A recent VA initiative targeting the care of fragile veterans considering surgery received a national innovation award for patient safety – one of several examples of the department’s work to care for a rapidly aging patient population.

Why make this a priority? While the number of aging patients continues to grow across the U.S., those over 65 in the Veterans Health Administration (VHA) represent a greater portion of the patient population than that of any other health care system. The number of veterans enrolled in VA health care age 85 and older will increase by 38% in the next 15 years, according to VA projections.

Five years ago, the VHA set out to make itself, as the largest health care system in the U.S., an age-friendly system by establishing evidence-based practices to meet individual needs rather than a one-size-fits-all approach. Elderly, fragile patients are a particularly challenging population for health care systems and a known risk for poor health outcomes following surgery.

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The VA recently rolled out an initiative at all medical facilities called VA’s Surgical Pause, a program which quickly screens high-risk veterans for frailty and triggers a “pause” to review patient goals and care options when appropriate. On Feb. 13, the VA was presented with the John M. Eisenberg Patient Safety and Quality Award for this novel approach to improving safety and quality of care outcomes for fragile veterans considering surgery. 

“The Surgical Pause is an innovative, data-driven clinical practice that saves veterans lives by predicting and preventing complications before they happen,” said VA Under Secretary for Health Dr. Shereef Elnahal. “We are thrilled to be rolling out the Surgical Pause across the nation as part of VA’s steadfast commitment to providing veterans high-quality, world-class health care they deserve.”

The Surgical Pause’s risk analysis index (RAI) takes about 30 seconds and can be performed at a patient’s bedside. The index “not only provided a rapid, flexible method for preoperative frailty assessment,” according to a 2023 study, “but also proved reliable for estimating postoperative outcomes following elective surgery.”

One-year mortality fell from 20% to 16% among the nearly 55,000 patients captured in the study, which included VHA and private-sector patients.

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Recognized as a promising practice, VHA’s Surgical Pause is a 2023 national initiative championed by VA’s National Surgery Office. The study offers an opportunity for VA and U.S. health systems to identify other practice settings to implement fragility screening and interventions to improve outcomes for these high-risk patients prior to surgery.

MOAA’s Role

MOAA is grateful for VHA’s focus on improving the health and safety of our aging veterans, and we remain committed to working collaboratively with the department and Congress to improve the lives of these veterans and their caregivers through legislation, funding, or changes in policy.

Ask your lawmakers to support the Elizabeth Dole Home Care Act, the Expanding Veterans’ Options for Long-Term Care Act, and the Veteran Caregiver Application and Appeals Reform (CARE) Act. This legislation will make a major difference in the lives of those who need this support the most.