The care of older adults is personal for Courtney Collins, MD, a clinical associate professor of Surgery. She watched as her grandfather faced health issues in his 80s and encountered reluctance from health care professionals to operate on him due to his age. Fortunately, her grandfather met a physician who really listened to him and got him the care he needed. He ended up living until he was 101 years old.
Today, Dr. Collins is the driving force behind Ohio State implementing the Geriatric Surgery Verification (GSV) program, created by the American College of Surgeons, in the Department of Surgery. The GSV endows Level I and Level II certifications to medical centers that meet 30 standards related to improved outcomes for patients and the hospital. The Ohio State University Wexner Medical Center aims to become the largest medical center in the country to achieve a Level I certification within the next year.
“With older adults comprising more than 40% of inpatient surgery patients – and having a 28% readmittance rate – it’s more important than ever that we have a specific program to care for this population,” Dr. Collins says. “We try to approach these vulnerable patients using a holistic approach that optimizes the entire care pathway from preoperative evaluation through discharge.”
GSV member hospitals must demonstrate improvement with common issues for elderly surgical patients. This includes reducing falls and other injuries, lowering lengths of hospital stays, lowering risks of delirium and significantly reducing costs overall. A key feature of GSV hospitals is the use of multidisciplinary nursing rounding teams that focus on reducing length of stay through strategies like discharge plans and decision-making conferences.
“So much of this patient-centered approach is ensuring everyone is communicating constantly. We may each know what to do individually, but the entire team has to huddle and close the gaps when it comes to shifts, specialties, serial assessments of overall health status and changing issues related to the patient’s family and caregiver,” Dr. Collins says.
She says reducing the risk of delirium alone could save $20,000 per patient on average, not to mention sparing more patients a dangerous and potentially preventable incident.
Dr. Collins was also instrumental in powering a change in Medicare reimbursement that incentivizes better care for all older adults. Led by Dr. Collins and the American College of Surgeons, the Age Friendly Hospital Measure is a combined effort with the American College of Emergency Physicians and the Institute for Healthcare Improvement to place best practices for older patients into a streamlined pathway throughout all areas of the hospital. Hospitals will be required to attest to completing this measure and could be at risk of financial penalties if they’re not compliant.
She also cites other improvement projects that have come to fruition in 2024, including building a Preoperative Screening Checklist into the Ohio State Wexner Medical Center’s electronic medical record to allow for the identification of geriatric-specific perioperative risk factors. It provides ready access to the list of both universal and specialty-related tasks that help lower risks and optimize results.
The Geriatrics team also won a grant to provide supplies like eye masks, activity books and audiovisual aids to make rooms more accommodating for older patients.
“I think overall we have some great foundational pieces and now we’re proactively working to expand on these. The support from the top of the institution down has been amazing,” she says.