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Inpatient geriatric consultation team investigates the big picture behind a hospital visit

Toronto, July 21, 2017

By Skaidra Puodziunas

Dr. Camilla Wong creates a mind map to visualize the big picture
Dr. Camilla Wong, a geriatrician at St. Michael’s and an inpatient geriatric consultation team member creates a mind map to visualize the “big picture” of a geriatric patient’s history. This photo was taken at the Elder’s Clinic at St. Michael’s Hospital.

When an older adult arrives in the Emergency Department with a fracture, two processes begin right away: the care team attends to the patient’s immediate needs, and the inpatient geriatric consultation team begins piecing together the root causes behind their fracture.

“We operate like private investigators, tasked with untangling and modeling complex geriatric problems, right from the start of a patient’s journey,” said Dr. Camilla Wong, a geriatrician and inpatient consultation team member at St. Michael’s.

All patients with fragility fractures are seen by the inpatient geriatric consultation team within 24 business hours of arriving in hospital. This proactive model is one of the first in Canada.

A fragility fracture is a fracture from a low-trauma fall (e.g., from standing height), usually caused by osteoporosis.

“Our approach is comprehensive and holistic,” said Dr. Wong. “We consult with the patient, their family and family doctor to understand the bigger picture. We want to get to the root cause of a fracture quickly and prevent common geriatric health issues from developing such as delirium. Then we present this information to the patient’s support teams, from orthopedics to anesthesia to allied health.”

Root causes could include underlying health or social issues.

Did you know?
St. Michael’s staff and physicians’ teamwork and commitment to quality improvement and best practices have led to great outcomes for our patients with hip fractures. Watch this video to learn more.

“The goal is to understand as quickly as possible what medical strategies and social services will need to be built into the patient’s care plan,” said Dr. Wong.

Research evidence has shown that this proactive geriatric model can significantly improve patient outcomes after a fragility fracture, including reduction in mortality and length of stay.

“This model of involving geriatric consultation teams from the start has now been adopted by other hospitals across the GTA and we hope this trend grows,” said Dr. Wong.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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