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A Patient-Centered Surgical Home to Improve Outpatient Surgical Processes of Care and Outcomes

Douglas J. Morrice, U of Texas - Austin

Preparing patients for surgery is critical for achieving the best possible surgical outcomes. To do this most 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 an extensive study of outpatient surgery at the University of Texas Health Science Center at San Antonio, using statistical analysis and simulation, we demonstrate how this can be accomplished. We show that in order 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. We discuss the potential benefits of the PCSH in patient care, operating room utilization, and patient testing at the teaching hospital considered in our study. Since APC-like clinics are common in practice, our findings have great potential for wide-spread implementation of similar PCSH models with commensurate benefits. (Joint work with Dongyang (Ester) Wang , Jonathan F. Bard, Luci K. Leykum, Susan Noorily and Poornachand Veerapaneni)