The aging population is reshaping the landscape of healthcare with significant implications related to higher use of services to deliver care for both chronic conditions and complex conditions that require coordination between interdisciplinary teams.
Specifically, healthcare leaders at Rochester Regional Health in New York, which is situated in a rural setting, noted their growing geriatric clientele to be a vulnerable population. Patients often traveled long distances to seek care and had limited access to specialty services.
Rochester Regional Health serves the people surrounding the Finger Lakes region of New York and beyond. This health system is comprised of nine hospitals and employs more than 19,000 people, of which more than 2,000 are medical providers and almost 4,000 are nurses. The hospitals within the health system participate in many programs offered by the ACS, including the Trauma Verification, Review, and Consultation Program, Vascular Verification Program, National Surgical Quality Improvement Program (NSQIP), Quality Verification Program, Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, Commission on Cancer, and the Geriatric Surgery Verification (GSV) Program.
Addressing the Challenge
In an effort to better serve this aging population, Matthew Schiralli, MD, FACS, executive medical director of surgical services, proposed that Unity Hospital of Rochester Regional Health become a beta site for the ACS GSV Program. In December 2020, Unity became the first site to achieve verified status.
Seeing the success at Unity Hospital, the health system made the decision to implement GSV at two additional hospitals in New York: Newark-Wayne Community Hospital and Clifton Springs Hospital & Clinic. A team, including Julie Giles, AGNP-C (geriatric provider), Jana Cooper-Slifko, FNP-C (geriatric surgery program manager), and Taylor Woodworth, PT, DPT, MBA (system surgical quality project manager), was convened. They focused on a targeted population of patients, 75 years of age and older and having urgent or elective surgery to define the scope of their problem.
The team used an internal data repository and ACS NSQIP data. The data collected from NSQIP were considered the “source of truth,” as the information was manually abstracted by nurses, leading to a high degree of accuracy. Data were collected from January through December 2020 (pre-implementation) and January through November 2023 (post-implementation/verification).
Key Findings
Notably, the team discovered that hospitals in the Rochester Regional Health system had begun implementing GSV standards prior to the start of COVID-19. During the pandemic, adherence to the GSV standards was suspended for a period, and as a result, the hospitals’ NSQIP data showed worsening outcomes. When the GSV implementation work resumed, outcomes improved. Woodworth noted that “When compliance [with the program] is high, the outcomes are better.”
In the pre-implementation phase, data were collected on 264 patients. Of those patients, 79.17% were discharged home after surgery and 19.32% went to rehab. In the post-implementation/verification phase, data were collected on 273 patients. Of those patients, 83.5% were discharged home and 15.4% were discharged to rehab (see Figure 1, below).
