The American College of Surgeons (ACS) launched its new Geriatric Surgery Verification (GSV) Program at the ACS Quality and Safety Conference. This new surgical quality improvement program introduces 30 new surgical standards designed to systematically improve surgical care and outcomes for the aging adult population.
Older adults already account for approximately 41 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.1-2 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, studies show that older adult patients may more often prioritize quality of life over longevity when it comes to their treatment goals.3
“Given the distinct care requirements for this growing population of older adults, we saw a clear need to identify the most important aspects of their surgical care and to create a new program that will help hospitals consistently provide efficient, high-quality surgical care to older adults that still prioritizes each individual’s unique treatment needs and goals,” said Clifford Y. Ko, MD, MS, MSHS, 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.
The GSV Program provides hospitals with a validated list of 30 evidence-based and patient-centered standards for geriatric surgery that hospitals can implement to continuously optimize surgical care for this vulnerable population. These standards define the resources and processes that hospitals need to have in place to perform operations effectively, efficiently, and safely in older adults, while also always prioritizing what matters most to individual patients with regard to their needs and treatment goals. For instance, the standards include 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.
The ACS, with support from The John A. Hartford Foundation, led a group of over 50 stakeholder organizations—collectively called the Coalition for Quality in Geriatric Surgery—in the development of the GSV Program and its surgical standards. The program was specifically designed to be applicable to all hospitals across the country, regardless of their size, location, or teaching status, and the standards were rigorously piloted and refined to ensure they are meaningful, without being so burdensome that hospitals would find it difficult to implement them.
“Through our collaborative development of this program with stakeholders representing the needs of patients and families, health care professionals, advocacy and regulatory groups, and multiple medical and surgical specialties, we believe we’ve captured the most important considerations for creating standards that truly have the potential to systemically advance surgical care for older adults,” said Ronnie A. Rosenthal, MD, MS, FACS, who serves as the Chair of the ACS Geriatric Surgery Taskforce and is also a professor of surgery and geriatrics at Yale University School of Medicine. “In piloting the standards, we were pleased to see feedback from participating hospitals who noted that their implementation of the GSV Program would help standardize care for their older adult patients across all departments and positively impact all surgical subspecialties. We hope all hospitals will see the value this program can bring to not only their older adult patients, but also to their entire surgical care teams.”
The GSV Program’s 308 preliminary standards were rigorously developed through a combination of extensive literature review, hospital field visits, and meetings with the Coalition for Quality in Geriatric Surgery to identify surgical care gaps and ideal solutions. From there, the preliminary standards were refined to a set of 92 that were analyzed by 15 hospitals—one in Canada and 14 in the U.S.—as part of an alpha pilot study aimed at proving the validity of the standards and the value they would bring to hospitals and patients.
Feedback gleaned from the alpha pilot study helped refine the standards to a set of 33 that were implemented in eight diverse hospitals across the U.S. as part of a beta pilot study to evaluate the standards’ feasibility in the hospital setting. Following the pilot studies, the standards were refined to the final set of 30 required standards introduced today.
“Our quality program for geriatric surgery is built on the past success of other ACS quality programs in cancer, trauma, bariatric, and pediatric surgery. It’s based on a proven foundation and shows great potential to transform the way surgical care is approached for older adults across the nation. Moreover, the program is being released at an auspicious time. More people are growing older and seeking surgical care, while at the same time our health care system is showing a probable shift toward creating a safer and more efficient care system that’s patient-centered,” said ACS Executive Director, David B. Hoyt, MD, FACS.
- 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 June 2019.
- Hall MJ, Schwartzman A, Zhang J, Liu X. Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010. Natl Health Stat Report. 2017;(102):1-15.
- 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.