As the U.S. population ages, surgical programs must evolve to meet the complex needs of older adults. During a featured session at Becker’s Hospital Review 15th Annual Meeting, leaders from Oakland, Calif.-based Kaiser Permanente Northern California, Rochester (New York) Regional Health and the American College of Surgeons (ACS) shared how its Geriatric Surgery Verification (GSV) program is delivering better outcomes while controlling costs.
Speakers emphasized how targeted interventions can reduce complications, shorten stays in the intensive care unit and improve patient satisfaction — particularly for urgent and high-risk cases.
Here are four insights from the conversation.
Note: Quotes have been edited for length and clarity.
1. Older patients are the highest-risk surgical population
About one-third of inpatient surgeries at Rochester Regional Health are performed on geriatric patients, according to Matthew Schiralli, MD, the system’s executive medical director.
“When you really measure where your risk is, the highest risk patients are the oldest and the oldest most urgent patients,” Dr. Schrialli said
After implementing GSV, Rochester Regional saw meaningful reductions in postoperative complications patient days spent in the ICU. Also, more patients were safely discharged home instead of to skilled nursing facilities.
2. A small investment in pre-op screening goes a long way
Both Kaiser Permanente and Rochester Regional use simple, scalable tools to identify frailty and cognitive risks before surgery. Rochester Regional built screening and care planning into its existing pre-op clinic workflow, while Kaiser staffed a regional team of nurses to coordinate GSV implementation across hospitals.
“We recognized the potential cost savings of the program was enough to hire 13 nurses to help with the implementation,” said Hemant Keny, MD, a regional lead for surgical quality and safety with Kaiser. “Now even the other Kaiser regions are taking up this playbook — Southern California, the Pacific Northwest, the Mid-Atlantic, all of these regions are taking this on as well. They see the benefits.”
3. Successful GSV requires the entire care team, not just surgeons
The most successful programs integrate input from pharmacists, therapists, social workers, hospitalists and nurses. “First of all, you need a champion. It’s usually a surgeon, but it doesn’t have to be. You need someone with fire in the belly who recognizes we need to do something about this vulnerable population,” Dr. Schiralli said. “From there, you need to invite everyone else to the table when you’re building the program.”
4. This isn’t optional for long — CMS is watching
Dr. Ko closed the session by noting that CMS now includes geriatric-focused metrics in its Inpatient Quality Reporting (IQR) Program through the new Age Friendly Hospital Measure. These align closely with GSV standards, and all IQR hospitals will have to report on their compliance with the Measure beginning this year.
“This is not going away,” Dr. Ko said. “Our country’s getting older and care is getting more complex. And hospitals are going to be taking care of these patients.”
