Specialty Care Education Center of Excellence Grant

A Center of Excellence grant is supporting the establishment of VA POSH (VA Perioperative Optimization of Senior Health) at the Durham VA Medical Center.

The funding comes from the Office of Academic Affiliation (OAA) as a collaboration between the VHA’s Geriatrics Research, Education, and Clinical Centers (GRECC), Surgery, Anesthesia, and other services.

VA POSH builds on the success of POSH at Duke. In addition to providing POSH services to older veterans, VA POSH also has an education component for trainees.

Co-directors: Sandhya Lagoo-Deenadayalan, MD, PhD, and Mitchell T. Heflin, MD
Program manager: Nancy Loyack, DNP, FNP-BC

Confusion Avoidance Led by Music (CALM)

Some POSH patients have had the opportunity to participate in a project called Confusion Avoidance Led by Music (CALM). The first year of CALM was funded by the Duke Institute for Health Innovation (DIHI).

Numerous studies have demonstrated the effectiveness of personalized music in reducing the perception of pain and anxiety in hospitalized patients, which may in turn reduce incidence of delirium.

A member of the CALM team visits POSH participants on the day of their appointment in the GET clinic to explain how music can improve their hospital stay. POSH patients that elect to participate receive an iPod shuffle after surgery with some of their favorite music pre-loaded onto it. They are encouraged to listen to the music in the hospital whenever they wish, but ideally at least twice a day for 20 minutes at a time. Nursing assistants are enlisted to help and encourage patients to listen to the music.

Data collected from this project—including length of stay, episodes of delirium, and discharge disposition—are currently being analyzed. Neema Sharda, MD, said that in general, “Patients are satisfied with the music and they believe it influences mood and pain.”

One participant said, "I had knee surgery 3 years ago, and was really ‘out of it.’ I wasn't ‘out of it’ at all after this surgery, and the music made it easier to control my pain."

Sharda plans to continue to offer CALM to POSH patients, perhaps with the help of hospital volunteers.

Project leadership: Neema Sharda, MD, and Heidi White, MD

Optimization of Perioperative Care Through Machine Learning

A project funded by the Duke Institute for Health Innovation (DIHI) is looking to harness the power of computers and electronic health records to help POSH reach more patients who could benefit from its services.

Sandhya Lagoo-Deenadayalan, MD, PhD, one of the principal investigators of the project, said, “If a patient needs surgery, we should be able to scan the electronic record and pull out important variables that tell us whether the patient is low risk, medium risk, or high risk.” High-risk patients would automatically be referred to POSH, while those at low risk would receive a telephone call to double-check for any potential problem areas. Those in the middle would be assessed face-to-face in the Preoperative Screening Clinic to determine whether they would benefit from POSH or not.

Another aspect of the project is to use computers and electronic health records to identify those POSH patients who could benefit the most from active interventions, such as physical therapy before surgery, meeting with a nutritionist before surgery, and/or delirium-avoidance strategies.

Principal Investigators: Sandhya Lagoo-Deenadayalan, MD, PhDMitch Heflin, MDErich Huang, MD, PhDKatherine Heller, PhDMadhav Swaminathan, MDAnnemarie Thompson, MDZhifei Sun, MD, Katherine Stanley, MBA