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Anesthesiologist-led program maintained positive clinical outcomes
Use of the Perioperative Surgical Home helped maintain excellent clinical outcomes among patients who underwent total knee arthroplasty, with reduced hospital length of stay and increased skilled nursing facility bypass rate, according to results presented at the Anesthesiology Annual Meeting.
Researchers at Kaiser Permanente implemented a patient-centered, physician-led system of team-based care — called the Perioperative Surgical Home (PSH) — to guide patients through the entire surgical experience. Outcomes data were collected for 546 patients who had knee replacement surgery within 1 year prior to the implementation of the PSH and 518 who had the procedure within 1 year after the PSH was implemented.
Length of hospital stay, average pain score on discharge, completion of physical therapy on postoperative day zero, skilled nursing facility bypass rate and 30-day readmission rate were used to evaluate the effectiveness of the team and compared with data from the previous year.
Study results showed an average length of stay of 1.9 days for the PSH group vs. 3.2 days for the pre-PSH group. The researchers also found 94% of patients in the PSH group went home after being released from the hospital and 6% went to a skilled nursing facility, whereas 80% of patients in the pre-PSH group went home and 20% went to a skilled nursing facility.
The 30-day readmission rate was low in both groups, with 0.9% of patients from the PSH group being readmitted vs. 1.2% of the pre-PSH group, according to the researchers.
The researchers surveyed 130 patients in the PSH group and found 71% rated their experience as excellent and 25% rated it as satisfactory. Overall, $942,000 was saved due to reduced length of stay and skilled nursing facility bypass.
“The implementation of the PSH has been very beneficial, but we cannot pinpoint a single element that is responsible for its success,” study author, Chunyuan Qiu, MD, said in a press release. “It’s an entirely new practice model that demonstrates the value of having physician anesthesiologists’ direct care of knee replacement patients. We believe the PSH model would benefit patients having other types of surgery, as well.”
Reference:
Qiu C. Paper #BOC01. Presented at: Anesthesiology Annual Meeting. Oct. 11-15, 2014; New Orleans.
Disclosure: The authors have no relevant financial disclosures.