Aims
At our hospital, geriatric input was limited to assessment for subacute occurring late in admission. An inpatient consult geriatric service was introduced to provide earlier geriatric involvement. This project aimed to describe the first year of implementation and explore factors influencing referral uptake using iterative Plan–Do–Study–Act (PDSA) cycles and practical challenges in embedding consult geriatrics within acute workflows.
Methods
Over 12 months (February 2025 – February 2026), an inpatient consult geriatric service staffed by a geriatrician and registrar was implemented. Multiple PDSA cycles tested referral and case-finding approaches, including open referrals, pooled screening of patients with Clinical Frailty Scale (CFS) ≥6 admitted to a medical ward, and combined clinical factors triggering referral. Service data included patient numbers (n = 402), demographics, referral timing, indications, and interventions delivered. Staff perceptions were explored via anonymous survey (response rate 7%), providing insight into referral behavior.
Results
The pooled screening model and CFS-based referral criteria were resource-intensive and difficult to operationalize, leading to discontinuation. Staff feedback was strongly positive (94% satisfaction) but referral volumes remained modest (mean 12/month). Feedback suggested that consult geriatrics was not embedded in routine workflows and easily overlooked in busy environments. Expectations that patients would transition to subacute settings for geriatric input also influenced referral behavior.
Conclusion
Implementing an inpatient consult geriatric service beyond a subacute assessment model enabled earlier geriatric input but highlighted challenges in translating perceived value into sustained referral uptake. Iterative PDSA cycles were essential in identifying ineffective strategies and refining the service within real-world constraints.