a model for tackling today’s pressing health issues

A column invited by the American Society of Anesthesiologistsexclusive to KevinMD.com.

The healthcare landscape has never been more complex. A deadly and long-lasting pandemic; challenges in health care delivery that put some communities at higher risk of adverse outcomes; an opioid crisis that is claiming nearly 200 American lives a day; and an ever-changing regulatory climate. Amid these challenges, healthcare organizations are under pressure to cut costs and shift to value-based care.

With so many difficulties to face, hard work and good intentions are not enough. We need new approaches to delivering care. Healthcare organizations need an accessible, inclusive, and scalable organizational model that breaks down silos, empowers clinicians to coordinate care team workflow, and encompasses specialists across the spectrum of the surgical journey. ‘a patient. A fiercely patient-centric model that facilitates standardization, customization, and coordination can give healthcare organizations a platform to help them thrive in this challenging climate.

What is the Perioperative Surgery House?

The American Society of Anesthesiologists (ASA) first introduced the Perioperative surgery house (PSH) in 2012 to address the wide range of challenges in the delivery of surgical care that impact quality and patient safety. PSH was systemically designed and fine-tuned to advance the Quadruple Goal: Improve population health, improve patient care and outcomes, reduce cost of care, and improve provider and team satisfaction . A physician-led, patient-centered coordinated care model, PSH is a modular holistic health care model adaptable to all settings, service lines and facility sizes. It has been used successfully to focus on isolated issues and on broad and deep systemic issues.

A history of proven results

From the outset, the PSH would be under scrutiny to deliver on its promise to tackle widely varying delivery models, skyrocketing costs, fragmented care, and more.

In 2014, the first PSH Learning Collaborative brought together leading U.S. healthcare organizations and diverse service lines from across the country to develop, pilot, and evaluate the PSH model. Two more Learning Collaboratives followed, testing PSH’s ability to drive meaningful and lasting change.

Indeed, Learning Collaboratives have proven that PSH can successfully move the needle for healthcare organizations. Learning Collaborative participants reported reducing length of stays by up to 50%, pain scores by up to 75%, hospital-acquired conditions by up to 30%, readmissions by up to 75%, and episode costs care up to $4,000 to $10,000. per patient. Participants improved patient outcomes by combining proven and innovative tactics such as the design of preoperative optimization clinics, risk assessment and stratification tools, and optimization pathways. They reduced costs by creating pro forma financial statements to forecast expenses and revenues and by reducing case cancellations, surgery complications and readmission rates. Provider satisfaction was increased through the implementation of regular meetings, data dashboards, collaborative practice agreements, and new pathways in electronic health records. Additionally, participants enhanced the patient experience by developing educational tools and materials, patient navigators, and processes for the patient journey from the surgeon’s office to PSH preoperative clinics.

The Learning Collaboratives disseminated protocols, lessons, and results across the country. More than 100 hospitals and healthcare organizations have adapted, customized and scaled PSH in their facilities. The model is modular, which means PSH practitioners can adapt it to positively impact a wide range of discrete and systemic challenges.

PSH saves hospital $12 million and increases patient satisfaction.

New Hanover Regional Hospital in rural North Carolina used PSH to address rising complications and readmissions, as well as operating room inefficiencies, treatment delays and cancellations, resulting in millions of dollars in penalties for the Centers for Medicare & Medicaid Services (CMS). The hospital implemented PSH to review and identify variables to revise and adapt to evidence-based practice improvement pathways. As a result, New Hanover has improved care delivery processes, increased patient satisfaction, and transformed the culture of their care team by breaking down silos between clinicians and staff. Since implementing the PSH model, they have not paid a CMS readmission penalty. Additionally, the use of multimodal pain management processes, they reduced prescriptions for oxycodone tablets by more than one million tablets. They were so successful in streamlining the perioperative optimization process with their hospital colleagues that the surgeons saw the results and brought more procedures to the group for standardization. In 2018, with eight service lines, they saved $12 million and created 2,268 hospital bed days, enabling them to care for an additional 768 patients.

And they are not alone. New Hanover is a great example of the difference PSH can make, but it’s just one example of many.

Leveraging PSH to Meet Today’s Needs

PSH’s success is due, in part, to its adaptability. The model enables rapid response to the ever-changing needs of today’s healthcare environment. For example, a healthcare team can leverage their existing PSH infrastructure to address the opioid epidemic, respond to the COVID-19 pandemic, engage patient stakeholders in the c-suite, and more. . Once PSH is established, the value multiplies through the scaling of new processes and workflows across various service lines and episodes of care. Additionally, today’s healthcare landscape is littered with organizations that have one foot in fee-for-service and the other in value-based care. A framework like PSH that seamlessly adapts to every payment model and facilitates the inevitable transition to value-based care responds to the complex environment of the healthcare industry.

The PSH Implementation Guide to Driving Lasting Change

In the decade since its launch, PSH has become more nimble, more efficient, and more committed to making a meaningful impact on pressing and unresolved health issues. The demand to deliver value through cost reductions, improve outcomes, deliver more for less, and participate in bundled care and risk payment arrangements means healthcare facilities must remain flexible , agile and financially viable.

PSH gives healthcare teams the framework and guidelines to advance best practices that reduce variation in care, provide continuous quality improvements, maximize value for patients and healthcare organizations at every stage of the process. journey, then measure success and adapt to improve. That’s why, earlier this year, ASA introduced a PSH Implementation Guide, a “how-to” manual with tips, instructions and best practices to help healthcare professionals adapt, customize and scale all or part of the various solutions offered by PSH. By bringing the PSH model – along with insights on how to customize it – to healthcare teams around the world, it will help healthcare organizations achieve better care, reduce costs and improve outcomes. in all communities across the country.

Randall M. Clark and Robert Chakar are anesthesiologists.

Image credit: Shutterstock.com


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Christine E. Phillips