American Society of Anesthesiologists
New research shows hospitals that use of a Perioperative Surgical Home (PSH) model of care may be more likely to achieve good clinical outcomes and lower costs of care for their surgical patients, than hospitals without a PSH program.
Those are the findings of a new systematic review published in the Journal of Clinical Anesthesiology (JCA), the peer-reviewed journal of the Association of Anesthesia Clinical Directors. This review analyzed 11 previous studies of the PSH model to examine the success PSH programs have had in improving patient care and reducing costs.
The PSH concept developed by the American Society of Anesthesiologists (ASA) in 2012, promotes interdisciplinary and coordinated care before, during and after surgery for each patient. A physician, such as a director of perioperative services, leads team members from surgery, anesthesia and hospital departments like radiology, nursing and laboratory services. Team members work together to provide coordinated patient care at each step of the surgical process, from pre-surgical planning to hospital discharge and beyond.
PSH program goals generally include reduced length of stays, reduced readmissions, improved complication and mortality rates, decreased resource use and improved operational efficiencies. The ultimate goal is to provide each patient with an improved surgical experience, while also reducing the costs to provide that experience.
The fact that the JCA study is a systematic review is important because most experts consider well-done systematic reviews to provide the best scientific evidence since they evaluate the findings of multiple studies. Authors identify studies to analyze by conducting a comprehensive literature search, then eliminate studies that are not done well or do not meet other scientific criteria. Authors then apply a set of consistent, exacting criteria to evaluate each study.
The review’s senior author, Thomas R. Miller, PhD, MBA, serves as ASA’s Director of Analytics and Research Services. “Early evidence indicates that through elements that emphasize care coordination, standardization, and patient-centeredness, PSH programs can improve patient postoperative recovery outcomes and decrease hospital utilization,” he said. “These benefits may be more pronounced when the PSH program is led by a perioperative anesthesiologist with expertise in caring for the patient across the entire spectrum of care.”
The researchers examined PSH outcomes like length of stay, postoperative recovery, how many patients were readmitted due to late complications, and whether patients were discharged home or to a rehabilitation facility. The study found that each described PSH was unique to its institution because individual hospitals may have prioritized different outcomes or emphasized different program structures. However, the review also found that PSH programs shared some common elements, too. Most programs described in these studies emphasized preoperative patient education, standardized care protocols for all phases of surgery, use of opioid-sparing multimodal analgesia, and collaborative staffing models.
“PSH program implementation was often associated with decreased length of stay, decreased utilization of postoperative opioids, decreased utilization of the ICU, and increased probability of discharge to home,” Miller noted. “PSH implementation was not meaningfully associated with reductions in readmission rates. Findings for cost reductions following PSH implementation were mixed and additional research is needed to explain these differences and perhaps fine-tune the PSH model.”