A Rural Community Hospital’s Perioperative Surgical Home Model Compared to a Traditional Surgical System

Abstract

Background: The Perioperative Surgical Home (PSH) was designed by the American Society of Anesthesiologists (ASA) to improve perioperative care through more coordinated and communicative decision-making. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas. Thus, this study compared surgical outcomes – LOS, discharge disposition, and 90-day readmission – at a rural hospital from cohorts before and after the implementation of PSH. Method: An initial model of a PSH system was initiated in a local rural hospital. This newly created clinical team and outpatient clinic retrospectively assessed total joint surgeries occurring from November 2017 to April 2018 (before PSH, n = 324) as well as from November 2018 to April 2019 (after PSH, n = 326). General linear models were used to understand the impact of PSH on rural surgical outcomes. Results: Implementing PSH had a positive impact on LOS (P-value < 0.01), discharge disposition (P-value < 0.01), and readmission (P-value = 0.03).Conclusion: Implementation of the PSH system in a rural, community hospital reduced LOS, 90-day readmission, and increased direct to home discharge. Increased clinical management standardization across internal and external stakeholders was achieved because the PSH clinic enabled a centralized navigation point for clinicians, patients, and their families to better communicate and coordinate care.

Rural implementation of the perioperative surgical home: A case-control study

“…This research study’s primary objective was to evaluate the newly implemented PSH system at a local rural, community hospital by comparing TJR surgical outcomes using a longitudinal case-control study design. Based on our preliminary study[ 32 ], it was hypothesized that the implementation of the PSH in the rural community hospital would positively impact patients’ TJR outcomes ( i.e. , shorter LOS, reduced readmissions, and increased rate of home discharge) across three distinct cohorts for the case-control design.…”