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The Surgical Pause

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Data demonstrate there is no such thing as low risk surgery in high risk, frail patients; in fact, 1 in 3 frail Veterans will die within 6 months of even “small surgery”. Historically, there was no reliable and quick way to identify the highest risk patients at the point of care before committing to a surgical plan. Recognized as a Promising Practice by the VHA Innovation Ecosystem’s Diffusion of Excellence, the Surgical Pause utilizes the simple yet sophisticated Risk Analysis Index (RAI) to screen Veterans for frailty in 30 seconds, effectively flagging high risk Veterans so that the surgical team can ensure that the proposed treatment plans both mitigate known risks and align with the Veterans’ overarching life goals. Transparent communication about the risks of protracted recovery or loss of independence after surgery empowers patients to consider non-operative management strategies. And for those who nonetheless elect surgical intervention, preoperative exercise training for as little as 3-6 weeks before surgery may improve outcomes by increasing physiologic reserve. By bringing additional resources to such frail patients, the Surgical Pause improves outcomes and adds value.

This innovation is scaling widely with the support of national stakeholders. See more scaling innovations.

Adoptions:

7 successful, 33 in-progress

Awards and Recognition:

Part of SAGE QUERI Program (VISN 4) , Focus of the PAUSE Trial (HSR&D funded multi-site study), Diffusion of Excellence Promising Practice, Aligned with 4- Year HSR&D Funded Merit ... Part of SAGE QUERI Program (VISN 4) , Focus of the PAUSE Trial (HSR&D funded multi-site study), Diffusion of Excellence Promising Practice, Aligned with 4- Year HSR&D Funded Merit Review Project aimed at Improving Surgical Decision Making by Measuring and Predicting Long-Term Loss of Independence after Surgery, QUERI Partnered Evaluation Initiative

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Metrics

  • Length of Stay
  • Post-Operative Complications
  • Post-Operative Readmission
  • Decision Regret
  • Patient Centeredness of Care
  • Cost
  • Post-Operative Mortality

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

CA: Fresno VA Medical Center (Fresno)
  • Started adoption on 03/2021.
CA: Martinez VA Medical Center (Martinez)
  • Started adoption on 06/2021.
CA: Palo Alto VA Medical Center (Palo Alto, California)
  • Started adoption on 07/2021.
CA: Sacramento VA Medical Center (Sacramento)
  • Started adoption on 06/2021.
DE: Wilmington VA Medical Center (Wilmington, Delaware)
  • Started adoption on 04/2021.
FL: Bruce W. Carter Department of Veterans Affairs Medical Center (Miami)
  • Started adoption on 04/2021.
FL: C.W. Bill Young Department of Veterans Affairs Medical Center (Bay Pines)
  • Started adoption on 04/2021.
FL: James A. Haley Veterans' Hospital (Tampa, Florida)
  • Started adoption on 04/2021.
FL: Orlando VA Medical Center (Orlando)
  • Started adoption on 04/2021.
FL: West Palm Beach VA Medical Center (West Palm Beach)
  • Started adoption on 04/2021.
IL: Jesse Brown Department of Veterans Affairs Medical Center (Chicago, Illinois)
  • Started adoption on 06/2021.
IN: Fort Wayne VA Medical Center (Fort Wayne, Indiana)
  • Started adoption on 02/2021.
IN: Richard L. Roudebush Veterans' Administration Medical Center (Indianapolis, Indiana)
  • Started adoption on 02/2021.
KY: Troy Bowling Campus (Lexington-Cooper)
  • Started adoption on 01/2021.
MA: Jamaica Plain VA Medical Center (Jamaica Plain)
  • Started adoption on 12/2020.
MI: John D. Dingell Department of Veterans Affairs Medical Center (Detroit, Michigan)
  • Started adoption on 05/2021.
MI: Lieutenant Colonel Charles S. Kettles VA Medical Center (Ann Arbor, Michigan)
  • Started adoption on 05/2021.
MN: Minneapolis VA Medical Center (Minneapolis, Minnesota)
  • Started adoption on 01/2021.
NC: Durham VA Medical Center (Durham)
  • Started adoption on 02/2021.
NC: W.G. (Bill) Hefner Salisbury Department of Veterans Affairs Medical Center (Salisbury)
  • Started adoption on 01/2021.
OH: Cincinnati VA Medical Center (Cincinnati, Ohio)
  • Started adoption on 04/2021.
OH: Dayton VA Medical Center (Dayton)
  • Started adoption on 05/2021.
OH: Louis Stokes Cleveland Department of Veterans Affairs Medical Center (Cleveland, Ohio)
  • Started adoption on 05/2021.
PA: Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center (Philadelphia, Pennsylvania)
  • Started adoption on 04/2021.
PA: Lebanon VA Medical Center (Lebanon)
  • Started adoption on 04/2021.
PA: Wilkes-Barre VA Medical Center (Wilkes-Barre)
  • Started adoption on 04/2021.
PR: San Juan VA Medical Center (San Juan)
  • Started adoption on 04/2021.
TN: Nashville VA Medical Center (Nashville)
  • Started adoption on 07/2021.
TX: Audie L. Murphy Memorial Veterans' Hospital (San Antonio, Texas)
  • Started adoption on 07/2021.
TX: Dallas VA Medical Center (Dallas, Texas)
  • Started adoption on 08/2021.
TX: Michael E. DeBakey Department of Veterans Affairs Medical Center (Houston, Texas)
  • Started adoption on 02/2021.
WA: Mann-Grandstaff Department of Veterans Affairs Medical Center (Spokane, Washington)
  • Started adoption on 12/2019.
WI: William S. Middleton Memorial Veterans' Hospital (Madison)
  • Started adoption on 10/2020.

There are no unsuccessful adoptions for this innovation.