In 2016, the American College of Surgeons (ACS), in partnership with The John A. Hartford Foundation (JAHF), began conducting a 4-year initiative to improve the care of older adult surgical patients through the development of a quality improvement standards and verification program for hospitals. The Geriatric Surgery Verification (GSV) Program, originally known as the Coalition for Quality in Geriatric Surgery, aimed to produce a framework for improved geriatric surgical care, generalizable to all hospitals regardless of size, location, or population served.
The project convened experts and engaged a broad set of interprofessional, consumer, and industry stakeholders to
- Set evidence-based standards for hospitals for the needed infrastructure to provide optimal care
- Select and develop measures that truly matter for older patients that can be used to assess hospitals and guide improvements
- Develop patient and provider educational resources
- Build a self-sustaining peer-review verification program, similar to ACS’s successful trauma and bariatric surgery verification programs that have been shown to improve care and save lives.
In July 2019, the ACS GSV Program was successfully launched. With the successful launch of the program and despite the disruption of the COVID-19 pandemic, the GSV Program began to steadily recruit and enroll hospitals to participate and implement the program.
GSV Phase II: Evaluation and Improvement
The GSV successfully recruited initial participants and the ACS received expert input from the first JAHF-funded grant. The program then looked to expand implementation into a broad spectrum of hospitals across the nation representing diverse populations—including the seriously ill—in varying geographic locations with differing needs and across racial, ethnic, and socioeconomic lines. In 2021, again with the generous support of the JAHF, the ACS was awarded a 3-year grant initiative—“GSV Phase II: Evaluation and Improvement”—to specifically evaluate the GSV Program’s content, implementation, and outcomes to foster broad dissemination to diverse sites, including rural settings and safety net hospitals. The project team also worked with experts and stakeholder groups to incorporate palliative care standards into the program to better meet the needs of older adult surgical patients with serious illness.
Prior to conducting the evaluation, experts in geriatrics and geriatric surgical care from Brigham and Women’s Hospital in Boston, Mass., led an expert panel to identify and determine the critical palliative care elements missing from the GSV Program. Ultimately, the palliative care element identified by the panel will be incorporated into the next iteration of the GSV standards, Optimal Resources for Geriatric Surgery.
Subsequently, the ACS partnered with NORC at the University of Chicago, a third-party evaluation entity, to conduct this rigorous evaluation of the successes and shortfalls of the GSV Program. Not only did this evaluation independently confirm the feedback the ACS had been receiving from its participating GSV hospitals, but it also laid the groundwork for the next phase of the program’s growth.
GSV Phase III: Age-Friendly Surgery, A Delirium-Focused Entry to GSV
Building on the goal of expanding the implementation of GSV into hospitals across the nation, the ACS received another 3-year grant initiative from JAHF in 2024, “GSV Phase III: Age-Friendly Surgery, A Delirium-Focused Entry to GSV.” The aim of this project will be to continue improving surgical care of older adults by offering hospitals an entry level to GSV participation while focusing on one of the core pillars of the GSV Program—addressing the prevention, identification, and treatment of postoperative delirium.
Recognizing that delirium is a common and serious complication in older surgical patients, this new level is being designed to accommodate hospitals of all sizes and resource levels. The goal is to enable these hospitals to establish an age-friendly infrastructure that improves the quality of care for older patients. This level will introduce a targeted set of standards that hospitals can implement to lay the groundwork for comprehensive delirium management. To support this effort, a detailed protocol will be developed, providing clear, actionable steps for surgical teams to follow to better prevent, recognize, and treat delirium, ultimately leading to improved outcomes for older adults. Integration with other ACS Quality Programs will be pursued and educational resources will align with the Age-Friendly Health Systems 4Ms Framework.
