The Geriatrics Concurrent Service has several functions:
1. It provides in-hospital concurrent medical care for patients of Coffey Geriatrics Associates and affiliated Mount Sinai sites (e.g., Jewish Home Lifecare) who are admitted to MSH under other medical or surgical sub-specialties.
2. It responds to requests for consultation from all services for patients with age-associated problems and geriatric syndromes (e.g., multiple co-morbidities, functional impairment, polypharmacy, dementia, delirium, falls, osteoporosis, and frailty).
3. It provides a back up for the MACE and palliative care department when they are overwhelmed and above capacity.
4. The Concurrent Service provides a forum for education and clinical research for geriatric fellows, medical house staff and medical students, as well as a team-training site for nurse practitioner and social work students.
Levels of Service
1. Concurrent Care: All Coffey Geriatrics Associates patients who are hospitalized on a subspecialty service or in an intensive care unit fall into this category. The Concurrent Service will provide regular follow-up during the hospitalization and bill for this service as concurrent medical care. Involvement of the Concurrent Service is key in providing historical medical data (e.g. test reports, advance directives), continuity of care, and medical guidance, especially with respect to the multiple medical problems that do not fall under the purview of the specialist. A key role is that of liaison to the specialists, patient and family members: coordinating hospital care, participating in treatment decisions (e.g., placement of feeding tubes) and facilitating discharge planning.
2. Consultative Service: The Concurrent Service is called upon to provide consultations on hospitalized patients throughout Mount Sinai for geriatric syndromes. For billing purposes a written request must be part of the medical record. In order to evaluate the patient appropriately, the consultation request should be specific and clearly worded. These evaluations should be billed as 'Initial Consults." The name of the referring physician needs to be included on the submitted bill. If the Concurrent Service remains involved subsequent visits should be billed as "Subsequent Visits" (i.e., concurrent care). The reasons for consultation are myriad. Typical requests include evaluation of a change in mental status, pressure ulcer assessment and management and functional assessment. Assistance with end of life care, goals of care, symptom management at the end of life, advance directives, discharge planning should be directed to the Geriatric/Palliative Care team.
3. Primary Care: The Concurrent Service will be called upon to provide primary medical care to our Coffey Geriatrics Associates patients when the MACE unit is capped (more than 15 patients).
Palliative Medicine Fellowship
Additional training in palliative medicine is available for those fellows who desire it. Previous fellows in geriatrics have chosen to augment their training with an additional year of training in clinical, educational, research and administrative aspects of palliative medicine. Upon completion of training, fellows are board-eligible in both geriatrics and medicine. This Integrated Fellowship is designed for those fellows wishing to develop a career as an academic leader in Palliative Care and Geriatrics.
Any interested fellows should discuss this possibility with Helen Fernandez, MD.
Fellowship Academic Coordinator
Brookdale Department of Geriatrics and Palliative Medicine
One Gustave L. Levy Place
New York, NY 10029-6574