A patient-centered surgical home to improve outpatient surgical processes of care and outcomes

Preparing patients for surgery is critical for achieving the best possible surgical outcomes. To do this effectively, care must be coordinated across several types of specialists, and potentially across multiple settings. In this paper, we develop a Patient-Centered Surgical Home (PCSH) for outpatient surgery based on the concept of the Perioperative Surgical Home proposed by the American Society of Anesthesiologists. A key feature of the PCSH is to have an anesthesiology preoperative assessment clinic (APC) serve as system coordinator and information integrator. Based on a study of outpatient surgery at the University of Texas Health Science Center at San Antonio and its primary teaching hospital using statistical analysis and simulation, we demonstrate how this can be accomplished. We show that for the PCSH to succeed, APC must see the right patients with the right information by overcoming improper triaging of patients and patient information deficiencies. Our analysis shows that with the proper screening tool and modifications to the way triage is handled, it is possible to increase the number of patients that the APC sees each day with a modest increase in resources. Much of the potential benefits rest on the cooperation of the referring clinics as well as closing the gap between the current level of patient information and what is needed for optimizing medical decisions. Estimated cost savings are over one million dollars annually with a PCSH. Since APC-like clinics are common, our findings have great potential for widespread implementation of similar PCSH models with commensurate benefits.