At the CPC, patients can go through a prehabilitation protocol, to better prepare them for the rigors of surgery and hopefully, improve their post-surgical prospects, says Mary Kay Wisniewski, a senior improvement specialist at the Wolff Center of UPMC, the system's quality improvement arm.
Prior to working with Hall, Wisniewski says the Wolff Center had been collecting data on surgery and outcomes.
One interesting group of data showed that one of the system's AMCs had done more than 60,000 elective surgeries, and 13% of those patients were high risk. Post-surgery, those patients accounted for 30% of ICU admissions and a large portion of postop deaths, she says.
Hall's frailty index tool was much better than other tools available that were focused on certain conditions or body systems, Wisniewski says.
"We needed to really understand where we can help patients improve before surgery," she says. "Undergoing two hours of anesthesia is as stressful as running a 5k race. Would you run that race without being prepared?"
That analogy got traction and interest from surgeons, she says.
The CPC focuses on patients the surgeon thinks can benefit from prehabilitation. It employs surgery coaches, generally advanced practice providers, who help patients with nutrition, weight management, exercise, pain management, mental health, smoking cessation, and goals of care, pre-surgery.
"We have algorithms that help surgery coaches follow a pattern and care plan," says Wisniewski.
As a scientist, Hall says while strong evidence clearly shows outcomes, including mortality readmission, length of stay, and complication rates, are all related to the frailty score—the evidence base for intervening is not yet fully developed.
The hope is, however, that as the evidence base increases and as surgeons and other clinicians become familiar, frailty will factor in how patients and doctors will interact over a surgical decision.
Philip Betbeze is the senior leadership editor at HealthLeaders.