OR Manager - April 2020 - 19

OR business
Illustrative management dashboard for a joint arthroplasty perioperative surgical home
Current period
Management dashboard for a joint arthroplasty perioperative surgical home
Goal
Baseline
April 2019 - March 2020
Volume
Total hips
Total knees
Quality metrics
Mortality (%)
Complications (%)
30-day readmissions (%)*
Patient satisfaction
(HCAHPS)
*
Discharge destination
*
*Note: Other quality metrics could include length of stay (days), postoperative surgical site infection rate, and blood transfusion rate. For patient
satisfaction, track scores for each measure individually (eg, communication with physicians, communication about pain). For discharge
destination, track skilled nursing facilities, home health, and home discharge percentages separately.
Source: Surgical Directions. Used with permission.
of the surgical home. Quality and cost
metrics can change yearly to ensure
physicians are always engaged with new
performance targets. In addition, PSH
comanagement contracts can eventually
be expanded to include other programs
and/or bundled payment agreements.
Difficulty
with " tying it all
together "
An effective surgical home depends on
tight choreography of services and staff.
Failures in one area can affect performance
throughout the system. PSH coordination
can break down in several
ways, but many problems can be resolved
by answering three questions.
Are patients getting into the system
at least 2 weeks before their
procedure? A strong preadmission
testing process is a critical component
of the PSH model. This should
include screening all patients for risk,
using an evidence-based lab matrix,
and referring the highest-risk patients
for medical optimization.
One common problem is that surgeons'
office staff are not scheduling
patients with enough time to
benefit from the process. If the ultiwww.ormanager.com
mate
cause is poor surgeon buy-in,
use the physician engagement strategies
described above to resolve the
roadblocks. If office staff are simply
unaware of the new surgical home
processes, explain the importance of
using correct scheduling processes,
ordering appropriate labs, sending
clearances in a timely manner, and
other key practices.
Are you maintaining communication
with patients following discharge?
Patient commitment is critical
to ensure the best surgical outcomes,
so make sure your PSH pathways include
plans to engage and educate patients.
Several technological tools can
be useful. For example, the successful
colorectal PSH at Advocate Lutheran
General Hospital near Chicago uses
a digital platform to automate key patient
communications before and after
surgery.
Is one person responsible for steering
day-to-day operations? All successful
surgical homes that we have
encountered include a nurse navigator.
The PSH navigator acts as a liaison
between the patient and perioperative
services and is responsible for the
overall choreography of the program.
What should you look for when hiring
a PSH navigator? A good candidate
is highly organized, is willing to take
charge, has both a systems perspective
and emotional
intelligence, and
has earned the trust of physicians.
Strong foundation
Overcoming the obstacles to implementing
the surgical home model
is
well worth the effort. ORs that adopt
PSH successfully are able to establish
a strong foundation for high performance
under value-based care. ✥
Barbara McClenathan, MBAHCM,
BSN, RN, CNOR, is director
of perioperative nursing
at Surgical Directions, a
healthcare consulting firm
specializing in operating
room transformation.
Lisa Branding, MHSA, is
director of strategy and
value-based care at Surgical
Directions.
Reference
American Society of Anesthesiologists.
Perioperative surgical home (PSH).
https://www.asahq.org/psh.
OR Manager | April 2020
19
April 2020
Current period
vs baseline
Current period
vs goal

https://www.asahq.org/psh http://www.ormanager.com

OR Manager - April 2020

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