In older adults having surgery, frailty is one of the strongest predictors for complications, longer hospital stays, high healthcare costs, and mortality. Screening can identify patients who are at risk, but screening alone won’t improve patient outcomes unless it is paired with targeted and actionable risk reduction. With a new one-year Learning Health Demonstration Project award from the UW Institute for Clinical and Translational Research (ICTR) and UW Health, Division of Colorectal Surgery Associate Professor Julia Berian, MD, MS will be partnering with Alexis Eastman, MD from the UW Division of Geriatrics and Gerontology to implement a scalable frailty screen that also links high-risk patients to appropriate risk reduction interventions without adding additional work for nurses, physicians, and other frontline clinical staff.
“We think of frailty in older adults as the body losing its natural reserves and its ability to ‘bounce back’ from illnesses or injuries. It’s characterized by symptoms like exhaustion, weakness, slowness, physical inactivity, and unintentional weight loss, all of which can make a patient vulnerable to health problems and make it harder for them to recover from surgery,” Berian explained. “We have not yet implemented routine frailty screening for older surgical patients at UW Health, and we have this amazing resource in the Perioperative Optimization for Senior Health (POSH) Clinic that is currently being underutilized.”
The POSH Clinic was founded by Eastman and delivers the gold-standard Comprehensive Geriatric Assessment (CGA) to identify and address modifiable frailty-specific surgical risks, such as polypharmacy and nutrition. Although the CGA is greatly valued and has been demonstrated to be highly effective, UW Health surgeons currently refer only 8% of eligible frail older patients to the POSH Clinic, resulting in inconsistent clinic fill rates. In addition, the CGA is resource-intensive, so any effort to increase referrals needs to consider the operational costs of doing so. Berian and Eastman are thus partnering up to test automated frailty screening for surgical patients aged 80 and older combined with automatic POSH referral if screening results indicate the patient is high risk. This intervention will be compared to usual care, which involves notifying the surgeon of the patient’s frailty score and leaving it to the surgeon to initiate POSH Clinic referral. Results from this study at the UW will be used to support grant applications to conduct more widespread testing through a multi-center trial.
“We’re hopeful that the automated screening and referral system will ensure that the right patients – those who are the frailest – are referred to UW’s POSH Clinic without overwhelming the team’s capacity to see these patients. If successful, this study could not only improve surgical care for older adults at the UW, it could also generate knowledge about the implementation of POSH Clinics and automated screening and referral pathways at other institutions, benefitting older adults across the U.S.”
The project described here is being jointly funded by UW Health and ICTR. ICTR is supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR002373. The content is solely the responsibility of the authors and does not necessarily represent the official views of UW Health or the NIH.