Coalition for Quality in Geriatric Surgery: Creating Standards for Geriatric Surgical Care

Transcription

1 Coalition for Quality in Geriatric Surgery: Creating Standards for Geriatric Surgical Care Melissa Hornor, MD John A Hartford Foundation/American College of Surgeons James C. Thompson Clinical Scholar

2 The American College of Surgeons Quality Programs

3 Four Guiding Principles of Continuous Quality Improvement 1. Set the Standards - Highest clinical standards - Based on evidence - Individualize to the patient 3. Collect Robust Data - From medical charts - Post-discharge tracking - Continuously updated - Risk adjusted 2. Build the Right Infrastructure - Appropriate, adequate staffing levels, specialists, equipment and IT systems 4. Verify through a Third Party - External peer review - Establish public assurance

4 The Coalition for Quality in Geriatric Surgery (CQGS) Project Goal: To systematically improve the surgical care of older adults by establishing a verifiable quality improvement program with standards based on best evidence and focused on what matters most to the individual patient. Eligibility: All hospitals regardless of size, location or teaching status

5 Stakeholder Organizations AARP ACS Advisory Council for Rural Surgery ACS Committee on Surgical Palliative Care Aetna American Academy of Ophthalmology American Academy of Orthopaedic Surgeons/American Association of Orthopaedic Surgeons American Academy of Otolaryngology American Academy of Physical Medicine and Rehabilitation American College of Physicians American Geriatrics Society American Hospital Association, Health Research & Educational Trust American Society of Anesthesiologists American Society of Consultant Pharmacists American Society of PeriAnesthesia Nurses American Urological Association Association of perioperative Registered Nurses Association of VA Surgeons Carealign (Patient Priorities Care) Case Management Society of America Center to Advance Palliative Care Centers for Medicare and Medicaid Services Eastern Association for the Surgery of Trauma Family Caregiver Alliance Florida Hospital Association Geriatrics for Specialists Initiative Gerontological Advanced Practice Nurses Association Hartford Institute for Geriatric Nursing Hospital Elder Life Program Kaiser Permanente Memorial Sloan Kettering Cancer Center National Association of Social Workers National Committee for Quality Assurance National Gerontological Nursing Association Nurses Improving Care for Healthsystem Elders Patient and Family Centered Care Partners Penn Medicine Department of Anesthesiology & Critical Care Pharmacy Quality Alliance Society for Academic Emergency Medicine Society for Critical Care Medicine Society of General Internal Medicine Society for Hospital Medicine The American Association for the Surgery of Trauma The American Board of Surgery The American Congress of Obstetricians and Gynecologists The Beryl Institute The John A. Hartford Foundation The Society of Thoracic Surgeons University of Colorado/Care Transitions US Department of VA Geriatrics and Extended Care Yale New Haven Patient Experience Council UAB Division of Gerontology, Geriatrics and Palliative Care University of Chicago MacLean Center for Medical Ethics

6 The CQGS Project Standards PROCESS Brainstorm (Summer 2015) Core Team Meeting Informational Calls Stakeholder Kickoff Meeting & Call Field Visits (Winter 2016) 11 Hospitals 7 Cities 4 Community-Based 3 Academic Centers 1 System, 1 VA, 1 Safety Net and 1 Rural 125 Provider and Leadership Connections Stakeholder Comment (Winter 2017) Revise Goals of Care Standards with experts Stakeholders comment on next iteration of standards Beta Pilot (Fall 2017) Invitation to pilot and stakeholder network Six hospitals will be selected to test 32 standards inenvironment Consolidated verification process and site visit Research (Fall 2015) Continuum of Care, Clinical Care, Program Management, Patient Outcomes 3 Literature Searches 1000 s of Articles Best Practice Guidelines Write (Spring 2016) 308 Preliminary Standards Stakeholder input 100 s of Supporting Articles Rate (Summer-Fall 2016) Stakeholders individually rate each standard Validity and Feasibility Scale Ratings Meeting CDT analyzes data Alpha Pilot (Spring 2017) Standards survey completed by 15 hospitals on 92 standards Debrief calls Tested if standards were already in place; rate of difficulty for implementing new standards; prove validity; identify real world strengths and weaknesses; discussed ROI Developing older adult surgical standards TOGETHER

7 CQGS Standards for Geriatric Surgical Care Berian et al Ann Surg. 2017

8 Multicomponent Delirium Prevention Protocol # Standard The following standards apply to all inpatient surgical procedures, both elective and nonelective. 20 There must be pathways, bundles, or order sets in place for delirium: Prevent Sensory and mobility aids available Avoid restraints Avoid Beers criteria medications Control pain Recognize Daily screens Look for infection, metabolic derangement, dehydration, urinary retention/fecal impaction, occult alcohol or drug withdrawal, medication effect Treat Non-pharmacologic interventions first Pharmacologic interventions reserved only for patients who pose substantial harm to themselves or others 30% of delirium potentially preventable Siddiqi et al Cochrane Database Syst Rev

9 Coalition of Quality in Geriatric Surgery More info: The Best of the ACS Quality Programs Today 1:45 PM Grand Ballroom, Third Floor Developing a Geriatric Surgical Program at your Hospital Saturday 4:30 5:30 PM Gramercy, 2 nd Floor

10 Geriatric Abstract Session Geriatric surgery quality improvement and clinical outcomes research Sunday, 2:30 4:30 pm Sutton Center Sutton South, 2 nd Floor

11 @hornormd #CQGS