A Needs Assessment for the Perioperative Surgical Home Model

Abstract

The United States is ranked first for health care expenditure and 11th for quality of care. Surgical care is complex, multifactorial, and medical expenses continue to increase. The necessity for surgery normally disconnects the patient from their primary care provider, frequently resulting in uncoordinated care between medical providers regarding surgical care. A fragmented healthcare system results in unnecessary diagnostic labs and tests, insufficient surgical care resources, and patients experiencing a lapse in their medical care. If adopted, the Perioperative Surgical Home (PSH) model has the opportunity to improve patient outcomes by increasing patient satisfaction rates while decreasing surgical complications and hospital stay duration. The PSH model is patient-centered, and directed by anesthesia providers coordinating surgical care by adequately optimizing patients for surgery. The five model components are: patient involvement, comprehensiveness, coordination of care, accessibility, and commitment to quality and safety. Purpose: The purpose of this project was to perform a needs assessment at a Central Phoenix Hospital to identify if there was a need to implement the PSH model to decrease surgical complications and 30-day surgical hospital readmission rates. Methods: This was a non-experimental needs assessment. Retrospective data collection was used to explore and identify if the PSH model was needed at this Phoenix hospital. A needs assessment tool was created guided by the Rothwell and Kazana's needs assessment model utilizing their five key phases. The General Systems Theory was used to assess the complexity of an open surgical system to identify gaps in performance and results. Results: Data collected from fiscal year 2015 demonstrated a total of 7,829 surgical cases were performed at this hospital. The number of patients with a surgical complication was 826 (10.6%). A reported 147 (1.9%) patients had a surgical hospital readmission at this facility. Data from fiscal year 2016 demonstrated 7,778 (10.3%) total surgical cases. The number of surgical complications reported was 800 (1.5%). A reported 116 patients had a hospital surgical readmission at this facility. Conclusion: The reported high health care expenditure and low quality of care received in the U.S. supports the need to improve our health care delivery system with models such as the PSH. There was not an obvious problem in performance of surgical complications and 30-day surgical hospital readmission rates. There were identified system gaps in data collection of surgical reporting that correlate with clinical practice. These findings were the starting point for a needs analysis to follow by focusing on development and implementation of the PSH model if adopted.