Anesthesiologists' and Surgeons' Perceptions of the Impact of the American College of Surgeons Geriatric Verification Program on Co‐Management of Older Surgical Patients: A Qualitative Mixed Methods Analysis
Bibliographic record
Abstract
BACKGROUND: The American College of Surgeons (ACS) published the Geriatric Surgery Vlerification (GSV) program in 2019, establishing standards to improve geriatric care perioperatively. A multidisciplinary approach to the management of these patients aims to optimize preoperative health, mitigate perioperative complications, and provide valuable insights in terms of postoperative expectations for recovery. At Brigham and Women's Hospital (BWH), the first major academic hospital to be verified by the ACS, implementation of GSV standards has included a collaborative effort by a team including anesthesiologists, geriatricians, nurses, and surgical clinicians. Our novel study investigating clinician perceptions on the impact of this co-management program at BWH will serve to inform other hospitals that are in the process of or considering implementation of GSV. PARTICIPANTS AND SETTING: Participants included 20 anesthesiologists who completed surveys and 22 clinicians (anesthesiologists, geriatricians, and surgeons) who participated in interviews at BWH. METHODS: We used a convergent mixed-methods design. Quantitative surveys assessed exposure to geriatric co-management and perceived practice changes. Semi-structured interviews explored clinician experiences. Survey items covered demographics, perioperative decision making, and barriers to implementation. Interviews were transcribed and analyzed using inductive content analysis. RESULTS: Ninety-five percent of surveyed anesthesiologists reported modifying care based on geriatric recommendations. Changes included anesthesia technique, medication choices, monitoring strategies, and attention to goals-of-care discussions. Ninety percent said geriatric input influenced their preoperative communication, and 85% indicated documentation of goals of care informed anesthesia planning. Interview themes included enhanced advance care planning, detection of vulnerability, alignment with patient goals, reinforcement of best practices, and improved interdisciplinary communication. Limited access to geriatric consultation was the primary barrier to broader implementation. CONCLUSION: Clinicians reported favorable perceptions of GSV implementation. These findings support broader GSV dissemination and highlight opportunities to optimize interdisciplinary collaboration. Future studies should evaluate clinical outcomes, scalability, and the role of non-geriatrician providers in geriatric co-management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.023 | 0.035 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.005 | 0.004 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".