Reduction in resource utilization and increase in patient satisfaction two years after implementation of Perioperative Surgical Home

Perioperative Surgical Home (PSH) provides coordinated, team-based care that is patient-centered, designed to guide patients efficiently through the surgical experience. We applied several changes to our anesthesia practice during 2014 and evaluated outcomes for all orthopedic major joint replacement surgeries completed in 2015. Since this was a quality improvement/utilization study, we were granted approval from our institutional review board to retrospectively review these data.Methods: We conducted a utilization review of all 1,356 patients who received total knee, hip, or shoulder joint replacement from 4 major surgical providers in 2015. Preoperative evaluation was limited and focused to each patient’s unique medical conditions. Additionally, we reduced intraoperative fluid use, reduced continuous femoro-sciatic nerve or brachial plexus blocks by increasing the administration of single-shot regional blocks, limited transfusion, and minimized urinary catheter use. We improved pain consult response time and provided timely discharges.Results: We noted 9% reduction in preoperative imaging per case, 22% decrease in average number of tests per case, 87% fewer average units of red blood cell used per case, and a 0.4 day reduction in average length of stay (LOS). Patient satisfaction data showed constant improvement in pain management, and doctor communication.Conclusions: Numerous small modifications to patient care collectively contributed to these progressive observed changes in patient outcomes from quarter to quarter.