We provide care for older patients at risk of poorer recovery from surgery due to frailty, multiple medical issues, cognitive and functional impairment.
- Comprehensive assessment of older patients considering surgery
- Risk assessment, shared decision-making, perioperative goals of care discussion
What we do
We provide comprehensive preoperative assessment and management for older patients considering surgery. We are also called POPS.
We care for older patients who are in hospital or are coming to hospital for surgical treatment. Our role includes:
- Assessment of geriatric syndromes
- Optimisation of medical issues
- Perioperative risk assessment
- Shared decision-making
- Discussing perioperative goals of care with patients
Patients who undergo surgery receive a postoperative medical review to try to reduce the risk of postoperative complications and to support discharge planning.
Who can use our service
The following people can use our service:
- Older patients considering surgery who have geriatric syndromes, increased perioperative risk or are thought to benefit from geriatrician review can be referred to the POPS Clinic.
- Older surgical patients from all subspecialty disciplines, including some patients considering cardiology procedures.
Most patients are aged above 65 years, however we can also see younger patients with geriatric syndromes.
|Perioperative Care of Older Patients Undergoing Surgery Clinic
|The RMH Parkville
Direct Access Unit
We accept GP and specialist referrals:
- Use the RMH Community Services Referral Form, the RMH GP Referral Form or a template from your own system
- Complete and fax your referral to Direct Access Unit on (03) 8387 2217
DAU welcomes phone enquiries. Contact us on (03) 8387 2333 to discuss potential or existing referrals.
Referrals should include:
- Relevant clinical history
- Reason for referral
- Patient details including address, date of birth and contact phone numbers
- Your details and provider number
- Name of the consultant (for Medicare clinics)
- Investigation reports related to the referral
Referrals are triaged based on priority. In an emergency, patients can go to the Emergency & Trauma Service at any time.
For advice, urgent referrals and out of hours support, call The RMH Switchboard on (03) 9342 7000 to page our registrar on call.
Some examples of patient characteristics which may prompt a referral to our service include:
- People living with frailty (for example, clinical frailty score ≥ 5)
- People with multiple medical issues and/or polypharmacy
- People residing in a residential aged care facility
- People with dementia or a past history of delirium
- People who are functionally impaired, disabled or require assistance for everyday activities
- People who are uncertain whether to pursue surgery
- Anyone thought to benefit from geriatrician review
HealthPathways Melbourne provides guidance on best practice assessment and management of common medical conditions, including when and where to refer patients.
Parkville Connect is a secure web-based portal providing GPs, specialists and other health professionals with information in the Parkville electronic medical record (EMR).
POPS Clinic overview
Patients attending the POPS Clinic receive a one-hour or longer comprehensive assessment by a geriatrician, anaesthetist and physiotherapist.
A portion of patients may subsequently return for POPS review – for example, for ongoing assessment, review of investigations or planning perioperative goals of care.
Components of the POPS comprehensive geriatric assessment may include and are not limited to:
- Medical history with focus on active issues and conditions associated with increased perioperative risk
- Screening for geriatric syndromes (such as memory, mood, nutrition, continence, falls)
- Social history
- Functional assessment
- Anaesthetic assessment
- Perioperative risk assessment
- Shared decision-making
- Perioperative goals of care discussion and planning
- Preoperative optimisation and planning
- Patient and carer education – for example, delirium, deprescribing, health issues such as smoking cessation, appointing medical treatment decision-maker
We spend time identifying patient values, goals and expectations. This informs important shared decision-making discussion whereby the benefits, risks and alternatives to surgery can be openly considered.
Where a non-surgical management strategy is decided on, POPS can make suggestions and/or link patients with appropriate support services.
For those who pursue surgery, the preoperative period is frequently an opportune time to improve overall health in an effort to improve postoperative recovery. For example, many older people may benefit from individually-tailored prehabilitation strategies.
Following surgery, the POPS inpatient team provide medical review geared towards the prevention and management of postoperative medical issues, assistance with acute recovery and discharge planning.
What to bring
Every time you come
Every time you come in for a test, day procedure, surgery or treatment, you should bring:
- Medicare card
- Health Care card (if you have one)
- Concession card (if you have one)
- Adverse drug alert card (if you have one)
- Medications you are currently taking, including any that you have bought without a prescription
- X-ray films, scans, ultrasounds or any other test results you have which are related to your procedure
- Private health insurance card (if you want to use it)
- Aids (glasses, hearing aid, walking frame)
For a clinic appointment
If you come for a clinic appointment, you should also bring:
- Your appointment letter
- Any special items listed on your letter
- Your appointment book (if relevant)
- TAC or WorkCover claim number
Interpreters & cultural support
We provide qualified, professional interpreters to help you communicate with us at any time during your stay and at your clinic appointments.
- Μάθετε περισότερα γιά διερμηνείς & υποστήριξη κουλτούρας
- Scopri di più sugli interpreti e sul supporto culturale
- Tercümanlar ve kültürel destek hakkında daha fazla bilgi edinmek için
- Tìm hiểu thêm về thông dịch viên và hỗ trợ văn hóa
- لمزيدٍ من المعلومات عن خدمة الترجمة الشفهية والخدمات الثقافية
What will happen at the clinic?
At the POPS Clinic we will:
- Ask questions about your health issues, values and goals
- Assess different parts of your health including your memory and function
- Have a detailed discussion surrounding your specific benefits and risks of surgery - this is called ‘shared decision-making’
- Discuss your wishes while receiving care in hospital - this is called ‘goals of care’
We may make recommendations about your health issues and improving your health and function leading up to surgery.
Some patients who attend the POPS Clinic decide the risks outweigh the benefits of surgery. If this occurs, we can make an alternate plan.
Who is involved in a patient's care?
At the clinic, patients may see several health professionals, including:
Robert Campbell Wing (Building 17)
34-54 Poplar Rd, Parkville, Victoria