Sustainable implementation of geriatric care on non-geriatric hospital wards

Dr Katleen Fagard, geriatrician at the University Hospitals Leuven describes the development and implementation of a sustainable model for integrating geriatric care principles into non-geriatric hospital wards, based on experiences at University Hospitals Leuven. 

An initial geriatric co-management program was implemented on two cardiology wards as part of a clinical study. The intervention included systematic geriatric screening, comprehensive geriatric assessment, and tailored geriatric interventions, with the primary aim of evaluating clinical effectiveness. During the study period, implementation fidelity was high and the intervention functioned well. However, once the study ended and research-specific support structures were withdrawn, the program gradually diminished and ultimately ceased. This experience highlighted a key limitation of research-driven implementation strategies, namely their vulnerability to decline once external oversight and resources are removed.

This realisation led to the development of the G-COMAN project, which aimed to implement geriatric–surgical co-management on three surgical wards—traumatology, abdominal surgery and vascular surgery—in a sustainable manner. The central objective was to move from a reactive consultative model, in which geriatric input was provided only upon request, to a proactive and structurally embedded model of care. Responsibility for maintaining geriatric care principles was deliberately integrated into the daily routines of surgical teams, in contrast to the previous project where protocol adherence was monitored by a dedicated study nurse.

A structured and phased implementation plan was developed, consisting of preparatory pre-implementation, active implementation, and post-implementation phases at the ward level, followed by an aftercare phase focused on consolidation, continuation, and potential scaling. The entire process was documented in an implementation handbook to facilitate transparency and reproducibility. Stakeholder engagement was addressed at multiple organisational levels, including ward teams, hospital management, and supporting departments such as information technology and medical data services. A multidisciplinary project team and ward-specific implementation teams were established to guide and oversee the process.

Adequate resourcing was considered essential for success. Based on favourable outcomes from prior research, hospital leadership allocated funding for a part-time project coordinator, a geriatric project nurse, and a surgical project nurse to support implementation activities. In parallel, a bottom-up approach was adopted to ensure engagement and ownership among clinical teams. Through focus groups and structured discussions, surgical staff were encouraged to reflect on care for older patients, express local needs, and identify perceived barriers. This iterative dialogue allowed the intervention to be tailored to the specific context, population, and workflows of each ward and prevented the introduction of an overly complex or simultaneous set of changes. Instead, geriatric care topics were introduced sequentially.

To support learning and sustainability, educational and communication materials were developed, all unified by a consistent visual identity and hosted on an internal platform. Ongoing visibility and dissemination of achievements helped to embed the program within the wider organisation. Implementation progress and effectiveness were monitored using predefined process and outcome indicators, which were discussed with surgical teams during regular audit and feedback sessions every three to four months, extending beyond the formal implementation period.

The G-COMAN project demonstrates that sustainable integration of geriatric co-management into non-geriatric wards is achievable when care principles are collaboratively designed, context-sensitive, and embedded into routine clinical practice.