Working for Improvements in Geriatric Surgery

By Jane Farrell

An alliance of medical and health organizations has completed the first comprehensive set of the highest possible surgical care standards for older adults.

The report was published in the Annals of Surgery.

“Hospital Standards to Promote Optimal Surgical Care of the Older Adult” is the culmination of a two-year evaluation by the Coalition of Quality in Geriatric Surgery (CQGS), a multidisciplinary coalition representing the American College of Surgeons (ACS) and 58 diverse stakeholder organizations committed to improving the quality of geriatric surgical care.

The new geriatric surgical care standards build on already existing quality indicators, National Quality Forum-endorsed quality measures, and previous work by the American College of Surgeons, American Geriatrics Society, and John A. Hartford Foundation, which have already collaboratively developed and released two sets of perioperative care guidelines.

The preliminary standards in the report were divided into four sections:

Continuum of Care, encompassing patient-centered goals and decision making, perioperative optimization, and transitions of care.

Clinical Care, encompassing the phases of immediately preoperative, intraoperative, and postoperative care.

Program Management, encompassing personnel and committee structure of a geriatric surgery program, and credentialing and education standards for hospital personnel who care for older surgical patients.

Patient Outcomes and Follow-Up.

Study authors wrote, “The widespread agreement on the validity of these comprehensive standards indicates that we know what high-quality care for older adult surgical patients should look like.” However, in terms of feasibility they found that “some standards were perceived to require high resources, and, therefore, the feasibility of implementation across hospitals that vary in size, location, and teaching status remains uncertain.”

Although the end goal is to implement these CQGS standards in a formalized verification and quality improvement program through the ACS, there is still more work to be done. The preliminary standards are currently undergoing a two-phased pilot process.

A beta pilot phase to follow in late 2017 will engage six hospitals to actually implement the standards for older surgical patients.

“Now that we’ve confirmed what high-quality surgical care for older adults should look like, we’re ready to evaluate how these standards will work in a hospital environment. This is an important aspect of the project, and the feedback portion from hospitals is vitally important,” said Ronnie Rosenthal, MD, MS, FACS, CQGS ,Co-Principal Investigator.

“More older people at increasingly advanced ages are undergoing surgery and it is critical that we move the evidence we have about good surgical care for this population into practice. These preliminary standards put a focus on outcomes that really matter to older people and their families, and are a monumental step forward. We are proud to support and partner with the American College of Surgeons on this important work,” said Terry Fulmer, PhD, RN, FAAN, President of The John A. Hartford Foundation.