{
  "abstract": "Introduction Older patients admitted under surgical care have longer length of stay (LOS) and are at risk of functional decline, hospital-acquired complications and geriatric syndromes. Embedded specialist geriatrician models within surgical care teams can reduce length of stay and perioperative complications. Evidence gaps remain regarding the implementation of these models of care and their impact on patient outcomes. This study aims to measure hospital, patient and implementation outcomes of an embedded perioperative geriatric service in a large Australian tertiary referral hospital.Methods and analysis This hybrid type 1 effectiveness-implementation trial involves four services (emergency general, elective general, urology and vascular surgery), with a predicted reach of >2000 patients over 24 months. The intervention consists of a proactive geriatrician-led service providing a comprehensive geriatric assessment and ongoing review during the acute admission. Service evaluation will be via (1) traditional hospital outcomes (primary outcome LOS); (2) implementation outcomes; and (3) patient reported outcomes across three 6 month phases: (1) prior to service implementation; (2) during service implementation and (3) continued service but without active implementation. Data analysis will include descriptive statistics of patient demographics, clinical characteristics and implementation outcomes; cost-effectiveness; univariate and multivariate analysis of outcomes against demographic and clinical characteristics and thematic analysis of qualitative data.Ethics and dissemination This trial has been approved by the Hunter New England Research Ethics Committee (2024_ETH023259). The findings will be disseminated via peer-reviewed publications and conference presentations. The research team will facilitate adoption more broadly within the health service.Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12625000404426)",
  "authors": [
    {
      "affiliations": [
        "John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia",
        "School of Medicine and Public Health, The University of Newcastle Australia, Newcastle, New South Wales, Australia",
        "Hunter Medical Research Institute, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia"
      ],
      "name": "Clarissa Sagi"
    },
    {
      "affiliations": [
        "John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia",
        "School of Medicine and Public Health, The University of Newcastle Australia, Newcastle, New South Wales, Australia",
        "Hunter Medical Research Institute, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia"
      ],
      "name": "Henry Logan"
    },
    {
      "affiliations": [
        "John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia",
        "School of Medicine and Public Health, The University of Newcastle Australia, Newcastle, New South Wales, Australia",
        "Hunter Medical Research Institute, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia"
      ],
      "name": "Erica Epstein"
    },
    {
      "affiliations": [
        "School of Medicine and Public Health, The University of Newcastle Australia, Newcastle, New South Wales, Australia",
        "Hunter Medical Research Institute, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia"
      ],
      "name": "Elizabeth Holliday"
    },
    {
      "affiliations": [
        "John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia",
        "School of Medicine and Public Health, The University of Newcastle Australia, Newcastle, New South Wales, Australia",
        "Hunter Medical Research Institute, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia"
      ],
      "name": "Stephen Ridley Smith"
    },
    {
      "affiliations": [
        "John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia",
        "School of Medicine and Public Health, The University of Newcastle Australia, Newcastle, New South Wales, Australia",
        "Hunter Medical Research Institute, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia"
      ],
      "name": "Jenny Mackney"
    },
    {
      "affiliations": [
        "School of Medicine and Public Health, The University of Newcastle Australia, Newcastle, New South Wales, Australia",
        "Hunter Medical Research Institute, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia"
      ],
      "name": "Christine L Paul"
    },
    {
      "affiliations": [
        "Hunter Medical Research Institute, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia"
      ],
      "name": "Suzanne Clark-Pitrolo"
    },
    {
      "affiliations": [
        "John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia"
      ],
      "name": "Donna Gillies"
    },
    {
      "affiliations": [
        "John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia",
        "School of Medicine and Public Health, The University of Newcastle Australia, Newcastle, New South Wales, Australia",
        "Hunter Medical Research Institute, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia"
      ],
      "name": "Christine J O’Neill"
    }
  ],
  "title": "Better outcomes for the older surgical patient trial (BOOST): protocol for a hybrid type 1 effectiveness-implementation trial of an embedded geriatric perioperative service within emergency and elective surgery in an Australian tertiary referral hospital",
  "uid": "92b78839-6fcc-513e-a50b-cf7c4e338d23"
}