The Perioperative Surgical Home — Integrated Care

The Perioperative Surgical Home (PSH) is a patient-centered, physician-led system of coordinated care that guides patients throughout the entire surgical experience. From the decision for surgery to discharge from a medical facility and beyond, the PSH model of care is structured to improve patient care and outcomes.

 

The concept is a new way of thinking introduced by physician anesthesiologists to address a fragmented system whose inefficiencies create barriers to quality health care. The problem comes with a high price: Lack of coordination costs hospitals, payers and the health care system millions of dollars each year in delayed and canceled surgeries, postoperative complications and readmissions. Of the more than 51 million procedures performed in this country annually, surgical care accounts for more than half of hospital admission expenses. One post-surgical complication, such as pneumonia, can wipe out the entire revenue from a surgery.

Like the patient-centered medical home, PSH models are integrated systems of perioperative care designed to reduce fragmentation, improve efficiency and standardize procedures throughout the perioperative period.

Initial research shows that the PSH can improve outcomes and reduce costs as follows:

Reduces hospital length of stay:

  • In patients undergoing radical cystectomy, length of stay decreased by 55 percent.1
  • In patients undergoing an open nephrectomy, length of stay decreased by 50 percent.1
  • In patients undergoing total knee and hip replacement, length of stay decreased by 35 percent.2
  • In patients undergoing laparoscopic nephrectomy, length of stay decreased by 33 percent.1

Improves pain scores:

  • In patients undergoing outpatient orthopedic surgery, pain scores at discharge decreased by 50 percent.1
  • In patients undergoing outpatient orthopedic surgery, “recommend UC Irvine Health” and “pain satisfaction” rose to 100 percent (up from 80 percent).1

Saves money:

  • Saved $1.7 million in hospital operational costs (328 patients undergoing joint replacement and urological procedures).1
  • 92 percent of the first surgical cases of the day started on time.1
  • In total joint replacement surgeries, operating room turnover time improved by 30 percent.1

Reduces canceled surgeries:

  • Reduced same-day cancellation of surgery by 20 percent.2

Reduces postoperative emergency room visits:

  • In patients undergoing total knee and hip replacement, postoperative emergency room visits decreased by 33 percent.2

Improves patient satisfaction scores:

  • Press Ganey patient satisfaction scores were in the 98th percentile for patients undergoing hip and knee replacements.1

  1. UC Irvine Health, Department of Anesthesiology & Perioperative Care
  2. Kaiser Permanente Baldwin Park Medical Center