Improving Surgical Outcomes: The Perioperative Surgical Home

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Complications related to surgery and anesthesia result in harm to patients, systemic issues, and increased healthcare costs. The Perioperative Surgical Home (PSH) was created by the American Society of Anesthesiologists to meet the goals of improved outcomes, reduced costs, and better patient experiences. In 2017, Wake Forest Baptist Health System created a PSH at Davie Medical Center for total knee and hip arthroplasty patients. Clinical care pathways were developed in cooperation with a multidisciplinary team led by the Orthopedic Surgery Department. In 2019, the program was expanded to include total joint revisions and more complex patients. This study focuses on the PSH at DMC from 2019 to 2021, collecting data on surgical outcomes, costs, and patient experiences to determine if the program can evolve for these higher acuity cases. Data collected from this period showed a continued decrease in postoperative hospital length of stay, improved functional scores demonstrated by Hip Disability and Osteoarthritis Scores and Knee Injury and Osteoarthritis Scores, >96% discharge to home rather than another facility, < 1% 30-day readmission rates, and increased revenue with decreased costs. The PSH has also improved team dynamics and communication resulting in increased job satisfaction for staff. Due to the improved efficiency with the PSH, almost 200 more cases are done each year now, increasing access to care and making it more timely for the patient.



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