Surgery for Older Adults Must Change to Improve Outcomes

The rapidly aging population of America is one of the greatest healthcare challenges of our time. And through a new program, the surgical care community is working diligently to address it.

Over the past four years, the American College of Surgeons (ACS), with support from the John A. Hartford Foundation, led a group of stakeholders representing the needs of patients, families, healthcare providers, hospitals, payers and regulatory bodies in the development of the new Geriatric Surgery Verification (GSV) Program.  

The GSV Program aims to systematically improve the surgical care of older adults by providing hospitals with 30 care standards that were rigorously tested and established based on the best scientific evidence and an understanding of what matters most to individual patients. The GSV Program formally launches at the 2019 ACS Quality and Safety Conference, July 19-22, in Washington D.C. There, the final standards will be released and interested hospitals can obtain more information on how to participate.

Recently, Clifford Y. Ko, MD, FACS, Director of the ACS Division of Research and Optimal Patient Care, and Director of the GSV Program, answered some key questions about the new program and what it could mean for hospitals, healthcare providers and patients. 
 

Ko: The program came from an understanding that older adults not only have unique goals for their care, but they also have unique care needs given their physical and social vulnerabilities. 

These factors, coupled with a recent shift in healthcare financing from volume-based to value-based care, meant we needed to hone in on the most important aspects of surgical care for older adults to create a new system that gives healthcare professionals the best opportunity to consistently provide better, completely patient-focused care.
 

Ko: The program consists of 30 standards of surgical care for older adults developed by the ACS, with input from more than 50 other organizations, and refined and rigorously tested through two pilot programs. 

The first pilot showed these new care standards are valid and necessary to improve care, while the second demonstrated the standards are feasible for hospitals to implement.^1-2 We were happy to see feedback from participating hospitals who said using this program could help standardize care for their older adult patients across all departments and surgical subspecialties.² This program truly has the potential to bring about system-wide changes in surgical care. 
 

Ko: We designed the program to be implemented by any U.S. hospital, regardless of size, location or teaching status. The program guides a hospital through the implementation and verification of the 30 standards for surgical care of older adults. These standards define the resources, infrastructure and clinical processes a hospital needs to have in place to perform surgical operations effectively, efficiently and safely in older adults. In developing the program, we made sure the standards are meaningful without being so burdensome that hospitals would find it too difficult to implement them.
 

Ko: One of the most important aspects of this program is it never deprioritizes the patient’s goals for surgery. For example, the program mandates surgeons and their older adult patients take time to discuss and align on what matters most to the patient regarding their health and how a procedure could affect that.

For hospitals, this program empowers them to implement verifiable, patient-centered standards based on the best evidence that can be used to continuously advance surgical care for this vulnerable population. By putting these new standards into place, hospitals will be better equipped to prevent costly, avoidable complications, which can result in better patient outcomes and lower costs.
 

Ko: This program deeply aligns three priorities – those of the patient, the providers and the hospitals/systems. While relying on evidence-based standards, the redesign of older adult surgical care in each facility will ostensibly lead to better outcomes for the patients, improved efficiencies and effectiveness for the providers, and the delivery of value-based care for the hospitals. Over the years, we have seen this win-win-win achieved; and now we are spreading the list of standards for everyone to implement and benefit. 

Note: Hospitals and surgical facilities interested in learning more about the GSV Program and the enrollment process can contact the ACS at [email protected] as well as sign up for more information and program updates here. 

Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS is Director of the American College of Surgeons Division of Research and Optimal Patient Care, Principal Investigator for the Coalition for Quality in Geriatrics Surgery project, and Director of the ACS GSV Program. Dr. Ko is also a practicing surgeon and Professor of Surgery and Health Services at the UCLA Schools of Medicine and Public Health.
 

The American College of Surgeons (ACS) is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. It is the largest surgical organization in the world (over 82,000 members).