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“As the older population ages, the numbers of older adults seeking surgical intervention to improve their general wellbeing has increased (Lin et al., 2016). The older adults have significant variability in physiological reserve and, as such, biological importance outweighs chronological age. According to Partridge et al., 2012, studies in various surgical populations have identified frailty as an independent risk factor for major postoperative complications, protracted length of stay (LOS) and institutional discharge. Most healthcare organization has placed emphasis on the detection of frailty in the pre-operative setting given its association with unfavorable surgical outcome (Milder et al., 2018).The importance of measuring frailty in a surgical population lies in its utility both as a tool for preoperative risk stratification, also as a method for identifying potentially modifiable factors that can be optimized preoperatively (Partridge et al., 2012)
In order to improve patient outcome after surgery, there is a shift towards recognizing the pre-surgical period as an effective means tooptimize the physical status of the patient before the stress of their operation (Scheede-Bergdahl et al., 2019). Given the increased vulnerability of frail patients presenting for surgery,Prehabilitation might be especiallyadvantageous in the older adults’ population (Milder et al., 2018). Early implementation ofPrehabilitation will increase the physiological reserve of frail patients, reducing the risk of irreversible functional decline following surgery.Prehabilitation is defined as a process of improving the functional capability of a patient prior to a surgical procedure so the patient can withstand any postoperative inactivity and associated decline (Prehabilitation, n.d.). This Quality Improvement (QI) project address Safe and Timely domain on the Institute of Medicine (IOM)
This QI projectseeks to improve completion of prehabin a timely manner, with improvements in pre-operative functionalcapacity, and reductions in complications and length of hospital stay using the Edmonton FrailScale
References
Lin, H.-S., Watts, J. N., Peel, N. M., & Hubbard, R. E. (2016). Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatrics, 16(1).https://doi.org/10.1186/s12877-016-0329-8
Milder, D. A., Pillinger, N. L., & Kam, P. C. A. (2018). The role of prehabilitation in frail surgical patients: A systematic review. Acta Anaesthesiologica Scandinavica, 62(10), 1356–1366.https://doi.org/10.1111/aas.13239
Partridge, J. S. L., Harari, D., & Dhesi, J. K. (2012). Frailty in the older surgical patient: a review. Age and Ageing, 41(2), 142–147.https://doi.org/10.1093/ageing/afr182
Prehabilitation. (n.d.). American College of Surgeons. Retrieved October 2, 2020, from https://www.facs.org/quality-programs/strong-for-surgery/clinicians/prehabilitation
? Scheede-Bergdahl, C., Minnella, E. M., & Carli, F. (2019). Multi-modal prehabilitation: addressing the why, when, what, how, who and where next? Anaesthesia, 74, 20–26.https://doi.org/10.1111/anae.14505
Six Domains of Health Care Quality | Agency for Healthcare Research & Quality. (2018). Ahrq.Gov. https://www.ahrq.gov/talkingquality/measures/six-domains.html”