherapist
Occupational therapist
Dietician
Social worker
Case manager
Don’t know
Other (prompt free text field)
Intraoperative phase: time from the beginning of the surgical procedure to the transfer to the post-anesthesia care unit
15. (S2) In your hospital, does an INTRA-operative geriatrics program/pathway exist?
Yes
No
Don’t know
If yes, then prompts INTRA-operative Question #16.
If no, then prompts Question #18.
If don’t know, then prompts Question #18.
Intraoperative phase: time from the beginning of the surgical procedure to the transfer to the post-anesthesia care unit
16. (I1) Your hospital’s INTRA-operative geriatrics/pathway program includes which types of surgery? Select all that apply. (If the INTRA-operative geriatrics pathway/program only applies to a subgroup of patients within a type of surgery, provide more details under “other”).
Cardiac Surgery
General Surgery
Neurosurgery
Orthopaedic Surgery
Otolaryngology
Plastic Surgery
Trauma Service
Urology
Vascular Surgery
Don’t know
Other (free text)
17. (I2) Your hospital’s INTRA-operative geriatrics pathway/program includes which of the following elements? Select all that apply.
Peripheral nerve blocks
Geriatric-specific intravenous fluid administration (e.g. decrease in fluid administration)
Geriatric-specific management (e.g. dose or drug choice adjustments)
Additional monitoring for depth of sedation (e.g. bispectral index)
Additional blood work
Don’t know
Other (prompt free text field)
Postoperative phase: time from end of care in the post-anesthesia care unit to discharge from hospital
18. (S3) In your hospital, does a POST-operative geriatrics program/pathway exist?
Yes
No
Don’t know
If yes, then prompts POST-operative questions #19–21.
If no, then prompts Final Questions #22–23.
If don’t know, then prompts Final Questions #22–23.
Postoperative phase: time from end of care in the post-anesthesia care unit to discharge from hospital
19. (Po1) Your hospital’s POST-operative geriatrics pathway/program includes which types of surgery? Choose all that apply. (If the POST-operative geriatrics pathway/program only applies to a subgroup of patients within a type of surgery, provide more details under “other”.)
Cardiac Surgery
General Surgery
Neurosurgery
Orthopaedic Surgery
Otolaryngology
Plastic Surgery
Trauma Service
Urology
Vascular Surgery
Don’t know
Other (prompt free text field)
20. (Po2) Eligibility for your hospital’s POST-operative geriatrics pathway/program is based on which of the following characteristics? Select all that apply. If not applicable leave blank.
If responded “other” in previous question, provide additional comments here. (free text field)
21. (Po3) Your hospital’s POST-operative geriatrics pathway/program includes which of the following elements? Select all that apply. If not applicable leave blank.
22.
If responded “other” in previous question, provide additional comments here. (free text field)
23. (F1) Is there anything else you would like to tell us about your perioperative geriatrics program/pathway or geriatric resources available at your hospital for surgical patients?
Free text field.
24. (F2) We are also conducting an optional phone interview to learn more about existing structured perioperative geriatrics program/pathways. If you would like to participate, please provide your email.
Not interested.
Interested
If not interested, prompt Submit Form page.
If interested, prompt email collection page (Question #23).
25. Provide your name and email if you are interested in participating in an additional phone interview.
Name: (free text)
Email: (free text)
Thank you for filling out this survey. If you would like to enter for a chance to win a gift card, please provide your contact information at the following link. (Link here)
Hello, this is [interviewer’s name here], one of the research investigators involved in the study, “A Canadian Environmental Scan of Perioperative Geriatric Models of Care”. Since you have opted to participate in a phone interview at the end of the survey and have signed the consent form, we are calling you to conduct the interview at this time.
We would like to remind you that all of the questions are completely optional to answer and you may choose to skip questions, end the interview and/or withdraw from the study at any time. Please let me know if you have any questions or concerns before we begin.
If the participant has consented to the phone interview being recorded: Please note that this interview is being recorded for transcribing purposes only.
Q1) Do you work at a hospital with a structured perioperative geriatrics program or pathway?
If participant answers “yes” to Q1:
Q2) What benefits do you believe your hospital’s geriatrics pathway or program provide for patients?
Q3) What benefits do you believe your hospital’s geriatrics pathway or program provide for the health care team involved in the pathway or program?
Q4) What improvements can be made to your hospital’s geriatrics pathway or program?
Q5) We asked basic questions about your hospitals’ perioperative geriatrics pathway or program, are there any other details that you wanted to tell us about?
If participant answers “no” to Q1:
Q6) Do you believe your hospital would benefit from a structured perioperative geriatrics program or pathway? Why or why not?
Q7) What are the resources needed to create a structured perioperative geriatrics program or pathway at your hospital?
COPYRIGHT
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivative license (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use and distribution, provided the original work is properly cited.
Canadian Geriatrics Journal, Vol. 26, No. 3, September 2023