American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

About Geriatric Surgery Verification

Mission

To improve the quality of geriatric surgical care by creating a system that allows for a prospective match of every older adult’s individual surgical needs with a care environment that has optimal resources for the patients undergoing inpatient surgery.

History

In 2004, the Task Force on Geriatric Surgery was created with the support of the American College of Surgeons (ACS). This task force is composed of a multidisciplinary group of leaders interested in geriatric surgical care and participation of ACS leadership. The overall mission is to improve the quality and safety of surgical care for all older adults in the United States and actively works to improve care for older patients through education, partnering, and advocacy.

On July 1, 2015, the ACS was awarded a four-year grant from The John A. Hartford Foundation (JAHF) to develop and implement a Geriatric Surgery Verification and Quality Improvement Program. This broad-reaching quality program would be designed to systematically improve care and outcomes for the older adult surgical patient. Developing a quality improvement program centered on older patients undergoing surgery was driven by a number of factors, including the rapid growth in the number of Americans ages 65 and older.

A team of ACS members with geriatric expertise and ACS staff worked with a diverse group of stakeholders to:

Engage Key Stakeholders

Multidisciplinary engagement played a key role in program development. Stakeholders representing several health professions, patients and families, and payors vetted the standards and contributed to the development of patient-centered outcome measures. Three stakeholder meetings were conducted during the course of the grant. A select group of stakeholder partners served as the advisory panel for the program which provided guidance throughout the four years of the CQGS.

Set the Standards and Develop Measures that Matter

Beginning in 2016, the core development team, advisory panel, and multidisciplinary stakeholder groups worked to set the standards for geriatric surgical care. This endeavor was done through a combination of extensive literature review, a series of hospital field visits, and meetings with engaged stakeholder organizations that rated the proposed standards on both validity and feasibility using a modified version of the RAND-University of California Los Angeles (UCLA) Appropriateness Methodology.

The 308 standards were ultimately reorganized into 92 standards, and the CQGS invited 15 hospitals to participate in a survey to determine which of the standards were already implemented, understand how easy or difficult the standards would be to implement if not already in practice, and identify and record standards that were confusing or difficult to interpret. Following completion of this survey in 2017, the information was used to refine the standards further into a core group of 33 standards that focused on the following four areas: goals-of-care and decision making, cognitive screening and delirium prevention, maintenance of function and mobility, and nutrition and hydration optimization.

The data collection component includes a combination of existing and new 30-day process and outcome measures that are patient-centered. The measures closely reflect issues of importance to both the older adult patient undergoing surgery and the patient’s caregivers.

Pilot the Program

From 2017 to 2018, the standards were presented, discussed, and pilot tested in eight hospitals representing diverse geographic locations, as well as hospital types and sizes. Formal site visits were conducted by the core development team members, which included chart review, interviews with key team members, review of hospital processes and policies, and an evaluation of certain physical parts of the hospital. The results of the pilot testing showed that each hospital was able to implement most of the standards. Several best practices for standard implementation were collected from the pilot sites, including creation of a preoperative checklist for important geriatric surgical screening tools, the use of telecommunication to bridge the gap between hospitals and post-acute care facilities, and others. The information derived was used to help finalize the Optimal Resources for Geriatric Surgical Care standards manual.

Develop the Verification Process to Ensure Delivery of High-Quality Care. Use of the standards must be verified in order to build public trust and ensure success of the program. Building on ACS’ past experiences, we will add to our infrastructure in order to consistently and reliably perform verification.

Launch the Geriatric Surgery Quality Campaign

In July 2019, the ACS GSV Program officially released the Optimal Resources for Geriatric Surgical Care. The GSV Program will help hospitals of any size prepare for the influx of older adults considering surgery with care standards that define the resources hospitals need to have in place to perform operations effectively, efficiently, and safely in this vulnerable population. The standards take into account that older adults have distinct physical and social vulnerabilities, as well as unique goals for their care, that warrant a more thorough and individualized approach to surgery.

The standards outline processes for systematically improving older adult surgical care, including, but not limited to:

  • Improving communications with patients before surgical procedures to focus on outcomes that matter most to the patient
  • Screening for geriatric vulnerabilities
  • Better management of medications
  • Providing geriatric-friendly rooms
  • Ensuring proper staffing is in place

Impact

The Geriatric Surgery Verification and Quality Improvement Program will provide a framework for the optimal care of the geriatric surgical patient, generalizable to more than 4,000 facilities regardless of size, location, or teaching status. The program will reside with other verification programs in the Division of Research and Optimum Patient Care, where it will be maintained by ACS staff.