Goals

• At present, Internal Medicine involvement at Kelowna General Hospital (KGH) occurs predominantly downstream in the perioperative pathway. Consultations are most commonly initiated on the day of surgery when patients are placed on a “medical hold” or experience procedure cancellation due to unstable medical conditions, or postoperatively after complications have already developed. This reactive model limits opportunities for preoperative optimization and contributes to inefficiencies, delays in care, and avoidable patient harm. Local data support this concern: current NSQIP (National Surgical Quality Improvement Program) metrics demonstrate that postoperative morbidity among geriatric patients at KGH exceeds expected benchmarks, with 11.98% of patients aged over 65 experiencing morbidity compared with an expected rate of 9.79% (NSQIP ISAR, March 2025). As the surgical population continues to age and medical complexity increases, surgeons are increasingly seeking earlier and more consistent medical expertise to support shared decision-making and optimize patient outcomes across the perioperative journey. This proposal seeks to address that need by integrating an Internal Medicine consult service directly into Presurgical Screening Services at KGH, while also expanding consultative support for hospitalized surgical patients with medical complexity. By shifting from a reactive to a proactive model of care, this initiative aims to reduce last-minute surgical cancellations and medical holds, improve perioperative efficiency, and lower postoperative morbidity in our geriatric population to expected NSQIP benchmarks. The project funding is requested to help workshop and integrate Internal Medicine into current perioperative pathways at KGH. This will require some overhaul of current perioperative workflows, policies and booking pathways, and involve extensive review to capture the most at risk patients early in their perioperative journey for intervention.