The impact of a patient-centered surgical home implementation on preoperative processes in outpatient surgery

ABSTRACT

Purpose: To report results of a pilot study quantifying the impact of a Patient-Centered Surgical Home (PCSH) implementation on preoperative processes in outpatient surgery at University Health System in San Antonio, TX. As a key feature of our PCSH model, an Anesthesia Preoperative Clinic (APC) served as system coordinator and information integrator. Materials and methods: Pre- and post-intervention statistical analyses were conducted on observational data, including patient volume, health condition, information deficiency, and clinic waiting time. Additional analyses were conducted on 63 months of APC patient volume data and 89 weeks of operating room (OR) first-case delays. Results: The average number of patients assessed by APC increased by 19% while APC average clinic time decreased by 9%. Operating Room (OR) patients assessed by APC increased from 45% to 59%. Patient information deficiency improved but the health condition of patients seen in-clinic at APC remained unchanged. OR first-case delay rates that the intervention was designed to impact decreased: anesthesia (69%), surgeon (43%) and patient (33.6%). OR first-case delay rates not impacted by the intervention, but attributable to the hospital, increased by 90%. Conclusions: The PCSH implementation improved several preoperative process metrics for outpatient surgery. Additionally, the study revealed opportunities for improvement.

KEYWORDS:

• Outpatient clinics
• patient flow
• process improvement
• statistics

Acknowledgments

We would like to thank our clinician and administrative colleagues at University of Texas Health Science Center at San Antonio and UHS who worked with us to implement this model and collect these data. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Additional information

Funding

This work was supported by grant #153239 from the University of Texas Office of the Executive Chancellor for Health Affairs.