Unity Hospital is the first in the nation to achieve verification by demonstrating that GSV standards are in place and verified across one or more surgical specialties and can reach 50 percent or more of their hospital’s total population of surgical patients aged 75 years or older who are program eligible.
“This important achievement by Unity Hospital is also a much-anticipated milestone for the ACS Geriatric Surgery Verification program,” said Clifford Y. Ko, MD, FACS, Director of the ACS Division of Research and Optimal Patient Care and professor of surgery at the University of California-Los Angeles David Geffen School of Medicine. “This evidence-based quality program has been more than five years in the making. Now that we’ve seen how verification is achieved when a hospital dedicates itself to meeting program standards, the GSV program can begin to fill a critical gap in providing specialized surgical care for older adults across the nation.”
As a verified geriatric surgery facility, the surgical care team at Unity is implementing the program standards to continuously make the most effective use of surgical care for a vulnerable aging population. These standards are evidence-based and define resources and processes that hospitals must have in place to perform operations effectively, efficiently, and safely for older adults. The standards are also patient-centered so hospitals can also always prioritize what matters most to individual patients with regard to their needs and treatment goals. Older adults also have distinct physical and social vulnerabilities, as well as unique goals for their care, that warrant a more thorough and individualized approach to surgery. In fact, research shows that older adult patients may more often prioritize quality of life over longevity when it comes to their treatment goals.1
The standardized program includes recommendations for improving communications between patients and their health care team, managing medications, screening for cognitive, nutrition, and mobility decline, and ensuring proper staffing is in place, among other concerns.
“We have created a new standard of care at Unity, a better way of approaching the individual needs of the community,” said Matthew Schiralli, MD, FACS, director of the geriatric program and Rochester Regional Health’s chief of surgery, eastern region. “By assessing preoperative risks, we are able to provide anticipatory care that is tailored to older adults to help them meet their individual goals of surgery.”
Hospitals seeking verification undergo an extensive site visit by an ACS team of site reviewers. These teams consist of experienced experts in geriatric care who review the hospital’s structure, process, and clinical outcomes data. The current standards document, Optimal Resources for Geriatric Surgery, drives the application and is used as a guideline in conducting the site visit.
“The ACS Geriatric Surgery Verification Program helps my patients get home sooner,” said Steve Ryan, MD, medical director of geriatric services at Rochester Regional Health. “Our excellent team of surgeons at Unity Hospital looks at every surgical patient under the American College Standards for Geriatric Care. The team applied geriatric risk assessment and risk reduction to all elective and urgent surgical admissions across all surgical specialties. It helps the hospital staff know who is at higher risk of delirium, function decline and other geriatric problems.”
The GSV program is based on other successful ACS quality improvement programs in surgical-care areas, such as cancer, bariatric surgery, trauma, and pediatric surgery. ACS developed the GSV program because the need for specialized surgical care for older patients is growing. Today older adults already account for more than 40 percent of all in-patient operations performed in the U.S. annually, and this number will continue to increase as the population ages and subsequent demand for surgical care grows.2-3
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- Hofman CS, Makai P, Boter H, et al. The influence of age on health valuations: the older olds prefer functional independence while the younger olds prefer less morbidity. Clin Interv Aging. 2015;10:1131-1139.
- Centers for Disease Control. National Hospital Discharge Survey: Number of All-Listed Procedures for Discharges From Short-Stay Hospitals, by Procedure Category and Age: United States, 2010. Available at: http://www.cdc.gov/nchs/data/nhds/4procedures/2010pro4_numberprocedureage.pdf, 2010. Accessed February 2021.
- Hall MJ. Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010. 2017; Natl Health Stat Report 2017 Feb;(102):1-15. Available at: https://pubmed.ncbi.nlm.nih.gov/28256998/ Accessed February 2021.
About the ACS Geriatric Surgery Verification (ACS GSV) Program
Introduced July 2019, the ACS GSV program, provides a standardized surgical quality improvement framework for optimal care of the geriatric surgical patient, generalizable to hospitals regardless of size, location, or teaching status. Verified hospitals implement program standards for a multidisciplinary team approach addressing preoperative work-up, postoperative management, care transition, data collection, quality improvement, professional and community outreach, and research. With support from The John A Hartford Foundation, the standards were collaboratively developed by the ACS Coalition for Quality in Geriatric Surgery Project, involving more than 50 stakeholder organizations that represent the needs of older patients and families, advocacy and regulatory groups, health care professionals, and multiple medical and surgical specialties.
