Kaiser Permanente Fresno has received the Level 1 – Comprehensive Excellence Geriatric Surgery Verification from the American College of Surgeons. It is only the second hospital in the nation to receive the recognition.

Kaiser Permanente Fresno was chosen as 1 of 8 facilities in the United States to participate as a beta pilot site for this program in 2018. In 2019, the American College of Surgeons Geriatric Surgery Verification standards were released. Critical program work and data collection at the local and regional level took place throughout 2020 until the verification survey occurred in August 2021.

“Kaiser Permanente Fresno’s verification is a powerful testament to its focus on quality care for our senior patients,” said Smita Rouillard, MD, associate executive director of The Permanente Medical Group. “Leveraging the integrated system our organization is known for, we are now focused on moving forward to achieve this important verification throughout our Northern California medical centers.”

Following the successful Fresno pilot, champions of the program are working to spread it to all 21 Northern California medical centers, starting with the Oakland, Richmond, Modesto, Manteca, Walnut Creek, and Antioch medical centers.  When this rollout is completed, Kaiser Permanente Northern California will be the largest health system to adopt the standards.

The elements of patient-centric geriatric care

“Geriatric surgery is an area of patient care that has not always been in the forefront of U.S. clinical discussions,” said Subhendra Banerjee, MD, assistant physician in chief of Quality and Patient Safety and Senior Surgical Care Program (SSCP) physician director at Kaiser Permanente Fresno. “Our program highlights how to provide the best care for older adults — care that is relevant and the type they would like to receive. It’s also a recognition for the medical and surgical community on how we evaluate and assess care for these patients before elective or emergency surgery. It’s a huge paradigm shift.”

The SSCP is a framework of evidence-based practices for surgical patients age 75 and older. At Kaiser Permanente Fresno, members 65 and older comprise 19% of the total membership. According to the U.S. Census Bureau, in 2034, older people are projected to outnumber children for the first time in U.S. history.

“Kaiser Permanente Fresno’s verification is a powerful testament to its focus on quality care for our senior patients,”

“We rolled out this program to our inpatient procedures for general surgery, orthopedics, urology, and vascular surgery,” said Gina Clarke, clinical innovation deployment leader and Kaiser Permanente Fresno SCCP coordinator. “There are 30 program standards developed by the American College of Surgeons (ACS). The standards include a variety of elements, but a key aspect includes discussing the patient’s overall treatment and goals of care. Surgeons have discussions beyond surgery risks and benefits to find out what’s important to our patients.”

Other program standards are related to postoperative management and transitions of care. The return of personal sensory equipment, such as glasses and hearing aids, soon after surgery are part of the program. Having geriatric friendly rooms is also important, Clarke said.

“These standards help prevent delirium,” she said. “Windows in patient rooms help patients determine the difference between day and night. And large clocks, nonslip floors, handrails, and contrasting wall and floor colors are all important factors in an elderly patient’s care.”

For elective surgeries, SSCP patients are evaluated by a geriatrician. High-risk patients are reviewed by a multidisciplinary group of physicians from different specialties. They discuss vulnerabilities and make recommendations. The final decision is made with the patient and the family.

Additional program goals include reduced incidence and severity of surgical complications, reduced post-surgical cognitive and functional decline, and reduced mortality and morbidity in older adults.

“Going through the ACS verification process assures we have adopted the evidence-based practices of the geriatric surgical care program with fidelity to the model,” said Robin Betts, vice president of Safety, Quality and Regulatory Services. “Each facility partners with the ACS to bridge any gaps in their performance against the program standards. This assures a highly reliable experience for every patient every time, no matter where they receive care in Northern California.”

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