American College of Surgeons introduces new standardized program

The American College of Surgeons (ACS) launched its newGeriatric Surgery Verification (GSV) Program at the ACS Quality and SafetyConference. This new surgical quality improvement program introduces 30 newsurgical standards designed to systematically improve surgical care and outcomesfor the aging adult population.

The GSV Program provides hospitals with a validated list of30 evidence-based and patient-centered standards for geriatric surgery thathospitals can implement to continuously optimize surgical care for thisvulnerable population. These standards define the resources and processes thathospitals need to have in place to perform operations effectively, efficiently,and safely in older adults, while also always prioritizing what matters most toindividual patients with regard to their needs and treatment goals. Forinstance, the standards include recommendations for improving communicationsbetween patients and their health care team, managing medications, screeningfor cognitive, nutrition, and mobility decline, and ensuring proper staffing isin place, among other concerns.

“Given the distinct care requirements for this growingpopulation of older adults, we saw a clear need to identify the most importantaspects of their surgical care and to create a new program that will helphospitals consistently provide efficient, high-quality surgical care to olderadults that still prioritizes each individual’s unique treatment needs andgoals,” said Clifford Y. Ko, MD, MS, MSHS, FACS, director of the ACS Divisionof Research and Optimal Patient Care and professor of surgery at the Universityof California-Los Angeles David Geffen School of Medicine

The ACS, with support from The John A. Hartford Foundation,led a group of over 50 stakeholder organizations – collectively called theCoalition for Quality in Geriatric Surgery ­– in the development of the GSVProgram and its surgical standards. The program was specifically designed to beapplicable to all hospitals across the country, regardless of their size,location, or teaching status, and the standards were rigorously piloted andrefined to ensure they are meaningful, without being so burdensome thathospitals would find it difficult to implement them.

“Through our collaborative development of this program withstakeholders representing the needs of patients and families, health careprofessionals, advocacy and regulatory groups, and multiple medical andsurgical specialties, we believe we’ve captured the most important considerationsfor creating standards that truly have the potential to systemically advancesurgical care for older adults,” said Ronnie A. Rosenthal, MD, MS, FACS, whoserves as the chair of the ACS Geriatric Surgery Taskforce and is also aprofessor of surgery and geriatrics at Yale University School of Medicine. “Inpiloting the standards, we were pleased to see feedback from participatinghospitals who noted that their implementation of the GSV Program would helpstandardize care for their older adult patients across all departments andpositively impact all surgical subspecialties. We hope all hospitals will seethe value this program can bring to not only their older adult patients, butalso to their entire surgical care teams.”

The GSV Program’s 308 preliminary standards were rigorouslydeveloped through a combination of extensive literature review, hospital fieldvisits, and meetings with the Coalition for Quality in Geriatric Surgery toidentify surgical care gaps and ideal solutions. From there, the preliminarystandards were refined to a set of 92 that were analyzed by 15 hospitals – onein Canada and 14 in the U.S. ­– as part of an alpha pilot study aimed atproving the validity of the standards and the value they would bring tohospitals and patients.

Feedback gleaned from the alpha pilot study helped refinethe standards to a set of 33 that were implemented in eight diverse hospitalsacross the U.S. as part of a beta pilot study to evaluate the standards’feasibility in the hospital setting. Following the pilot studies, the standardswere refined to the final set of 30 required standards introduced today.

“Our quality program for geriatric surgery is built on thepast success of other ACS quality programs in cancer, trauma, bariatric, andpediatric surgery. It’s based on a proven foundation and shows great potentialto transform the way surgical care is approached for older adults across thenation. Moreover, the program is being released at an auspicious time. Morepeople are growing older and seeking surgical care, while at the same time ourhealth care system is showing a probable shift toward creating a safer and moreefficient care system that’s patient-centered,” said ACS executive director,David B. Hoyt, MD, FACS.

The final GSV Program standards were formally released atthe ACS Quality and Safety Conference, and hospitals will be able to apply andformally enroll in the program beginning in October 2019 at the ACS ClinicalCongress in San Francisco.