Abstract
BackgroundA major restructuring of perioperative care delivery is required to reduce cost while improving patient outcomes. In a test implementation of this notion, we developed and implemented a perioperative consult service (PCS) for colorectal surgery patients.MethodsA 6-month planning process was undertaken to engage key stakeholders from surgery, nursing, and anesthesia in a healthcare redesign project that resulted in the creation of a PCS to implement a coordinated clinical pathway. After Institutional Review Board (IRB) approval, data were collected for all elective colorectal procedures for three phases: phase 0 (pre-implementation; 1/2014–6/2014), phase 1 (7/2014–10/2014), and phase 2 (11/2014–10/2015). Length of stay (primary endpoint; LOS), total hospital cost, use of clinical pathway components, markers of functional recovery, and readmission and reoperation rates were analyzed. Outcomes and patient characteristics among phases were compared by two-tailed t tests and Wilcoxon rank-sum tests. Categorical variables were analyzed by chi-square and Fisher’s exact tests.ResultsWe studied 544 patients (phase 0 = 179; phase 1 = 124; phase 2 = 241), with 365 consecutive patients being cared for in the redesigned care structure. Median LOS was reduced and sustained after implementation (phase 0, 4.24 days; phase 1, 3.32 days; phase 2, 3.32 days, P < 0.01 phase 0 v. phases 1 and 2), and mean LOS was reduced in phase 2 (phase 0, 5.26 days; phase 1, 4.93 days; phase 2, 4.36 days, P < 0.01 phase 0 v. phase 2). Total hospital cost was reduced by 17 % (P = 0.05, median). Application of clinical pathway components was higher in phases 1 and 2 compared to phase 0 (P < 0.01 for all components except anti-emetics); measures of functional recovery improved with successive phases. Reoperation and 30-day readmission rates were no different in phase 1 or phase 2 compared to phase 0 (P > 0.15).ConclusionsRestructuring of perioperative care delivery through the launch of a PCS-reduced LOS and total cost in a significant and sustainable fashion for colorectal surgery patients. Based on the success of this care redesign project, hospital administration is funding expansion to additional services.Electronic supplementary materialThe online version of this article (doi:10.1186/s13741-016-0028-1) contains supplementary material, which is available to authorized users.
Highlights
A major restructuring of perioperative care delivery is required to reduce cost while improving patient outcomes
A financial analysis of this program demonstrated a decrease in median total hospital costs per patient by 17 % in phases 2 v. 0 (P = 0.05)
The combination of reduced length of stay (LOS) and cost reveals that four colorectal surgical (CRS) patients can be cared for in the same time as three patients in the baseline group at a significantly reduced cost compared to historical baseline
Summary
A major restructuring of perioperative care delivery is required to reduce cost while improving patient outcomes. A major restructuring is needed to improve care coordination, quality, outcomes, and access, all while restraining or reducing cost (Holt 2014; Huang and Schweitzer 2014; Vetter et al 2013). The Institute for Healthcare Improvement (IHI) has proposed a Triple Aim, which is to (a) improve the individual experience of surgical care, (b) improve the health of a defined surgical population, and (c) reduce the per capita cost of surgical care (Vetter et al 2014; Berwick and Whittington 2008). The concept of the Perioperative Surgical Home (PSH), which is a patient-centered, physician-led, interdisciplinary, and team-based system of coordinated care for the procedural and surgical patient, has been proposed as a model of healthcare redesign in the USA (Cannesson and Kain 2014; Schweitzer et al 2013). The actual structure and function of such an entity remain vague
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
