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PERIOPERATIVE SURGICAL HOME
The PSH is a patient-centered system, led by a multidisciplinary care team, including a Director of Perioperative Services, surgical home leadership and supportive personnel. PSH spans the entire surgical experience from the decision to recommend surgery, through surgery and up to 90 days post-discharge from the medical facility2. The focus is on reducing variability in the perioperative care process.
Today, health care organizations across the nation are exploring the PSH model—developing, piloting and evaluating the model’s usefulness in enhancing clinical quality, outcomes, cost-controls
and the overall patient experience. The PSH model is strong on metrics for improved operational e ciencies and decreased resource utilization. It focuses on strategies that eliminate cancellations and delays in surgery, reduce lengths of stay (LOS) and readmissions, and lower complication rates and mortality.
To learn more and explore options for bringing the PSH model of care to your facility, talk with your local USAP Quality O cer. You can visit the ASA website at www.asahq.org/PSH for a comprehensive suite of services, resources and tools that support team-based care through education, consultation, engagement and economics.
In 2014, the Centers for Medicare and Medicaid (CMS) reported that nearly one in ve fee-for-service Medicare patients returned to the hospital within 30 days of being discharged4. That’s two million readmissions each year. Data from 2012 shows that 139,000 Medicare bene ciaries were readmitted three or more times. Readmissions cost Medicare
an estimated $26 billion per year; $17 billion of which is potentially avoidable5.
In April 2016, CMS launched the Comprehensive Care for Joint Replacement (CJR) model to test bundled payments and quality measurements for episodes of care associated with hip and knee replacements6.
In June 2016, the American Academy of Orthopaedic Surgeons (AAOS), the world’s largest association of musculoskeletal specialists, joined forces with the ASA to begin development of the PSH model to create an evidence-based “road map” for coordinated care best practices in orthopaedic surgery2.
THE COST OF UNCOORDINATED CARE
PERIOPERATIVE SURGICAL HOME OVERVIEW*
PHYSICIAN DIRECTOR OF SURGICAL HOME MANAGEMENT PERIOPERATIVE SERVIES LEADERSHIP TEAM
Preoperative
• Patient Engagement
• Assessment and Triage
• Optimization
• Evidence-based
Protocols
• Education
• Transitional Care
Planning
Intraoperative
• Right Personnel for Patient Acuity & Surgery
• Supply Chain
• Operational E ciencies
• Reduced Variation
Postoperative
• Right Level of Care
• Integrated Pain
Management
• Prevention of
Complications
Long-Term Recovery
• Coordination of Discharge Plans
• Education of Patients & Caregivers
• Transition to Appropriate Level of Care
• Rehabilitation & Return to Function
PSH
Return To PCP/Medical Home Expectations Met
Quality Improvement
Health Care Analytics
SUPPORTING MICROSYSTEMS
Human Resources
Nursing Pharmacy Laboratory Radiology
In the PSH model, the patient’s experience of care is coordinated by a director of perioperative services, additional surgical home leadership and supportive personnel, which constitutes an interdisciplinary team. The expected metrics include improved operational e ciencies, decreased resource utilization, reduction in length of stay and readmission, and a decrease in complications and mortality—resulting in better patient experience of care.
*Figure developed by Daniel J. Cole, M.D.
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