EXECUTIVE SUMMARY
Most participants in a perioperative surgical home (PSH) initiative report they have enhanced quality, controlled costs, and/or improved patient experiences.
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A PSH pilot for adenoidectomy procedures at Nationwide Children’s Hospital decreased pharmacy costs by 32% and overall costs by 53%, which saved nearly $50,000 across the hospital’s first 19 cases.
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Most of the cost savings resulted from reduction in length of stay. This reduction was accomplished through a protocol, standardization of medications and anesthetics, and a YouTube teaching video.
Most participants in the perioperative surgical home (PSH) learning collaborative reported they enhanced clinical quality, controlled costs, and/or improved patient experiences as a result of their initiatives.
The PSH model is a patient-centered, team-based practice model of coordinated care that guides patients through the entire surgical experience, from the decision to undergo surgery to discharge and return to function. The results were announced by the American Society of Anesthesiologists (ASA) and Premier, a healthcare improvement company based in Charlotte, NC.
One success story was a PSH pilot for adenoidectomy procedures at Nationwide Children’s Hospital (NCH) in Columbus, OH, that decreased pharmacy costs by 32% and overall costs by 53%, which saved nearly $50,000 across the hospital’s first 19 cases.
“The PSH model and learning collaborative helped NCH providers truly work as a team, enabling us to lower costs, while still providing the highest quality of care,” says Vidya Raman, MD, a pediatric anesthesiologist at NCH. “The benefits of this improved system of care for our patients and their families are well worth the effort associated with implementing this initiative.”
Much of the cost savings came from eliminating the overnight stay for most adenoidectomy patients, Raman said in an interview with Same-Day Surgery. The pharmacy cost reduction resulted from having a protocol for the procedure from beginning to end, as well as using standardized medications and anesthetics. “It maybe is not the fanciest way, it maybe is not the newest drugs, but we’re using ones that have been shown to work and are associated with lower pharmaceutical costs,” Raman said.
Previously, adenoidectomy patients were kept for overnight stays due to sleep-disordered breathing, but even that situation was variable, she said. “Some were kept all night, and some were kept for a couple of hours on the floor and discharged,” Raman said. “We’re trying to standardize even that.”
Some of the critical steps for having the procedure be outpatient are pre-identifying patients and making sure they fit the criteria, ensuring the patients don’t have a far distance to travel home, and using a standardized cartoon YouTube video that patients can view with their caretakers at the hospital and then access again later if needed. (See the video at bit.ly/1R7c4Ha.) The video was done in-house with the media staff. The low-tech video emphasizes points such as when bleeding needs follow-up care. “I think that has helped the family,” Raman says.
The staff had to work to obtain the manpower needed to make the video, but the hospital leaders came to realize it would be valuable, because the teaching is standardized, Raman says. The hospital offers traditional discharge instructions as well.
Also, a physician follows up the night of the procedure with a standardized script of questions.
Sometimes surgery managers get “bogged down” with the name “perioperative surgical home,” Raman says. “It’s basically — call it whatever you want — an initiative to improve the process that’s in place,” she says. “You’re using various metrics, not going about it in a ‘hurly-burly’ fashion, but in a systematic fashion.”
Raman suggests that providers simply can look at patient care from beginning to end and ask, where does it need improvement? “If you have a preop weakness, you can work on that,” she says. “If you have postop issues, work on that. You shouldn’t shy away from it because you can’t do it in its entirely, which is sometimes hard.”
The PSH process isn’t just for large hospitals with infrastructure and resources, she emphasizes. “People can do this even without those, as long as you have a champion, a vested interest, and a [facility] that’s willing to go forth and save money and do good things,” Raman says. “It’s possible anywhere.”
The ASA/Premier PSH collaborative included 44 healthcare organizations that developed, piloted, and evaluated the model from July 2014 through November 2015. Most (73%) of the participants successfully launched one or more PSH pilot programs during the collaborative, with thousands of completed cases across 64 pilots. Many members of the collaborative selected pilots that focused on orthopedics, such as total hip and knee replacements, to help prepare for success in voluntary and mandatory bundled payment programs. Other commonly selected service lines included colorectal, general surgery, and urology.
The results of individual PSH pilot programs varied by institution, depending on variables such as service line chosen and key areas of focus.
In addition to the outcomes data collected by individual organizations, collaborative participants also collectively developed and tested common metrics to assess the impact of the model across the participants. Preliminary analysis of the data for these metrics will be a key area of focus for the next phase of the PSH learning collaborative, which will launch this month. (For more information, go to bit.ly/1XPFvCM.)
Daniel J. Cole, MD, ASA president, said, “The PSH, spearheaded by the ASA, was an opportunity simply to give better care to our patients, while at the same time achieving the goals of the triple aim: better health care, a better quality patient experience, and lower costs.”
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