Physician anesthesiologist-led care improves experience for patients having outpatient gallbladder surgery

Patients having outpatient gallbladder surgery whose experience was coordinated by a physician anesthesiologist through the Perioperative Surgical Home (PSH) model of care had shorter wait times before surgery, recovered more quickly after the procedure and were less likely to require care for complications, according to two studies presented at the ANESTHESIOLOGY^® 2015 annual meeting.

"While the safety and effectiveness of same-day gallbladder surgery is well documented, there is increasing evidence that long waits before surgery and long recovery times can contribute to a negative experience for the patient that can include complications, possibly requiring additional medical care," said Chunyuan Qiu, M.D., M.S., lead author of the studies and physician anesthesiologist at Kaiser Permanente Baldwin Park Medical Center in Baldwin Park, Calif. "Our goal is to give patients the best experience possible and reduce the need for additional resources to treat unexpected problems."

A PSH is an innovative patient-centered, physician-led, multidisciplinary team-based model of coordinated care that guides the patient throughout the entire surgical process - from the time of the decision for surgery until patient recovery - that aims to ensure patient safety and quality of care.

In the studies, researchers reviewed four years of data on 1,784 patients undergoing laparoscopic gallbladder surgery, the most commonly performed outpatient procedure in the United States. Half of the patients in the study received their care through an existing provider-centered "fast-track" surgical process aimed at speeding up the perioperative process, while the other half received care through the new PSH model, led by a physician anesthesiologist.

Patients who received their care through the PSH model experienced a 31 percent decrease in wait times before surgery (38 minute reduction), a 30 percent decrease in recovery time (79 minute reduction) and were 17 times less likely to require extra care to treat complications after surgery. Overall, there was a 29 percent decrease in length of stay (117 minute reduction) for patients in the PSH model compared to those in the previous fast-track method. Only four patients in the PSH group experienced a complication requiring additional care, compared to 61 patients in the fast-track group, representing a real cost savings for the organization, the authors note.

Dr. Qiu said the improvements in quality of care seen in the PSH were the result of coordinated team-based efforts involving administrators, surgeons, operating room (O.R.) nurses, technicians, schedulers and quality improvement specialists, with a physician anesthesiologist leading the team.

"In putting our PSH into practice, we realized that physician anesthesiologists need to take on new leadership roles and expand their roles beyond the O.R.," said Dr. Qiu.

In addition to the current studies, Kaiser researchers previously presented data showing faster recovery times, higher patient satisfaction and lower costs for patients having knee replacement surgery in an inpatient PSH model of care at a large hospital.