The federal law
requires insurance companies pay for 96 hours of hospitalization after
cesarean section (C-section). But, it is safe and preferable to leave the hospital sooner if the
physician determines the mother and baby are healthy and the mother
Women who used a smartphone app as part of a Perioperative Surgical
Home (PSH) program were released from the hospital sooner after
delivering their babies via cesarean section, revealed a study
presented at the American Society of Anesthesiologists PRACTICE
MANAGEMENT 2017 meeting.
‘Women who used a smartphone app as part of a Perioperative Surgical Home (PSH) program were released from the hospital sooner after delivering their babies via cesarean section.’
This study, and other research presented at the
meeting, highlight how PSH programs and physician-led care lead to
improved quality of care, while lowering costs.
Smartphone app empowers C-section patients:
Women scheduled for
C-sections downloaded a special app on their smartphones four weeks
prior to the procedure as part of a PSH, a patient-centered,
physician-led, team-based model of coordinated care that spans the
entire surgical experience, from the decision to have surgery to
discharge and beyond.
The app reminded them of appointments, provided
pre-surgery information - such as when to start and stop medications -
and facilitated remote post-surgery health checks such as pain control
and wound recovery. Researchers reported on the first 30 women using the
app and found the average length of hospital stay after delivery
decreased from 3.7 days to 2.7 days.
The program is the first in the
United States to employ enhanced recovery after surgery (ERAS) for
C-section. An element of the PSH, ERAS programs use a variety of methods
to ease the effects of surgery and fast-track patient recovery. When
factoring in the cost savings of shorter hospital stays with the cost of
the resources required to participate in the program and develop and
implement the app, the return on investment was significant - 216% the first year and an estimated 282% in subsequent years,
While it is too soon to report quality outcomes such
as surgical site infections, urinary tract infections and patient
satisfaction, early results are promising, said study author Attila
Kett, division chief of obstetric anesthesia at Saint
Peter's University Hospital, New Brunswick, N.J. "The app empowers women by putting them in control of
their health care needs," said Dr. Kett.
Revamped pre-anesthesia clinics improve patient care:
To improve and
standardize patient care, Cleveland Clinic created a centralized,
flexible, anesthesia-led model of preoperative care that followed the
same guidelines-driven clinical protocols, practice management,
resources, staffing models and process flows at all 14 of their
The new Pre-Anesthesia Consultation Clinics
(PACC) concept included changes such as centralizing and streamlining
the scheduling process, updating protocols to reflect a more
evidence-based approach and enabling patients to have their pre-surgery
evaluation at any of the clinics, regardless of where the surgery would
take place, said study author Maureen Keshock, assistant
medical director PACC at Cleveland Clinic.
The rollout of the large
project throughout the Clinic Enterprise required attention to metrics
and frequent assessment of staffing needs. At one point during the
rollout, patients were only seen an average of two days prior to
surgery. After evaluating staffing needs and changing the process in
which PACC visits were scheduled, patients were seen an average of 10
days before surgery. This gave providers more time to assess and address
issues before surgery, such as prescribing medications early enough to
prevent anemia and reducing the need for blood products.
followed was the number of patients calling to schedule their surgeries
or ask questions who hung up before an operator addressed the call. This
dropped-call metric during the lowest point of the roll out was 18%. Three additional scheduling operators were added and that
number decreased to 1.9%.
This single model of service throughout
the organization eliminated redundancies, saving an estimated $1.4
million in annual operating costs. "Patient care was improved by
decreasing variability and creating a unified set of anesthesia
guidelines," said Dr. Keshock.
Anesthesia care team increases efficiency:
The 2008 implementation
of an anesthesia care team at Memorial Hermann Hospital-Texas Medical
Center in Houston - the nation's largest level 1 trauma center - led to
more efficient care, increased volume and improved employee
satisfaction, a retrospective study shows.
The most effective aspect of
the program was the change in culture as a result of creating effective
teams, improving communication and establishing accountability, said
study author Carin A. Hagberg, former chairman of the Department
of Anesthesiology at the University of Texas Medical School at Houston
and current division head of Anesthesiology, Critical Care and Pain
Medicine at the University of Texas MD Anderson Cancer Center.
- real-time tracking of all surgical cases, which
eased staffing assignments and enhanced communication;
surgical service lines into a pod system (for example, putting general,
gynecological and urological surgeries together), which improved
efficiency, quality of patient care and surgical team satisfaction;
- employing anesthesiologist assistants as members of the care team to
help manage service expansion.
From 2009 to 2015, operating room volume
increased by 33%. First case on-time starts improved from 66% in 2009 to more than 80% by 2010. Case cancellations
decreased from 4% in 2009 to 1% in 2010. From 2009 to 2015
physician satisfaction scores increased from 20% to 91%
and overall surgical team satisfaction improved with composite scores
increasing 23% or more.
"Strategic partnership between the
hospital and physician group, as well as the support of administrators,
nursing staff and surgeons enabled successful change in the culture of
care," said Dr. Hagberg.