A recent article in The New York Times highlights the risk taken by frail patients who undergo any kind of surgery, as well as a new tool that can assess that risk. Daniel Hall, MD, MDiv, MHSc – a VA surgeon and core investigator with HSR&D’s Center for Health Equity Research & Promotion (CHERP), as well as an Episcopal priest – was awarded Gold Status in the Diffusion of Excellence Shark Tank Competition for research on improving the decision-making and pre-operative care of frail patients scheduled for elective surgery. Dr. Hall’s Gold Status project features a clinical tool called the risk analysis index that allows healthcare providers to screen frail elderly Veterans before they have surgery. At the Omaha VA Medical Center, the tool triggered administrative review of frail patients considering surgery, and the mortality rate among frail Veterans dropped from 25% to 8%. Developed by Dr. Hall and his colleagues, the screening tool has subsequently been implemented at VA Medical Centers in Pittsburgh, Phoenix, Atlanta, and Palo Alto. In each case, the tool elicited a “pause” for frail patients during which a variety of interventions were deployed – all aimed at improving care.
When appropriate, frailty needs to be added to the discussion between surgeons and their patients and families, who need to understand not only surgical risks, but what their lives may be like after surgery. “It might not dominate the decision, but it could engender a few more questions,” said Dr. Hall.