PSH model of care provides better outcomes and decreases length of hospital stay

Decreasing the number of tests, blood transfusions and length of time in the hospital, while improving patients' pain management and communication with physicians were the results of implementing the Perioperative Surgical Home (PSH) model of care at TEAMHealth Anesthesia at Tampa General Hospital in Tampa, Fla., according to a study presented at the ANESTHESIOLOGY® 2016 annual meeting.

"Implementation of the core PSH evidenced-based practice principles through physician leadership and redesign of the perioperative process has become 'job one' across all of our practices nationwide," said Sonya Pease, M.D., chief medical officer, TEAMHealth Anesthesia. "Being able to take better care of patients and be successful in new payment models can go hand-in-hand, this model of care does exactly this."

In the study, researchers reviewed the medical records of 1,356 patients who had total knee, hip or shoulder joint replacement surgery. Fifty percent of the patients received care under the PSH model, while the other 50 percent did not. Overall, they found a 9 percent decrease in imaging tests; the average number of laboratory tests prior to surgery decreased by 22 percent; blood transfusion requirements decreased, with 87 percent fewer units of blood used per case; average length of hospital stay decreased by slightly more than half a day; and patient satisfaction improved, with patients reporting better pain management and more effective physician communication.

"We took common sense ideas and implemented them," said Enrico Camporesi, M.D., professor emeritus at the University of South Florida and director of research, SE at TEAMHealth Anesthesia Research Institute.

"Patients were going for duplicate images because our systems across institutions did not communicate," said Devanand Mangar, M.D., chief of anesthesia at Tampa General Hospital and regional medical director, TEAMHealth Anesthesia. "Protocols for blood transfusions needed modification to limit unnecessary transfusion. Shifting from continuous nerve blocks to spinal blocks as well as a focus on better communication and more timely pain management consults realized overall improvements for our patients."

The PSH is an innovative patient-centered, physician-led, multidisciplinary team-based model of coordinated care spearheaded by the American Society of Anesthesiologists. In the PSH, a patient's entire surgical experience - preoperative, intraoperative and post-discharge - is fully coordinated and treated as a continuum of care. The PSH model emphasizes the cost-efficient use of resources and patient shared decision-making.​