The Importance Of A Perioperative Surgical Home Model

The Perioperative Care Collaborative (PCC) defines the ASP role “as the role undertaken by a registered perioperative practitioner

I enjoyed reading your post. During my clinical rotation, I had the opportunity to be part of hospital huddle. The physician, surgeon, dietitian, assigned nurse, charge nurse as well as the parents of the patient’s (minor) were all present discussing the patient health status from the day of admission to current day (day of huddle). Each member was getting a turn to give their insight of the patient’s health condition, plan of care, and new approach that can be taken to improve patient outcomes. During the huddle, the parents were given the opportunity to ask questions about the treatment plan, surgery options and any other concerns they may have. Then, the surgeon explained the risks and advantages of the surgery, how the surgery

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

VASNHS Surgical Specialty Outpatient department has a designated pre-operative management unit that oversees the patients undergoing surgery. The predicaments stem from various guidelines or protocol originating from numerous surgeons and clinics. At present, the pre-operative nurses abide simple pre-op instructions (NPO protocol, medications, what to bring, during the surgery, transportation, cancellation instructions) for the entire Surgical Specialty Outpatient department. Surgical procedures are being canceled due to lack of communications and cancelations of patients prior to surgery date.

Ambulatory Surgical Center provides same-day surgical care that includes diagnostic and preventive procedures. Ambulatory Surgical Center treats only patients who have already seen a health care provider and selected surgery as the appropriate treatment for their condition. Ambulatory Surgical Center must be certified and approved to enter into a written agreement with CMS. Ambulatory Surgical Center has a unique set of regulation and standards under the Medicare and Medicaid program or other third party payers. The outpatient payment provides a set payment for each surgical procedure. They must be licensed and inspected by the State and Federal government to see if they meet standards Certified facility standers.

• Since 1991, anesthetic and surgical techniques have improved, resulting in lower surgical risk for many patients. Concurrent with these changes, the VHA has implemented a rigorous program of surgical attending oversight of the process of care by resident operators, particularly in surgical suites.

Pre-operative data collection was obtained in the ambulatory minor surgery unit (AMSU). A communication sheet was filled out that collects patient data such as their diagnosis, the procedure they are having, drug allergies, vital signs, IV placement, and their current medications. This information is documented by the AMSU

As the ASC continued to grow in response to the increasing number of members, the procedures that were internalized not only increased, and were more complex. During that that time of expansion, I help strengthen the collaboration among ASC leadership and personnel to ensure that all surgical initiative is a success. In my role as perioperative educator, I spearheaded the development, implementation and evaluation of training and education via clinical simulation of procedures internalized in the ASC in 2015.

The trend for health care and hospitals is a movement towards a larger outpatient system of care while lowering the number of inpatient admissions. The health care system has made small changes towards this type of service for about a decade. Henry Ford Wyandotte Hospital should continue these efforts and implement the use of the Patient-centered medical home model. This model concentrates on patient care with a comprehensive, total patient care strategy, while lowering the incidence of emergency room use and lowering the number of times a patient is admitted to the hospital (Robeznieks, 2015). The health care team will evaluate the patient, monitor their condition while educating them about their specific needs and how to provide their own self-care at home.

This article looks at negative effects after surgery that can be avoided by ambulating patients early. The purpose of this study is to provide evidence to the outcomes of mobilizing patients versus not mobilizing them. The article states that

Health care industry representatives play a vital role in the perioperative setting. When providing technical support to the perioperative team, that can potentially decrease the impact of the operative procedure, they help in facilitating optimal patient outcomes.

When a patient is returned to the care of the PCP, it can be concluded that the surgical procedure process was successful. It is important to focus on returning the patient to the care of their PCP. These three ideas together help physician leaders identify opportunities for improvement in the PSH model.

I would provide patient centred care by assessing the whole patient by considering their culture, beliefs, values, social and economic determinants and how these factors can impact their surgical journey. Also, it includes taking the approach of offering my knowledge and the multidisciplinary team’s expertise, whilst working in collaboration with the individual to plan goals in the perioperative assessment. I will ensure accurate yet truthful information is exchanged. My intent is to create patient empowerment and inclusion in their own care. Further, I would thoroughly evaluate the care after implementation to ensure that patient satisfaction and improved outcomes are evident.

Although patients are cared for extensively at other hospitals, Shouldice’s approach to have patients care for themselves—not including the actual operation—seems quite suitable; patients need to be able to move around and adjust as much as possible after an operation. Davidow and Uttal (1989) state that “Measured by how often patients need treatment for the same problem, Shouldice is ten times more effective than other hospitals.” Very pleased with the treatment they received, many former patients honor hospital with at an annual reunion. The hospital also sends its former patients a letter in the mail every year for their follow-up program to assess the long-term success of each operation

This is out of our control.  The other issues, like incomplete work up resulting in a missed cardiac or pulmonary issue and cancellation by Anesthesia is mostly preventable.  This issue can be alleviated by placing a formal e-consult to Anesthesia for an extra thorough evaluation, in addition to the nurse evaluation currently done.  Other reasons for cancellations include same day surgery patients failing to bring a driver to the hospital with them, either because they think they will be fine and get away with the lie, or because they have no one at all to drive them home.  For these individuals, we are establishing a program called Companion Care.  We will trial it with small cases, like colonoscopy and eye procedures first. We will pay a caretaker, twenty-five dollars an hour for six hours to watch over the patient. This will help to eliminate the cancellations resulting from no caretaker and more importantly get the patient to the care they need.