The Perioperative Surgical Home Model

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.

A focused audit will be done on all patients undergoing operative or invasive procedures for the next year. Results will be analyzed by the nurse manager and discussed at staff meetings. Evaluation of compliance will be done at the staff meetings and any recommendations for improvement will be discussed and approved at these meetings. Implementation of any recommendations will be instituted the following month. Summaries of the audit and any recommendations for improvement will be sent to the PI committee on a quarterly basis.

• 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.

The Patient-centered Medical Home (PCMH) will be assessed to evaluate the effectiveness of other health care organizations (HCOs) to compare and contrast values and mission. In addition, program cost-effectiveness will be examined considering health insurance providers and HCO. As a health care administrator, it is beneficial to truly understand the basis and goals of the PCMH to effectively execute the medical home model and successfully provide the best care for each patient.

The passage of the Affordable Care Act (ACA) in 2010, created a paradigm shift in the way health care is delivered to its patients creating a greater emphasis on lowering costs while improving outcomes (Cascardo, 2014). One strategy to contain costs while improving the quality of patient care, thus outcomes, is transitioning outpatient surgeries from acute care hospitals to ambulatory surgery centers (ASCs). ASCs provide same day surgical care, as well as diagnostic and preventive procedures (ASCA, n.d.).

Furthermore, the cost of the current practice accounts for a substantial portion of the inpatient health-care expenses that can be reduced if cost-saving actions are put into place (Sathiyakumar et al 2014; Okike et al 2014; Centers for Medicare and Medicaid Services 2013]. The PSH model attempts to correct the current standard of care by focusing on three tenets: 1) improve clinical outcomes through standardized best practices, 2) increase patient-centeredness and experience 3) decrease the perioperative costs (Garson et al 2014; Prielipp et al 2015; Kain et al 2015; Kain et al 2014; Vetter et al 2013). There have been previous initiatives to improve perioperative care and reduce costs, but most have focused on reducing the patient’s length of stay (LOS) (Eskicioglu et al 2009). For example, Enhanced Recovery After Surgery (ERAS) programs utilize standardized perioperative care in order to accelerate recovery and reduce complication rates (Eskicioglu et al 2009). Although the ERAS programs have shown increased cost-effectiveness and reduced complications rates when compared to the traditional perioperative setting, there still is a need to provide a better continuity of care across the perioperative timeline (Eskicioglu et al 2009; Leee et al 2014). The PSH has been

More times than not, a surgical patient will not know the cost for the procedure before undergoing the operation. With all the possible variables involved, the providers most likely do not know the associated costs either. Even if cost were available, providers do not want to use the Wal-Mart strategy of being the low cost leader. People associate lower cost with lower quality of care. Since cost of care is not a marketable factor, other areas become overstated including the satisfaction of the patients. It is healthcare provider’s obligation to ensure the patient is satisfied or market share will be compromised. There are many variables to patient satisfaction, but research has shown a direct correlation between high patient satisfaction levels and a highly engaged staff.

Association of perioperative Registered Nurses (AORN) is a nonprofit organization that represents more than 160,000 perioperative nurses by providing nursing education, standards, and clinical practice resources-including the peer-reviewed, monthly publication-AORN Journal-to enable optimal outcomes for patients undergoing operative and other invasive procedures (ARON, 2015). The AORN organization focuses on best practice standards for quality patient care in the operating room. The OR setting is a fast pace environment that requires nurses to keep up on the latest technology, medicine, and positioning devices for the surgical patient. Nurses are advocates for patients during their surgical procedure to ensure safe and quality care. Our mission is to promote safety and optimal outcomes for patients undergoing operative and other invasive procedures by providing practice support and professional development opportunities to perioperative nurses (AORN, 2015).

Also discussed earlier, as of 2017, less than 20% of hospitals in the United States allow visitation in the PACU following surgery (Wendler et al., 2017). Establishing PACU visitation should be discussed in all healthcare institutions as evidence has demonstrated a positive outlook for the future. By implementing visitation, institutions will gain the opportunity to provide quality health care, improve patient

The patient centered medial home also abbreviated as PCMH is a care delivery model. This model ensures that patient treatment is arranged by their primary physicians to make sure that they will receive the obligatory treatment care. It is imperative that the patient receive required treatment and care when is it suitable and at any timely given manner.

phase of perioperative care beginning with the decision to perform surgery and continuing until the client reaches the operating area. Starts off whether the patient wants to perform the surgery then continues until the patient reaches the operating area. When a patient is admitted into ambulatory surgery or short before surgery the time for preoperative assessment, nursing diagnoses, and evaluation of the nursing management may be limited. It’s important to recognize the patient’s immediate preoperative needs. Although, the preparation for the surgery is still required by the nursing process. Assessment: in preoperative care it requires a complete assessment of the patient. The assessments differ based on the importance of the surgery and

Bates, O’Connor, Dunn, and Hasenau (2014) seek to understand the STAAR interventions relating to improving post-CABG surgical patient care. The article is a quantitative comparative study with exceptionally qualified authors. The level of evidence for the article is at the studies level. The background of the study introduces the Institute for Healthcare Improvement (IHI), which created a Triple Aim initiative. Triple Aim is able to target specific populations, focusing on three goals: (1) improved individual health outcomes, (2) improved experience of care, and (3) lower overall per capita cost (Bates et al., 2014). Because of high 30-day readmission rates in the post-CABG population, IHI added to the Triple Aim framework by also creating the STate Action on Avoidable Rehospitalizations (STAAR) initiative. STAAR incorporated two nursing interventions for the CABG patients: (1) a teach-back method to facilitate patient education, and (2) scheduling of post-discharge appointments prior to hospital discharge. The overall purpose of the study was to implement STAAR interventions to decrease post-CABG 30-day readmission rate (Bates et al., 2014). The quantitative comparative study was executed from 2011-2012 at a tertiary care facility located in the Midwest United States. Two groups were studied, a pre-intervention group containing 97 patients and a post-intervention group containing 92 patients. Total sample of post-CABG patients was

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.

Hospitals vary in their quality performance with different procedures and medical conditions. The lower the hospital’s performance level, the higher the mortality rate and health care costs of the said hospital. It was also mentioned in the report that if the surgeons opted to use laparoscopic approaches to applicable abdominal surgeries, it would reduce the risk of complications, shorten the hospital stays, and subsequently lower the cost for both