Women who used a smartphone app as part of a Perioperative Surgical Home (PSH) program were released from the hospital sooner after delivering their babies via cesarean section, according to a study presented at the American Society of Anesthesiologists PRACTICE MANAGEMENT 2017 meeting.
This study, and other research presented at the meeting, highlight how PSH programs and physician-led care lead to improved quality of care, while lowering costs.
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The smartphone app empowers C-section patients
Women scheduled for C-sections downloaded a special app on their smartphones, four weeks prior to the procedure as part of a PSH- a patient-centered, physician-led, team-based model of coordinated care that spans the entire surgical experience, from the decision to have surgery to discharge and beyond.
The app reminded them of appointments, provided pre-surgery information — such as when to start and stop medications – and facilitated remote post-surgery health checks such as pain control and wound recovery.
Researchers reported on the first 30 women using the app and found the average length of hospital stay after delivery decreased from 3.7 days to 2.7 days.
The program is the first in the United States to employ enhanced recovery after surgery (ERAS) for C-section. An element of the PSH, ERAS programs, use a variety of methods to ease the effects of surgery and fast-track patient recovery.
When factoring in the cost savings of shorter hospital stays with the cost of the resources required to participate in the program and develop and implement the app, the return on investment was significant – 216 percent the first year and an estimated 282 percent in subsequent years, researchers note. While it is too soon to report quality outcomes such as surgical site infections, urinary tract infections and patient satisfaction, early results are promising, says study author Attila Kett, M.D., M.B.A., division chief of obstetric anesthesia at Saint Peter’s University Hospital, New Brunswick, N.J.
While federal law requires insurance companies pay for 96 hours of hospitalization after C-section, it is safe and preferable to leave the hospital sooner if the physician determines the mother and baby are healthy and the mother agrees, he says.
“The app empowers women by putting them in control of their health care needs,” says Dr. Kett.
Revamped pre-anesthesia clinics improve patient care
To improve and standardize patient care, Cleveland Clinic created an anesthesia-led model of preoperative care that followed the same guidelines-driven clinical protocols, practice management, resources, staffing models and process flows at all 14 of their pre-anesthesia clinics.
The new Pre-Anesthesia Consultation Clinics (PACC) concept included changes such as centralizing and streamlining the scheduling process, updating protocols to reflect a more evidence-based approach and enabling patients to have their pre-surgery evaluation at any of the clinics, regardless of where the surgery would take place, says study author Maureen Keshock, M.D., M.S.H.A., assistant medical director PACC at Cleveland Clinic. The rollout of the large project throughout the Clinic Enterprise required attention to metrics and frequent assessment of staffing needs.
At one point during the rollout, patients were only seen an average of two days prior to surgery. After evaluating staffing needs and changing the process in which PACC visits were scheduled, patients were seen an average of 10 days before surgery. This gave providers more time to assess and address issues before surgery, such as prescribing medications early enough to prevent anemia and reducing the need for blood products.
Another metric followed was the number of patients calling to schedule their surgeries or ask questions who hung up before an operator addressed the call. This dropped-call metric during the lowest point of the rollout was 18 percent. Three additional scheduling operators were added and that number decreased to 1.9 percent. This single model of service throughout the organization eliminated redundancies, saving an estimated $1.4 million in annual operating costs.
“Patient care was improved by decreasing variability and creating a unified set of anesthesia guidelines,” says Dr. Keshock.
Anesthesia care team increases efficiency
The 2008 implementation of an anesthesia care team at Memorial Hermann Hospital-Texas Medical Center in Houston – the nation’s largest level one trauma center – led to more efficient care, increased volume and improved employee satisfaction, a retrospective study shows.
The most effective aspect of the program was the change in culture as a result of creating effective teams, improving communication and establishing accountability, says study author Carin A. Hagberg, M.D., former chairman of the Department of Anesthesiology at the University of Texas Medical School at Houston and current division head of Anesthesiology, Critical Care and Pain Medicine at the University of Texas MD Anderson Cancer Center.
Changes implemented included: real-time tracking of all surgical cases, which eased staffing assignments and enhanced communication; organizing surgical service lines into a pod system (for example, putting general, gynecological and urological surgeries together), which improved efficiency, quality of patient care and surgical team satisfaction; and employing anesthesiologist assistants as members of the care team to help manage service expansion.
From 2009 to 2015, operating room volume increased by 33 percent. First case on-time starts improved from 66 percent in 2009 to more than 80 percent by 2010. Case cancellations decreased from four percent in 2009 to one percent in 2010. From 2009 to 2015 physician satisfaction scores increased from 20 percent to 91 percent and overall surgical team satisfaction improved with composite scores increasing 23 percent or more.
“Strategic partnership between the hospital and physician group, as well as the support of administrators, nursing staff and surgeons enabled successful change in the culture of care,” says Dr. Hagberg.
