The number of aging Americans and their need for comprehensive healthcare is only growing. About 40% of surgical patients at Brigham and Women’s Hospital are over the age of 65, and on average, these patients are more likely to have worse surgical outcomes than younger people.
Teams across the Brigham have been working to elevate the quality and safety of geriatric surgical care for over a decade. In November 2023, the American College of Surgeons (ACS) validated these efforts by recognizing the Brigham as a national leader in geriatric care with Level 2 Verification-Focused Excellence status in its Geriatric Surgery Verification (GSV) Quality Improvement Program.
To earn GSV designation, hospitals must meet 32 quality standards for a percentage of surgical inpatients aged 75 and above. The Brigham is the first healthcare institution in New England and the first hospital of its size nationwide to achieve GSV designation.
Improving Care for Older Adults
Among many efforts from the Brigham to improve care for older adults are the Geriatric Inpatient Fracture Service (GIFTs) and Geriatric Co-Management for Orthopedic Patients programs, led by Houman Javedan, MD, clinical director of the Division of Aging. These programs aim to make orthopedic surgery safer for patients aged 70 and up.
A key part of this work is also the Superior Surgical Treatment for sEniors Pathway (SSTEP). SSTEP is a program available across the hospital that encompasses pain management, early mobility, sleep, and nutrition for older adults. The program has been shown to improve outcomes, decrease delirium, and lessen readmissions for older patients.
Some older patients require more specialized care, and the Brigham is championing protocols like SSTEP that lead to better care for more vulnerable patients. Across the Brigham’s 21 outpatient surgery clinics and Emergency Department, patients 75 and older are screened for frailty using the FRAIL scale, with questions that assess fatigue, resistance, aerobic capacity, illness, and loss of weight. If a patient is considered frail, has cognitive impairment or dementia, they have a consultation scheduled with a geriatrician. This entails a comprehensive assessment of the patient’s health, as well as discussing goals of care with the patient and their family before surgery or significant intervention.
In addition to these and other initiatives, Brigham physicians make sure to spend a significant amount of time sitting and talking with older patients and their families—not only to identify their problems and discuss goals of care, but to provide a human element that can sometimes be lacking in modern healthcare.
Read more about geriatric care the Brigham and its ACS Geriatric Surgery Verification on Brigham Bulletin.