Issue link: https://beckershealthcare.uberflip.com/i/351038
11 Executive Briefing: Surgical Homes Pre-operative preparation. From the moment surgery is sched- uled, the OR begins capturing and assembling key patient data. The focus is on identifying, managing and minimizing patient risks. Staff use an evidence-based matrix to schedule pre-surgi- cal testing based on the patient's medical conditions and current medications. Patients prepare for surgery and recovery at a "joint camp" education session. Anesthesia develops an individualized pre-op care plan, including management of chronic conditions, pain management and discharge strategy. During surgery. Intraoperative care follows protocols accepted by the surgery and anesthesiology departments. For example, anesthesiologists actively manage patient insulin levels accord- ing to evidence-based guidelines. Surgical treatment is based on national guidelines or department protocols. Post-op care. Clinicians continue to follow the perioperative care plan, including pain management, ambulation and discharge pro- tocols. An anesthesiologist or hospitalist serves as the "periopera- tive primary care physician" to monitor patient progress, respond early to recovery risks and maintain coordination of care. Case managers and home health nurses follow up with the patient to ensure early intervention for emerging complications and avoid high-cost readmissions. The comprehensive surgical home approach has enabled many organizations to achieve dramatic improvements in quality, out- comes and costs, including: Surgical quality gains. After the University of California Irvine Medical Center created a surgical home for joint replacement pa- tients, compliance with Surgical Care Improvement Project proto- cols increased to virtually 100 percent. Shorter length of stay. The University of Southern California's Keck Medical School in Los Angeles tested a surgical home mod- el of care against the conventional approach to patient manage- ment. Intensive care unit length of stay decreased 44 percent, and total hospital length of stay decreased 32 percent. Better outcomes. Surgical home care can also help prevent post-op complications. The Keck initiative reduced 30-day mortal- ity by 47 percent. Lower costs. Standardized care reduces unnecessary testing costs, while evidence-based pathways reduce costs associated with poor outcomes. A Mayo Clinic knee replacement surgical home initiative cut the mean cost per episode by $956. These and other cost control achievements help ORs maintain revenue under shared savings arrangements such as bundled payment contracts or ACOs. In addition, surgical homes create a higher-quality care environment, which can increase surgeon satisfaction and drive volume growth. How to get started Developing a surgical home program is complex, but leading ORs have laid a strong foundation. Hospital executives can play a key role by keeping the entire organization focused on three priorities: Build broad support. The surgical home model requires strong participation from all OR stakeholders. Identify a physician cham- pion for OR quality improvement and partner with him or her to build support for the new care model. The goal is to gain com- mitment from every point in the perioperative continuum — sur- geons, anesthesiologists, nursing, care management, rehabilita- tion, pharmacy, materials management and other departments. Pick low-hanging fruit. Most successful surgical homes start by focusing on one or two high-volume, high-cost procedures. Im- proving care and outcomes for coronary artery bypass grafting or hip replacement, for example, can have a big impact on overall quality performance and costs. Measure gains. A surgical home will help your OR meet Medicare quality requirements, but maintaining government revenue is just the start. Leading hospitals are leveraging surgical home gains to negotiate favorable contracts with private payers. The key is to establish relevant measures, track performance and demonstrate improvement in clinical and financial outcomes. While the surgical quality threshold is rising, the opportunities are expanding as well. Building a surgical home program can help your OR meet increasing quality requirements, secure higher payment and become established as a preferred surgical provider in your market. n Jeffry Peters, MBA, is president and CEO of Surgical Directions. Barbara McClenathan, RN, BSN, MBA-HCM CNOR, is the se- nior nurse executive with Surgical Directions. Directions' consultants deliver sustainable operational improvement through measurable results and culture change. perioperative & anesthesia assessment · interim management 312.870.5600 www.surgicaldirections.com discuss your specific issues within Perioperative Services as well as tell you about strategies used by other organizations to address similar situations. Contact us to schedule obligation conference call to review your situation and design a path to operational excellence! active consultants help you enhance your bottom line through improved quality outcomes, perioperative process and overall operational improvement. IMPROVE YOUR BOTTOM LINE. satisfaction over time cut time starts consistently helps hospitals improve their perioperative the past seven years, our consultants have changed the importantly, improved the bottom line for more than community-based hospitals to large quaternary academic Our multi-disciplinary teams of an esthesia, nursing and consultants typically help hospitals increase profitability by $750,000 per OR by improving: ◗ Block time ◗ Materials/supply spend ◗ Labor spend ◗ Anesthesia service levels ◗ RN and anesthesia staffing models ◗ Profitable incremental OR volume ◗ Improving OR leadership Surgical Directions is the nation's premier Perioperative and Anesthesia Services consulting firm. We are led by nationally recognized anesthesiolo- gists, surgeons, CRNAs and surgical services professionals who passionately help our clients improve their perioperative and anesthesia services through operational, financial and cultural transformation. We typically showcase between $250,000 to $500,000 of financial improvement per operat- ing room within 12 months of each engagement, based upon proper allocation of existing resources, non-labor cost savings and improved revenues through strategic growth planning. The Surgical Directions team provides hands-on assistance with an assessment of existing services, gap analysis of existing state versus benchmark and implementation of recommendations to improve overall service levels. We have extensive experience with: • Organizational design, strategic planning, man power/medical staff development strategy, scheduling optimization, pre-admission testing opti- mization, supply chain management/materials management, central sterile processing, information systems design, staffing, OR management, inter/intra-operative work flow and throughput efficiencies, physician relations, anesthesia contracts and negotiations, revenue cycle manage- ment and facility planning. Over the past decade, we have successfully helped more than 500+ hospitals. Our client hospitals enjoy a sustainable competitive advantage by providing improved clinical outcomes, increased surgical and procedural volumes, a reduced cost structure and improved physician/staff/ patient satisfaction.