Perioperative Surgical Home - CHI Health, Nebraska (NE) - Southwest Iowa (IA)

Care plans for patients before, during and after surgery, “the perioperative period,” can be fragmented, causing unnecessary duplication of tests, lapses in care and sometimes complications. The process of having a surgical procedure itself can cause a patient to be disconnected from his or her regular care provider. The American Society of Anesthesiologists piloted a program, the Perioperative Surgical Home, designed to eliminate gaps in care, improve surgical outcomes, increase patient satisfaction and reduce costs.

Similar to the strategy of the medical home, the perioperative surgical home is a patient care model in which care is coordinated at a central point throughout the perioperative period. Think of it as home base of care.

Up to 30 days prior to surgery, an entire team becomes involved the patient’s care and continues after surgery, into the recovery process. The team is made up of anesthesiologists; the patient’s other physicians, nursing staff, physical therapists, occupational therapists, pharmacists and others.

Perioperative Surgical Home Pilot Program

CHI Health Anesthetists, Dr. Charles Youngblood and Dr. Mark Reisbig read a paper on the model’s use at the University of Alabama-Birmingham and the University of California-Irvine and felt this was the future of surgical care. They conducted a pilot study at CHI Health Creighton University Medical Center.

The pilot program for the PSH at Creighton University Medical Center involved patients undergoing knee replacements. Once the decision was made for these patients to have surgery, the patient was scheduled with our "surgical optimization clinic" where patients are evaluated for surgery.

At the clinic. patients received training from orthopedic educators,  physical therapists and occupational therapists. The PSH team members spoke with patients about their expectations for pain, and the anesthetic they were going to receive, and their post operative pain control.

The patients were given non-narcotic pain medications from different drug classes (multimodal pain therapy) to take for 2 days before surgery. The day of surgery, more medications are added.  Along with a standardized evidence-based anesthetic, and multimodal pain control regimen, they receive continuous peripheral nerve blocks for post operative pain control. Aftercare was closely coordinated with the nursing staff and other services on the floor, such as physical therapy and occupational therapy.  

Reduced Pain and Need for Pain Medications

The team found that that giving pain medications before surgery significantly reduces pain after surgery.

By adding pain control prior to surgery, the CHI PSH team was able to wean patients off narcotics sooner after surgery.

The drop in narcotics use is significant because complications from their use can keep patients in the hospital longer.

With a perioperative surgical home, there is constant coordination between among all care team members, so that all care occurs in a logical sequence. Another example of a perioperative surgical home is the anesthesiologist’s use of nerve blocks for orthopedic patients. Without the team’s coordination, an anesthesiologist could apply a nerve block that numbs up the patient’s leg. A physical therapist might then visit the patient but because of the block, he or she couldn’t help the patient with physical therapy -- what they came to the room to do. 

 A perioperative surgical home is the right care, at the right place, at the right time and is another effort to support CHI Health's commitment to delivering value-based care. The PSH model may be expanded to other CHI Health hospitals.