The American College of Surgeons (ACS) describes the rapid growth of the American geriatric population as “one of the greatest health care challenges of our time.”
Improving geriatric patient outcomes is of particular interest to Courtney Collins, MD, clinical assistant professor of Surgery at the Ohio State College of Medicine. “One out of five patients is over the age of 65,” Dr. Collins says, “and a lot of surgeons just aren’t trained to take care of patients who are that complex.”
Dr. Collins is leading the Ohio State Wexner Medical Center’s effort to obtain certification from the ACS as part of its Geriatric Surgery Verification (GSV) program. The Wexner Medical Center is currently putting the necessary infrastructure and processes in place to apply for certification, from preoperative screening through postoperative recovery care.
As part of the project, Dr. Collins recently completed a pilot study on the feasibility of screening geriatric patients for frailty, nutrition and cognitive issues. The study found that 40% of patients screened as high risk in at least one of these areas. The results highlight the need for a comprehensive set of guidelines to ensure the highest quality of care for geriatric patients.
Setting new standards of care
In 2019, the ACS published its GSV program, which established 32 standards for geriatric care that break out into several categories. The Ohio State Wexner Medical Center has completed or is in the process of establishing protocols and standards to meet these rigorous requirements
Leadership and oversight
The ACS requires a letter of support from the hospital CEO or administrative leadership, confirming their commitment to the GSV program. Institutions must also establish an internal governance team to administer the program and maintain compliance with the GSV standards. The team comprises a geriatric surgery director, a geriatric surgery coordinator and a geriatric surgery quality committee.
Additionally, the ACS requires the appointment of a geriatric surgery nurse champion for each floor or care unit to provide more direct oversight for the nursing staff and help implement quality improvement projects.
Facilities and equipment resources
GSV standards require institutions to ensure rooms are safe for geriatric patients. This includes providing space for family and caregiver visitation either in the patient room or in a commons area. Rooms must also include elements for geriatric patient reorientation such as clocks with large displays and calendars that can provide clear information on treatments, tests, medications and rehab schedules.
Patient care protocols
The majority of the GSV standards establish a comprehensive set of requirements for geriatric patient care, from preoperative screening through discharge. These include directions for assessing the patient’s overall health goals, treatment strategies in accordance with those goals, vulnerability screens, postoperative care, medication management, surgeon-PCP communications, discharge documentation and communication with post-acute care facilities.
Currently, Dr. Collins’ team is focused on implementing a preop screening process for older patients to help identify those at a higher risk of complications after surgery. They’re incorporating questions about nutrition, cognition, mobility and other factors into either preoperative visits or phone calls. Dr. Collins says their next steps will be to create working groups to help improve processes in all the different phases of care: preop, intraop and-postop.
Data collection and review
Another vital part of the GSV program is the collection and analysis of patient data. This includes data required by national regulatory bodies like CMS, along with any other clinically relevant data. The hospital’s geriatric surgery quality committee (GSQC) must regularly review this data to identify trends and opportunities for improvement and to provide feedback to all care providers.
Quality/performance improvement projects
Each year, the institution must engage in a quality improvement or performance improvement project based on the data analysis and feedback from the GSQC. Additionally, an institution may opt to join the ACS’s National Surgical Quality Improvement Program and work collaboratively with other hospitals to improve the quality of geriatric surgical care on a national level.
Community outreach/continuing education
The GSQC must also oversee a community outreach project related to geriatric surgical care each year. Additionally, they must ensure that surgeons, critical care physicians, advanced practice providers and nurses are educated on:
- Patient goals and ensuring care is concordant with them
- Screening and management strategies for high-risk geriatric vulnerabilities in cognition, mobility/function and nutrition/hydration
Basic research/clinical trials
Finally, institutions may engage in some type of scholarly research designed to promote the advancement of geriatric surgical knowledge and care. While this standard is optional, it’s highly recommended by the ACS.
Ohio State places a strong emphasis on education, research and community outreach. We’re helping to teach and lead the next generation of physicians. We also participate in a wide range of research projects and utilize well-established protocols for collecting and analyzing patient data. And we’re deeply committed to serving our local community. These characteristics make us ideally suited to implement the GSV standards.
Better care, better outcomes
“Ultimately, the GSV program is about improving the quality of care and the quality of outcomes for geriatric patients,” Dr. Collins says. “We’ve shifted our thinking about older patients to take into account all of their needs, not just their surgical pathology.”
Dr. Collins believes they should be ready to apply to the program within a year, after when the ACS will perform a site review to complete the verification process.
When certified, the Ohio State Wexner Medical Center will be one of the largest health care systems in the GSV program.