The UTSW POSH Program

New Patient Appointment or 214-645-8300

Elderly woman walking with a cane outdoors

Specialized Care for Older Patients Needing Surgery

What is the POSH Program? The UT Southwestern Perioperative Optimization of Senior Health (UTSW POSH) Program is an innovative, interdisciplinary model of care designed for older adults undergoing elective surgical procedures.

Making the Process Smoother – and Safer – Before and After the Procedure

Presurgery service

This program is specifically designed to evaluate older adults before surgery, to anticipate any risk of adverse postoperative events, and to provide an optimization plan to avoid complications and improve outcomes.

Postsurgery service

After the procedure, UTSW POSH care team members continue to provide consultative management of medical comorbidities, make recommendations for delirium prevention, and assist with a safe transition out of the hospital.

Comprehensive benefits

Patients in the UTSW POSH Program receive the following advantages:

  • Complete preoperative evaluation and risk assessment resulting in a plan for optimization
  • Coordination of care based on recommendations from the POSH multidisciplinary team
  • Improved patient outcomes
posh-team.jpg

POSH Team Providers

Pictured: Megan Maxwell, M.D., Sarah Wingfield, M.D., Amaka Opute, M.S.N., APRN, ACNP-BC, Sarah Oltmann, M.D.,

Not pictured: Thomas Dalton, M.D.

Who Is Eligible for the Program?

  • Patients who are age 85 or older, or
  • Patients who are age 70 or older who also:
    • Have a known or suspected cognitive impairment
    • Use more than five medications
    • Have three or more chronic conditions
    • Have experienced an unintended weight loss of more than 10 lbs. in one year

Our Goal: Ensuring the Procedure Is as Seamless as Possible

Following an initial geriatrics evaluation, the UTSW POSH team’s plan for optimization might include:

  • Referral to physical therapy prior to surgery
  • Referral to nutrition prior to surgery
  • Referral for further testing for risk stratification (e.g., stress test, echocardiography, etc.)
  • Recommendations for perioperative medication management
  • Recommendations for delirium prevention
  • Referral to social work to assist with obtaining needed support at home or to assist with developing a postoperative discharge plan

To learn more, read our Frequently Asked Questions below or call the UTSW POSH team at 214-645-8617.

Frequently Asked Questions

What is the UT Southwestern POSH Program?

The UT Southwestern Perioperative Optimization of Senior Health (POSH) Program is a service offered by the Division of of Geriatric Medicine and the Departments of Surgery and Anesthesiology that is aimed at providing comprehensive evaluation of older adults who are planning to undergo surgery.

How does the UT Southwestern POSH Program work?

The program is led by a physician who is board certified in internal medicine and geriatric medicine. The physician will perform a comprehensive preoperative evaluation to anticipate your individual risks related to surgery, and then develop a plan to help optimize your health status throughout the surgical period to ensure the best possible outcome. The evaluation is focused on understanding the status of chronic health problems, ensuring appropriate prescribing, and analyzing the risks for complications that threaten the older adult facing surgery. In addition, a geriatric medicine consult team will help care for you while you are in the hospital following surgery, assisting the surgical team in managing chronic medical conditions, preventing complications, and aiding you as you transition safely from the hospital following discharge.

What can I expect at my UT Southwestern POSH clinic appointment?

You will see a UT Southwestern geriatrician who will discuss your goals and expectations for your surgery. Your medical history and any current conditions for which you are being treated will be reviewed with you, along with your risk of developing complications after surgery. You will also have an evaluation of your mood and your risk of developing confusion after the surgery. Your ability to complete your daily activities will be assessed in order to allow planning for care following your surgery. Based on the findings of the assessment, you might need additional lab tests, heart function assessment tests, preoperative physical therapy, or changes to your medications.

Will I have to attend any other appointments prior to my surgery?

You might have a Pre-surgery Testing (PST) appointment in addition to your UT Southwestern POSH appointment. This PST appointment could be necessary to allow a targeted evaluation by an anesthesia provider to develop the best plan for management of your anesthesia during surgery and management of any pain following surgery. If there are questions about insurance coverage or payment for your hospitalization, you might also receive financial counseling at this appointment. Based on the results of your visit with the geriatrician, you could need other specialized testing or evaluation by physical therapists or other medical specialists.

What should I bring to my UT Southwestern POSH appointment?

Please bring an accurate list of all medicines you take, including over-the-counter medications and supplements. It is also very important that a family member or loved one come with you.

Please remember that your surgeon is referring you to the UTSW POSH team because he or she wants to ensure that you have the best possible outcome before and after your operation.

Do I need to contact my surgeon with the results after my UTSW POSH clinic evaluation?

The UTSW POSH Program is a collaborative effort among the physicians who will care for you around the time of surgery. We will communicate with each other regarding your care plan.

As a referring physician, how do I refer a patient to the UTSW POSH Program?

Prior to surgery:

  • Place an order for a UTSW POSH consult in EPIC at the time the decision for surgery is made.
  • The patient will be called by a geriatrics clinic staff member to schedule a preoperative appointment.
  • Continue to also schedule the patient for the presurgical testing (PST) clinic for his or her anesthesia evaluation.

Postoperatively:

  • Enter an order for a geriatrics consult.

This work has been made possible in part through a collaboration with the team that developed the original Perioperative Optimization of Senior Health (POSH) Program at Duke University

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What Is Delirium?

Delirium describes a severe state of confusion and common in intensive care unit patients. Learn more about it.

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