Background: The landscape of surgical care has evolved significantly, characterized by an increasingly elderly population with a high burden of medical comorbidities, including cardiovascular disease, diabetes, and chronic kidney failure (1). These complex patients are at an elevated risk for major adverse perioperative events, such as myocardial infarction, acute kidney injury, and delirium (2). Hospitalist comanagement has emerged as a promising strategy to mitigate these risks (3). This approach leverages the distinct expertise of hospitalists in managing acute and chronic medical conditions, aiming to provide coordinated, evidence-based care throughout the perioperative period. The adoption of this model has been particularly robust in surgical specialties that frequently treat high-risk patients, such as orthopedic surgery (notably for hip fractures) and vascular surgery. However, with the increasing age of the population, there is a developing need for hospitalist comanagement in other surgical areas.
Purpose: Our goal was to implement a comanagement program for geriatric patients admitted to the emergency general surgery service. We aimed to identify frail patients and leverage this recognition to initiate hospital medicine consultation for comanagement.
Description: We formed a multidisciplinary work group with representation from hospital medicine, emergency general surgery, nursing, pharmacy, and rehabilitation services. We implemented a frailty screening for all patients 65 and older admitted to the emergency general surgery service. After reviewing multiple frailty scoring systems, the workgroup selected the modified five-item frailty index (4) due to its ease of use in the acute setting. This frailty index was embedded in the note template as a smart text. A score of two or more on the frailty index indicates frailty and was set as the threshold for triggering a hospital medicine consult. We developed an admission order set that included a pre-selected inpatient consult to hospital medicine. The reason for this consult was automatically set to “geriatric comanagement.” Recognizing the complex needs of geriatric surgical patients, including the importance of early mobility, adequate nutrition, and collaborative discharge planning, the order set also included consults to social work, case management, physical therapy, occupational therapy, speech therapy, and a dietitian. Our multidisciplinary group is currently reviewing adverse patient outcomes, including mortalities, unplanned ICU admissions, unplanned returns to the operating room, and readmissions, to identify additional quality opportunities within our comanagement model.
Conclusions: In 2025, our hospital received the American College of Surgeons Emergency General Surgery Designation. We were the first hospital in our state and the eleventh hospital in the nation to receive this designation. During the verification process, this geriatric comanagement protocol was denoted as exemplary.