Presentation Details
| Closing the Geriatrics Gap: A 4Ms Solution for Preoperative Surgical Care Evan M.Henricks, Ellen E.Schmitt, Victoria R.Nelson, Kurt J.Pfeifer, Katherine M.Denson. Medical College of Wisconsin, Milwaukee, WI, USA |
Abstract
BACKGROUND: By 2050, adults aged ≥65 are projected to account for up to 31% of surgical cases. Clinical practice guidelines (CPGs) from the American Geriatrics Society and the American College of Surgeons recommend incorporating the Age-Friendly Health Systems 4Ms framework (What Matters, Medication, Mentation, Mobility) into perioperative care. Access to preoperative providers with geriatrics expertise remains limited. At the Medical College of Wisconsin (MCW), a system-wide preoperative history and physical (H&P) template exists within the electronic medical record (EMR). This template addresses delirium but lacks other 4Ms components.
PURPOSE: Supported by the Geriatric Academic Career Award and the Tideswell Emerging Leaders in Aging Program, this project developed two institutional geriatrics resources: (1) a recurring geriatrics perioperative case-conference series and (2) a 4Ms-based template for the preoperative H&P. Development incorporated data from a needs assessment, feedback from interdisciplinary team members and key stakeholders, and perioperative CPGs. Interdisciplinary collaborators partnered with EMR personnel to build an institutional geriatrics template.
RESULTS: The geriatrics template was created in November 2025. It includes five selectable elements aligned with the 4Ms framework: (1) No issues identified; (2) Delirium; (3) Frailty; (4) Central Polypharmacy; and (5) Advance Care Planning. Each selectable contains guidance for users on the appropriate assessment and plan. The template appears automatically for patients aged ≥80 and in a separate section for clinicians to use with younger patients when relevant. Three case-conferences are slated to occur this academic year. They will introduce clinicians to the template and reinforce appropriate use. An anonymous survey will be circulated following each case-conference for feedback.
CONCLUSIONS: A scalable 4Ms-focused perioperative resource can be created through collaborative, interdisciplinary efforts. Ongoing work includes increasing awareness through the case-conference series, educating clinicians in effective template use, refining the template from usage data and learner feedback, and exploring dissemination to other institutions.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: Supported by the Geriatric Academic Career Award and the Tideswell Emerging Leaders in Aging Program, this project developed two institutional geriatrics resources: (1) a recurring geriatrics perioperative case-conference series and (2) a 4Ms-based template for the preoperative H&P. Development incorporated data from a needs assessment, feedback from interdisciplinary team members and key stakeholders, and perioperative CPGs. Interdisciplinary collaborators partnered with EMR personnel to build an institutional geriatrics template.
RESULTS: The geriatrics template was created in November 2025. It includes five selectable elements aligned with the 4Ms framework: (1) No issues identified; (2) Delirium; (3) Frailty; (4) Central Polypharmacy; and (5) Advance Care Planning. Each selectable contains guidance for users on the appropriate assessment and plan. The template appears automatically for patients aged ≥80 and in a separate section for clinicians to use with younger patients when relevant. Three case-conferences are slated to occur this academic year. They will introduce clinicians to the template and reinforce appropriate use. An anonymous survey will be circulated following each case-conference for feedback.
CONCLUSIONS: A scalable 4Ms-focused perioperative resource can be created through collaborative, interdisciplinary efforts. Ongoing work includes increasing awareness through the case-conference series, educating clinicians in effective template use, refining the template from usage data and learner feedback, and exploring dissemination to other institutions.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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