Collaboration between geriatricians and general surgeons

The operation over ten years of a simple and practical method of collaboration between general surgeons and geriatricians is described. This was designed, by means of a weekly ward round by geriatricians and consultant surgeons on general surgical wards (120 beds), to give geriatric medical advice and, when appropriate, to arrange transfer for geriatric assessment, medical treatment and rehabilitation, long-term care, or terminal care. Some 240 such transfers are described, comprising approximately 2% of all patients over the age of 65 admitted to the surgical units. The commonest single surgical diagnosis was of malignant disease. A total of 43% had had no operation and 18% had no medical diagnosis. 64% of those transferred for assessment etc. went home, half of them within two weeks, but nearly a third of them after more than four weeks. The system was effective, and benefited both surgeons and geriatricians, at no cost to the former and little to the latter in terms of time or increase in work load.