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Contrary to the intraoperative period, the current perioperative environment is known to be fragmented and expensive. One of the potential solutions to this problem is the newly proposed perioperative surgical home (PSH) model of care. The PSH is a patient-centred micro healthcare system, which begins at the time the decision for surgery is made, i...
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Context 1
... Real-time access to best practices and engineering strategies to propose and sustain a seamless quality of care: a commitment to quality and safety Perioperative medicine has to deliver the best possible pre-, intra-and postoperative care to meet the needs of patients undergoing surgery [37] (Fig. 3). The efficient design of related clinical pathways calls for the implementation of evidence-based medicine and social engineering strategies that make use of Information Technology (IT). Individualized care based on intuitive decision-making by physicians should be replaced by a multidis- ciplinary ''PSH model'' using standardized ...
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Citations
... Satisfaction is a psychological state that occurs due to confirmation or disconfirmation of expectation with reality [1]. In the context of health care, patient satisfaction is the subjective assessment of the cognitive and emotional response that results from the interaction between the patient's expectations of the ideal care and their perception of the actual care [2]. Lack of use of evidence based practices, increased demand for care, and human errors have all been cited as obstacles to improving the way that surgical care is currently provided. ...
... Lack of use of evidence based practices, increased demand for care, and human errors have all been cited as obstacles to improving the way that surgical care is currently provided. This results in both patient dissatisfaction and poor quality of care [2][3][4][5]. Patient satisfaction assessment is considered as a critical component of the analysis of the health care services provided [6]. ...
... four dimensions: information provision, discomfort and needs, staff-patient relationship, and hospital service and the environment. The tool has a five-point Likert scale options ranging from very dissatisfied [1], dissatisfied [2], Neutral [3], satisfied [4], and very satisfied [5]. Five B.Sc. and three M.Sc. ...
Background:
Patient satisfaction is a growing concern in all aspects of healthcare. Assessing patient satisfaction has paramount importance for measuring the level of care provided by a health system. The present study aimed to measure the levels of satisfaction among patients undergoing invasive surgery in the referral hospitals of the Western Amhara Regional State.
Methods:
A cross-sectional study design was employed. The data were collected from 422 study participants from February 6 to April 6, 2020. The participants were selected using systematic random sampling technique. Interviewer administered questionnaire and chart review were used for data collection. A binary logistic regression model was used to identify the association between independent variables and patient satisfaction. Level of significance was considered at p value less than 0.05 with 95% confidence level.
Result:
Of the total participants, 290 (68.7%, 95% CI: 64.5-73.5) were found to be satisfied with surgical service. Factors such as age >58 years [AOR = 3.80, 95% CI (1.53-9.46)], 47-58 years [AOR = 2.47, 95%CI (1.07-5.71)], those with no formal education [AOR = 2.73, 95% CI (1.18-6.32)], primary school education [AOR = 3.89, 95%CI (1.65-9.17)] and secondary school education [AOR = 3.37, 95%CI (1.38-8.23)], no history of previous surgical admission [AOR = 2.09, 95%CI (1.07-4.08)], length of stay in the hospital <7 days [AOR = 2.13,95%CI(1.21-3.75)] and elective admission for surgery [AOR = 1.75, 95%CI (1.03-2.99)] were significantly associated with patient satisfaction towards surgical service.
Conclusion:
The proportion of patient satisfaction towards surgical service was found to be low. Factors including age, educational status, history of previous surgical admission, length of stay in the hospital and elective admission for surgery were associated with patient satisfaction. This suggests that healthcare organizations should focus on providing patients with respectful and compassionate patient care approach while paying close attention to how patients are treated.Moreover, in order to provide patient-focused care, health care providers should strengthen their usage of patient characteristics including age, educational level, and type of surgery while developing patient focused care plan.
... [9] Meanwhile the American Society of Anesthesiologists (ASA) has made an effort to organize fragmented peri-operative care with the use of the Perioperative Surgical Home (PSH). This model includes intra-op protocols as well as pre-op optimization of comorbidities and follows the patient for the immediate postoperative period while engaging all providers in the care process [10]. The PSH organizational entity has also been shown to facilitate adherence to ERP [11]. ...
Purpose: A perioperative surgical home is a program that combines enhanced recovery protocols (ERP) with pre-operative optimization and intra-op protocols to improve outcomes post-operatively. There is no significant research on them in colorectal surgery. Our objective was to study the effect of a surgical home on re-admissions and ED visits of colorectal patients compared to traditional management.
Methods: This was a retrospective study in a single system with multiple hospitals. The study group had elective colorectal surgery resection after the implementation of a colorectal surgical home that provided perioperative optimization. Patients were compared to those who underwent colorectal surgery resection with ERP but before the surgical home was established. Hospital re-admissions and ED visits within 30 days were then compared between the groups.
Results: A total of 167 colorectal surgical home patient charts were compared to colorectal ERP patients only. The surgical home patients were younger than the ERP (61.6 vs 65.4). However, ASA scores and pre-operative comorbidities were very similar between the groups. The 30-day re-admissions and ED visits were improved but not statistically significant between the matched groups (10.2% vs 15.0% and 15.6% vs 19.8%) (p = 0.124 and p = 0.195). Secondary outcomes noted the surgical home group did have a lower length of stay and fewer conversions to open.
Conclusions: Although there was no statistical significance between the 30-day re-admissions or ED visits, this trended towards improvement in patient treated under a surgical home when compared to those treated under ERP. ED visits decreased by 1/4 and re-admissions decreased by 1/3.
... Contrary to the intraoperative period, it is well known that the current perioperative environment is fragmented and expensive. One of the potential solutions to this problem is that the Perioperative Surgery Home (PSH) care model proposed by Desebbe et al. is a patient-centered microhealth care system that starts when the surgical decision is made, runs through the entire perioperative period, and ends 30 days after discharge from the hospital [7]. e PSH researched by him has great reference value for this paper, and it would be more in line with the purpose of this paper if it can be added to machine assistance. ...
Orthopedic surgery and care during the perioperative period are the key to the treatment of orthopedic diseases, which can quickly and effectively treat orthopedic diseases and can quickly recover during the perioperative period. Therefore, this paper focuses on the observation of the effect of intelligent machine-assisted surgery and perioperative care, combined with smart wearable devices and C-arm camera calibration; the details of the bone surgery are assisted by the machine, and then the recognition ability is accelerated by writing into the digital bone bank. Based on machine vision, CNN training and learning are designed to design a machine-assisted perioperative nursing method. This paper also designed a bone surgery test experiment and perioperative adverse event data analysis, combined with the data obtained from the experiment, designed a comparison experiment with traditional surgery and perioperative nursing. The experimental results show that the success rate of machine-assisted surgery is increased by nearly 2%–15% compared with traditional surgery; and the rehabilitation degree of machine-assisted perioperative nursing is 15.83% higher than that of traditional perioperative nursing.
... Although the PlaneRecover network has achieved good results in the plane detection accuracy of the computer terminal, the detection rate is far from the requirements for the mobile terminal AR application. erefore, this paper analyzes the model structure and finds the influence on the network calculation efficiency; the performance bottleneck is optimized to increase the network plane detection rate and reduce the model storage [25]. is paper adopts the model acceleration method of network structure acceleration and replaces the complex backbone network according to the existing lightweight network ideas suitable for mobile terminals; since the mobile terminal AR application requires not very high plane detection accuracy, it only needs to be able to meet application requirements. ...
AR technology, also known as AR or virtual reality, refers to a technology that combines and allows interaction of the virtual world on the display system with the real world through the position and angle of the camera video and image analysis technology. This technology is different from VR technology, and its characteristics can be easily explained as follows: when using AR technology, the user’s eyes can see not only the real world but also the virtual world derived from the computer through things in the real world. At present, AR has been widely used in education, engineering, entertainment, and medical fields. In order to provide better perioperative care and bring patients a good nursing experience, this article mainly introduces the perioperative care of vascular decompression in the treatment of trigeminal neuralgia by augmented reality medical technology, in order to provide better care for patients with trigeminal neuralgia. This article proposes the perioperative nursing research method of vascular decompression for the treatment of trigeminal neuralgia under AR medical technology, including an overview of trigeminal neuralgia, perioperative related research, and AR medical technology algorithms, and designs related experiments to study whether AR medical technology can bring good news to nursing. Experimental results show that 96% of patients believe that with the enhancement of realistic medical technology, perioperative vascular decompression care for trigeminal neuralgia can help them recover faster and can be gradually popularized.
... Multimodal protocols that significantly reduce post-operative pain and limit opioid exposure also include a teambased approach to surgery that emphasizes the necessity of communication. This approach is best described by Dr. Zeev Kain, who coined the "Perioperative Surgical Home" (PSH), a model that begins at the moment the operation is scheduled and ends 30 days post-surgery (Desebbe et al. 2016). The PSH ensures coordination of care from staff to physician to caregivers in order to effectively manage pain and patient expectations. ...
Specific protocols have been established for each of the time windows involved in the perioperative surgical experience. We use a combination of medications, medical devices, local and regional anesthetics to minimize pain while trying to avoid Opioids.
... By facilitating interdisciplinary care coordination from preoperative optimization to hospital discharge, anesthesiologist-led perioperative homes improve patient outcomes while reducing the cost of care. [1][2][3] Building upon demonstrated successes with adult patients, emerging evidence suggests similar promise from pediatric perioperative surgical homes. High-performance teams, systems, and clinical pathways have demonstrated measurable improvement in both pediatric ambulatory surgery and more complex surgical scenarios. ...
Introduction
Successes from anesthesiologist‐led Perioperative Surgical Homes in the adult patient population have inspired similar initiatives by pediatric hospitals. Typically the care coordination for these perioperative homes is run through hospital‐funded, on site, pre‐anesthesia clinics. Preliminary data from Pediatric Perioperative homes have shown promising results in improved patient outcomes and decreased length of hospital stay. The majority of pediatric surgeries within the country are performed in non‐pediatric hospitals. Such centers may not have the infrastructure or financial resources for a free‐standing pediatric pre‐anesthesia clinic. Faced with this situation at the largest safety net hospital in New England, the authors present their experience designing and implementing a “Virtual Pediatric Perioperative Home,” a telemedicine‐based triage and pre‐anesthetic optimization for pediatric patients at Boston Medical Center, Boston, MA.
Methods
A retrospective chart review of all pediatric anesthesia cases at Boston Medical Center from February 1st, 2019, to January 31st, 2020, as well as the number of pediatric cases canceled or postponed on the day of surgery for any reason during the same time period was conducted.
Results
From February 1st, 2019, to January 31st, 2020, 1546 anesthetics were performed in children 18 years and under. Of those, 63 were designated as emergent and hence excluded from our analysis. 153 of the total 1483 (9.4%) of non‐emergent bookings were canceled or postponed on the day of surgery. The largest reason for case cancellations (41.8%) was due to the patient suffering from acute illness and thus not medically optimized for surgery. Cancellation rates varied from month to month, with the highest cancellation rate of the year in September 2019 (18.8%). The departments of Podiatry and Gastroenterology represented the highest cancellation rates as a denominator of their case volumes, 15.4% and 15.2% respectively. Younger children had 2.4 times the odds (95% CI: 1.720, 3.4) of cancellation compared to older children.
Conclusion
The authors describe the design and successful implementation of a telemedicine‐based pediatric pre‐anesthesia triage and medical optimization service at a large safety net hospital. By creating a communication network of pediatric subspecialists, the anesthesiologists were able to, at minimal institutional cost, coordinate care for children with a variety of comorbidities leading up to the day of surgery. This yielded a 9.4% same day cancellation rate in a complex, socioeconomically disadvantaged pediatric patient population at a general hospital.
... Participation in the CJR program is now mandatory for hospitals in 50 selected US metropolitan areas and is aimed to reduce such variation by financially incentivizing care coordination across a 90-day episode. In the bundled payment system hospitals and providers must optimize expenses relative to outcomes to benefit from revenue opportunities for each care episode [10]. Approximately 40-45% of the 90-day episode cost of total hip replacement [11] and total joint replacement [2] care is incurred after initial hospitalization. ...
Study objective
Physician-led multidisciplinary care coordination decreases hospital-associated care needs. We aimed to determine whether such care coordination can show benefits through the posthospital discharge period for elective hip surgery.
Design
Time Series of prospectively recorded and historical data.
Setting
Academic tertiary care medical center and health system.
Patients
449 patients undergoing elective primary hip surgery.
Interventions
For the intervention group we redesigned care with a comprehensive 14–16 week multidisciplinary standardized clinical pathway, the Ochsner hip arthroplasty perioperative surgical home (PSH). Essential pathway components were preoperative medical risk assessment, frailty scoring, home assessment, education and expectation setting. Collaborative team-based care, rigorous application of perioperative milestones, and proactive postoperative care coordination were key elements.
Measurements
The intervention group was compared to historical controls with regard to demographics, risk factors, quality metrics, resource utilization and discharge disposition, the primary outcomes were hospital length of stay and postacute facility utilization.
Main results
Compared to historical controls, the intervention group had similar risk factors and the same or better quality outcomes. It had less combined skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) utilization compared to controls (16.5% vs. 27.5%). More intervention patients were discharged with home self-care compared to historical controls (10.7% vs 5.3%). During the intervention period combined SNF/IRF utilization decreased substantially from 19.8% early on, to 13.2% during a later phase. Intervention patients had fewer hospital days compared to historical controls (1.86 vs 3.34 days, respectively; P < 0.0001).
Conclusions
A perioperative population management oriented care model redesign was effective in decreasing hospital days and postacute facility-based care utilization, while quality metrics were maintained or improved.
... The PSH model ( Figure 1) is a continuous patient-centered approach that involves a multidisciplinary team of physicians and healthcare providers, aimed at individualized attention that begins when the decision for operative care is made and ends approximately 30 days after hospital discharge [3]. Not only does this increase coordination between physicians, but it provides a standardized, evidence-based approach to patient care [4]. ...
... In contrast, PSH focuses on patient-centered care, lowering healthcare costs, and improving patient experience via quality of care and patient satisfaction [8]. However, due to a plethora of factors, such as increasing healthcare costs, decreasing quality of patient care, and government incentives, both France and the United States are opting toward PSH, an individualized approach to perioperative medicine [3]. ...
... Many hospitals have yet to adapt and mandate the implementation of PSH. Studies show that the benefits of implementing the perioperative surgical home are cost saving [3,8,21]. With this knowledge, the perioperative team should work collaboratively to implement and mandate all patients that present for elective procedures receive clearance from the perioperative surgical home. ...
Cancellations or delays in surgical care for pediatric patients that present to the operating room create a great obstacle for both the physician and the patient. Perioperative outpatient management begins prior to the patient entering the hospital for the day of surgery, and many organizations practice using the perioperative surgical home (PSH), incorporating enhanced recovery concepts. This paper describes changes in standard operating procedures caused by the COVID-19 pandemic, and proposes the expansion of PSH, as a means of improving perioperative quality of care in pediatric populations.
... cost-effectiveness of the perioperative process (Pasternak et al. 2012;Olivier et al. 2016). Following the progress in the preoperative assessment clinics, this has brought to a great declination in the number of surgical cancellations, lab tests, and length of hospital stay as well as associated costs of consultations by introducing the systematically developed practice guidelines (Van Klei et al. 2002;Pasternak et al. 2012). ...
... PNSA endorsement is not the sole motivator for RNs undertaking specialist postgraduate PNSA studies -many surgeons recommend undertaking further education to expand clinical practice, provide quality surgical assistance and increase personal and job satisfaction 3,13,14 . Hospital administrators also focus increasingly on service models that deliver holistic, higher quality, coordinated care at a lower cost 21 with the PNSA role shown to have benefits including reduced costs, improved leadership and mentoring, and reduction in operating theatre cancellations and delays 7,10 . The NMSA role can also prove to be costeffective by decreasing preparation time for surgery and shortening actual operation time 7 . ...
Advanced practice nurse (APN) roles have been implemented across all areas of the Australian health service and have extended into the perioperative environment in the form of the perioperative nurse surgical assistant (PNSA) or non-medical surgical assistant (NMSA). With a growing and ageing population, Australia will see an increased demand for acute care nurses. For the PNSA role to expand to meet this demand, the role requires recognition and regulation in Australia. Education programs also need to meet the increasing demand for acute care nursing and provide quality, accessible and collaborative education programs to meet the needs of all nurses in Australia, including those in rural and remote areas. © 2020, Australian College of Perioperative Nurses. All rights reserved.
