GSV hospitals achieve substantially higher delirium screening in older surgical patients

There is a stark gap in how often hospitals screen older adults for postoperative delirium, with verified geriatric surgery programs screening nearly every patient while non-accredited programs screen just half, according to new findings published in the Journal of the American College of Surgeons. This disparity may mean thousands of cases are going undetected and unaddressed. 

The American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) Program is a quality program focused on preventing common complications like delirium, falls, and pneumonia in older surgical patients. 

Delirium is marked by an acute change in mental status and can appear as confusion, disorientation, or uncharacteristic drowsiness. Validated screening tools take only a couple of minutes at the bedside, looking for signs like inattention, disorganized thinking, or an altered level of consciousness. 

It's great to see that our GSV hospitals are incorporating delirium screens into their routine care, but the variation across hospitals is wide. A lot of delirium, especially in older adults, is hypoactive - it is the quiet form where a patient is withdrawn or lethargic. If you are not doing routine screening, these cases go undetected and can be mistaken for fatigue. Some hospitals may only be screening when a patient has hyperactive, very clinically obvious delirium, essentially using a screening tool to confirm a diagnosis rather than to get ahead of it." 

Sarah Remer, MD, MS, lead study author, an ACS Clinical Scholar and general surgery resident at Loyola University Medical Center in Maywood, Illinois

Study results 

• Screening rate differences: 94.3% of patients at GSV hospitals were screened for delirium, compared to only 52.5% at non-GSV hospitals. 

• Positivity rates were similar: Despite the large gap in screening, the rate of positive delirium screens was similar (11.3% vs. 12.5%). Hospitals with the lowest screening rates had very high positivity rates. 

• GSV hospitals had shorter stays among screened patients: Among patients who were screened for delirium, those treated at GSV hospitals had shorter lengths of stay and fewer prolonged hospitalizations. 

• Once delirium sets in, benefits diminish: For patients who did develop delirium, outcomes like length of stay and readmission were similar regardless of where they were treated. 

"Delirium is associated with longer hospital stays, worse patient outcomes, and higher healthcare costs. Our findings suggest that one of the greatest benefits of GSV may be in the standardized, multidisciplinary care processes that support prevention, early recognition, and early recovery," Dr. Remer said. "Routine delirium screening is important because it allows for early recognition, the ability to intervene, and also the opportunity to evaluate for precipitating factors." 

Screening supports early recognition and intervention, but this study was not designed to determine whether screening itself prevents delirium. 

The role of family and friends 

Loved ones can play a critical role. Because delirium typically looks different from a person's usual behavior, family members and caregivers are often the first to notice something is wrong. "Families and caregivers are often first to notice subtle changes in a patient's thinking or behavior," Dr. Remer added. "Seeing a loved one confused postoperatively can be distressing, but family members play an important role in helping patients stay oriented and alerting the clinical team to any sudden changes. Because you know your loved one best, your observations can be incredibly valuable." 

Dr. Remer recommends these practical, age-friendly steps to help prevent and manage delirium: 

• Ensure glasses and hearing aids are returned to the patient as soon as possible after surgery. 

• Keep a clock and calendar visible to help patients stay oriented to the time and date. 

• Keep the room bright with windows uncovered during the day and dark at night to support a natural sleep-wake cycle. 

• Encourage patients to be awake and engaged during the day by talking about familiar people, places, and current events. 

GSV supports patients through each step 

The findings build upon a growing body of research demonstrating the value of the ACS GSV Program, which requires hospitals to implement standards that address the specific needs of older adults. 

Previous studies have linked GSV accreditation and geriatric-specific care with measurable improvements, including: 

• Improved outcomes: Older adult surgical outcomes improve with fall prevention and delirium screening. 

• Shorter hospital stays: Hospital stays were shorter and rates of postoperative delirium were lower during a beta test of the GSV program at a Veterans Affairs hospital. 

• Better care in the community: More patients maintain independence and have shorter hospital stays after major cancer surgery following GSV implementation. 

• Lower death rates: There was a 50% reduction in postoperative death rates and improved documentation of patient care preferences among hospitals participating in the GSV Program. 

• Fewer complications: A dedicated geriatric surgical pathway with GSV-aligned practices is associated with one fewer day in the hospital on average and a 50% lower risk of complications such as respiratory failure and sepsis.