ACS Leadership Cliff Ko MD Ronnie Rosenthal MD. ACS Staff Kat Christensen

Transcription

1 ACS Leadership Cliff Ko MD Ronnie Rosenthal MD ACS Staff Kat Christensen Team Members JoAnn Coleman NP Emily Finlayson MD Mark Katlic MD Sandhya Lagoo-Deenadayalan MD Tom Robinson MD Marcia Russell MD Vicky Tang MD

2 Disclosures Tom Robinson has no disclosures.

3 OPTIMIZING SURGICAL CARE FOR OLDER ADULTS

4 OPTIMIZING SURGICAL CARE FOR OLDER ADULTS The second question is whether or not you get a sense that there is something mutable about the [Frail] score? None of the factors seem mutable. Are there some clinical processes that we can work on to improve the predicted outcome? DR. CLIFFORD Y. KO (LOS ANGELES, CALIFORNIA) 2009 American Surgical Association Ann Surg (2009) 250 (3): 455

5 OPTIMIZING SURGICAL CARE FOR OLDER ADULTS The second question is whether or not you get a sense that there is something mutable about the [Frail] score? None of the factors seem mutable. Are there some clinical processes that we can work on to improve the predicted outcome? DR. CLIFFORD Y. KO (LOS ANGELES, CALIFORNIA) 2009 American Surgical Association Ann Surg (2009) 250 (3): 455

6 OPTIMIZING SURGICAL CARE FOR OLDER ADULTS The second question is whether or not you get a sense that there is something mutable about the [Frail] score? None of the factors seem mutable. Are there some clinical processes that we can work on to improve the predicted outcome? DR. CLIFFORD Y. KO (LOS ANGELES, CALIFORNIA) 2009 American Surgical Association Ann Surg (2009) 250 (3): 455

7 CHARACTERISTICS OF THE VULNERABLE OLDER ADULT Mobility Function Social Vulnerability VULNERABILITY Nutrition Cognition Co-Morbidity Burden

8 PARADIGM SHIFT FOR HEALTHCARE IN OLDER ADULTS Modern Healthcare Disease centric management using intervention-driven model Biologic Disease Process

9 PARADIGM SHIFT FOR HEALTHCARE IN OLDER ADULTS Cognition Modern Healthcare Disease centric management using intervention-driven model Mobility Nutrition Biologic Disease Process Social Function Geriatric-Centric Care Balanced management of presenting disease and physiosocial breakdown

10 MULTI-DISCIPLINARY TEAM CARE Surgeon Geriatrics / Hospitalist TEAM-BASED CARE Anesthesia Pharmacy Physical Therapy Case Manager Palliative Care / Social Work

11 MISSION STATEMENT VISION To improve the surgical care and outcomes of older adults by establishing a quality improvement program with verifiable standards and data, based on best evidence, and focused on what matters most to the patient

12 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 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 Stakeholder Organizations 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

13 FOUR STRATEGIC TARGET AREAS TO IMPROVE CARE OF OLDER ADULTS We focus our efforts on four target areas that foster quality improvement in the older adult surgical population. 1. Goals of Care and Decision Making 2. Cognition Screening and Delirium 3. Maintenance of Function and Mobility 4. Nutrition and Hydration Optimization

14 Standards Development Process Preliminary Standards (308) Written in 2016 by the CDT Extensive literature search Stakeholders rated validity and feasibility Alpha Standards (92) Alpha Pilot 15 centers Was the standard already in place? If not, how hard would it be to implement? Beta Standards (30) Beta Pilot 8 centers Full implementation of 30 beta standards Final Standards

15 THE STANDARDS HAVE ALREADY BEEN LAUNCHED Kaiser Permanente Fresno Denver VA Medical Center University of Alabama Hospital Rochester Regional Health Johns Hopkins Bayview Medical Center NYU Winthrop Hospital University Hospital - Rutgers University of Connecticut Medical Center

16 COALITION FOR QUALITY IN GERIATRIC SURGERY STANDARDS PRE-OP INTRA-OP POST-OP DISCHARGE FUNCTION Risk Screen/Modify: Function Mobility Pad pressure points Team-based care: Preserve function Room infra-structure Re-Assess at discharge Function Mobility COGNITION Risk Screen/Modify: Cognition Delirium Risk Multi-modal preemptive pain control Optimal med choices Team-based care: Prevent delirium Multi-modal pain Rx Re-Assess at discharge Delirium GOALS OF CARE NUTRITION HYDRATION Goal concordant care Advance directive High risk conference Risk Screen/Modify: Nutrition Supplement deficits Euvolemia Re-visit care goals if care escalation Honor care goals Avoided prolonged fast Early feeding Supplements as needed Communication on goals changes to PCP or transfer facility PCP communication Medication review Communication