The Surgical Pause is an evidence-based practice designed to optimize value-concordant care of high-risk, frail patients before and after surgery. The practice relies on a simple, 30-second patient-facing survey called the Risk Analysis Index (RAI) administered to every patient before meeting a surgeon. The RAI identifies the 5-10% of patients with the greatest risk of complications, extended hospital stays, readmissions, institutionalizations, and death. This allows the surgeon, patient, and interdisciplinary care team to pause and ensure that surgery is consistent with the patient’s overarching goals of care and provides an opportunity to optimize the chances of achieving those goals through preoperative rehabilitation. As many as 1 in 3 Veterans older than 65 have surgery in the last year of life. After implementing the Surgical Pause, 10-20% of Veterans choose non-operative treatment as most consistent with their goals. And for those who proceed to surgery, the Surgical Pause cuts postoperative mortality from more than 25% to less than 8%.