title: Quality improvement pilot program for vulnerable elderly surgical patients.
abstract: The elderly are a growing surgical population with more comorbidities and less physiological reserve compared with nonelderly patients. The objective of our study was to implement a quality improvement pilot program targeting the specific needs of the elderly. We prospectively enrolled  consecutive patients aged 65 years or older undergoing inpatient general or vascular surgery operations. Patients completed a preoperative assessment including the Vulnerable Elder Survey (VES) to determine baseline functional status and incidence of polypharmacy (five or more medications).  They were interviewed postdischarge Day 2 and Day 30 for changes in functional status. An intervention was implemented consisting of an elderly-specific postoperative order set and preoperative risk reports sent to the surgical team with instructions to order physical therapy consults and  home health nursing on discharge for VES 3 or greater and geriatrics consults for patients with polypharmacy. The elderly-specific order set was used for 71 per cent of the postintervention group. There were no differences in the percentage of participants receiving physical therapy, geriatric,  or home health nursing consults between the two groups. The postintervention group had significantly better functional status on postdischarge Day 30 (P < 0.01). Our preliminary data suggest that individualizing care for elderly patients is feasible and may improve postoperative  outcomes.
authors: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-6904, USA.
authors: Jennifer
authors: J
authors: Cronin
authors: Masha
authors: M
authors: Livhits
authors: Cheryl
authors: C
authors: Mercado
authors: Formosa
authors: F
authors: Chen
authors: Nova
authors: N
authors: Foster
authors: Charles
authors: C
authors: Chandler
authors: Melinda
authors: M
authors: Gibbons
authors: Clifford Y
authors: CY
authors: Ko
authors: David C
authors: DC
authors: Chen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D010865:Pilot Projects; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards / Q000639:trends*; D013514:Surgical Procedures, Operative; D011795:Surveys and Questionnaires