Implementation of shared decision-making conversations in the preoperative evaluation clinic: Developing an educational curriculum and improving quality

Abstract

BackgroundThe American College of Surgeons created the Geriatric Surgical Verification program to improve the quality of perioperative care for geriatric patients. The standards include the incorporation of shared decision-making with goals of care discussions as well as frailty and cognitive impairment assessments. As perioperative physicians, anesthesiologists can provide many of these discussions in the preoperative assessment clinic. Our project developed an educational curriculum for anesthesiology residents to train them to effectively conduct these conversations, eventually expanding these assessments to all providers in our perioperative clinic. We describe our team's implementation of shared decision-making conversations and frailty assessments into preoperative evaluation clinic workflow for patients greater than 65 years old MethodsUsing the six-step approach to curriculum development, we provided resources to improve anesthesiology residents’ communication skills and ability to use shared decision-making conversations to guide perioperative management.1 We also used Plan-Do-Study-Act cycles to streamline the assessments and expand its utilization for all providers seeing geriatric patients in the perioperative assessment clinic. We measured added time to clinic visit and volume of patients. We provided templates and literature with faculty support for residents. The documentation was further integrated with the preoperative assessment note. ResultsDuring the initial implementation period, 110 patients participated in shared decision-making conversation with residents, increasing visit time by an average of 7.29 minutes. This was a small enough increase that the template was expanded to all providers in the preoperative assessment clinic. Residents had only 1-5 prior goals of care discussions, and believed the curriculum provided greater opportunity and structure to improve their skills in this domain. ConclusionWe found this implementation to be successful with increased value in the preoperative evaluation clinic while also bolstering our shared decision-making educational curriculum for our anesthesiology residents. Since this study is a pilot, the impact and finalized intervention and curriculum are still being refined.