Submitted by Chitra Akileswaran on January 30, 2014 - 3:04pm
Last revised by Web Producer on March 13, 2014 - 12:43pm.
Idea Status:
The perioperative care episode (preop through postop discharge and recovery) often displaces patients from their usual care schedules with their primary care providers. During this time, a specialty service assumes full care for surgical patients, including addressing new medical issues and altering prior medication regimens. This has prompted interest in the idea of a “Perioperative Surgical Home,” which follows a patient through the arc of perioperative care via streamlined logistics as well as clinical standardization.
The SFGH GYN surgical volume is resident-driven and managed, with the senior resident on the service responsible for the complete set of perioperative tasks including: surgical planning, organizing and following up on preoperative testing, instructing patients on preop preparation such as NPO or medication restrictions, creating and tracking the OR schedule, ensuring insurance coverage, immediate and long-term postop care, discharge planning, and communication with patient/family. Vast practice variation in these tasks can lead to system-level costs including delays, no-shows, and unanticipated perioperative needs.
We propose developing a patient-centered bundle using checklists to simulate a Perioperative Surgical Home within the Gynecology Surgical service at SFGH. We believe that simple, patient-facing checklists and educational materials that help patients navigate preoperative and postoperative goals would minimize costs and errors, and allow the GYN surgical team to focus their creativity where it counts – on the surgery itself.
The goals of this proposal would be to:
1) Set expectations for both preoperative and postoperative goals so that patients play an active role in meeting these goals - which could conserve resources in terms of OR delays, shorter lengths of stay, and fewer bouncebacks/complications;
2) Prevent surgical no-shows;
3) Standardize the way we care for our surgical patients to promote patient outcomes, satisfaction, and safety.
Our Perioperative Surgical Home bundle could be replicated among other SFGH surgical services, and/or engage Anesthesia to centralize these activities, as has been described in the literature.
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