Pilot Study of Dissemination and Implementation of a Virtual Acute Care for the Elderly Program on a Gastrointestinal Surgery Unit
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Every year, over 130,000 patients aged 65 years and older will have gastrointestinal surgery, yet postoperative care for older patients is plagued by prolonged hospitalization with poor recovery of cognitive, physical and social function. Outcomes in older patients are improved by an Acute Care for Elders (ACE) treatment model, in which multidisciplinary teams apply evidence-based principles of geriatric care. Unfortunately, diffusion of the ACE model into surgical care is limited because there is a shortage of geriatric specialists and many hospitals lack the resources to implement an ACE program. There is an urgent need to develop better methods of dissemination and implementation of the ACE model because it can improve postoperative recovery, enhance quality of life, and decrease healthcare costs for older surgical patients. Our institution's geriatrics group has developed a modified ACE intervention (virtual ACE) that promotes adoption of ACE principles while reducing demand for formal geriatric consultation. We use software to create a desktop computer virtual ACE dashboard that highlights patients with poor mobility, cognitive impairment, inadequate pain control, and use of high-risk medications. The dashboard triggers collaborative protocols for nurses and physicians to address these issues, and also coordinates and tracks progress toward recovery. These protocols actively engage nursing staff in processes of care and promote a multidisciplinary approach. Consequently, non-geriatric specialists can manage routine geriatric issues, and consult geriatric specialists only for the most complex cases. Virtual ACE has reduced delirium and improved mobility on medicine wards at our institution, and the geriatric team is now planning how to introduce the intervention to a gastrointestinal surgery unit. This creates a unique opportunity to assess whether virtual ACE can be adapted from medical units to improve outcomes (mobility, cognitive function, rate of home discharge) for surgical patients. The goal of this proposal is to assess the feasibility of adapting virtual ACE for use on a gastrointestinal surgery unit. The applicant is an accomplished young surgical health services researcher with a K12 grant studying postoperative recovery in geriatric patients. The proposed research is a vital step in the applicant's plan to develop a research program that improves postoperative recovery for older patients. We will achieve these goals through two aims: Aim 1: To enhance implementation of virtual ACE for its first use on a gastrointestinal surgery unit by assessing barriers and facilitators to adoption and fidelity, using a mixed methods approach (focus groups, surveys, observation). Aim 2: To obtain preliminary estimates of how virtual ACE affects clinical outcomes (length of stay, rates of home discharge, mobility) for gastrointestinal surgery patients age 65 years and older on one surgical unit, using a pre- post study design. The deliverables of this proposal include critical preliminary data for designing the first randomized trials of dissemination, implementation, and effectiveness of virtual ACE for surgical patients.
