Best-in-Class Perioperative Care: Optimization for Accountable Care

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Efficient and effective perioperative care can make a huge impact on a hospital's bottom line, especially as healthcare moves toward accountable and value-based care.


At the 5th Annual Becker's Hospital Review conference in Chicago on May 16, President and CEO of Surgical Directions Jeff Peters gave a presentation titled "Creating a Best in Class Perioperative Service Line Under Accountable Care and Value Based Purchasing."

"If you do a good job in the operating room in terms of quality and outcomes, your OR is successful," Mr. Peters said. "That creates more pressure in new payment systems for value-based purchasing and accountable care. Our job as healthcare providers is to provide value and our formula is currently clinical outcomes over cost. However, that doesn't mean you'll succeed just by having lowest costs. If you look at outstanding organizations the reason they get great outcomes is because they focus on value."

The five key elements attributed to the American College of Surgeons’ NSQIP are:

  • Single-path scheduling
  • Document management
  • Presurgical testing
  • Daily OR huddles
  • Surgical safety initiatives

"A lot of organizations don't pay attention to scheduling," said Mr. Peters. "It's amazing that world-class organizations still take schedules by fax, physician calls and EMR. That's where safety begins, wrong site surgery is prevented and the patient is optimized. Scheduling is a small detail but it's important in preventing bad outcomes."

The huddles are also crucial to identifying issues in time to prevent patient safety issues. In one example Mr. Peters gave, the hospital staff took an hour each day to huddle on patient issues, identifying problems two or three days in advance. The team also meets with the surgeon to discuss what went right and what went wrong with the patient, and then addresses what can be done to make changes in the future.

"What can drive change is anesthesia. If you look at what went well in the OR and identify an effective anesthesia leader who is in the OR every day participating in the huddle, they can talk to staff members and discuss how to handle issues, such as surgeons showing up 20 minutes late for cases every day," said Mr. Peters. "They make sure everyone is on the same page for a solution. We firmly believe one of the key drivers to a well-functioning OR is anesthesia."

In another case study Mr. Peters presented, anesthesiologists wanted to take the lead on transforming the operating room and making it function more efficiently. The hospital's CEO was skeptical about the anesthesiologists' motives. However, the group was able to optimize the OR and really make a difference in the bottom line.

"For block time, the best performing organizations require 80 percent utilization to maintain the block," said Mr. Peters. "This organization was doing around 940 cases and should have been doing 1,100. They had five times the national average for same-day cancellations and were not doing well with on-time starts. If you don't have high utilization, you don't have the right revenue per OR minutes to meet the national benchmarks."

However, the anesthesiologists were able to work with the surgeons and run the OR more effectively. Surgeons are often data-driven, and it's the OR leaders' responsibility to provide them with those numbers. Surgeons can compare their numbers with each other and find a solution for variation.

"We found having surgeons in the room when patients were prepared had an impact because then the patient was positioned appropriately for surgery," said Mr. Peters. "Also, we implemented anesthesia preference cards. Every surgeon wants a minor difference in drugs or block, and anesthesia preference cards saved four to six minutes of instruction."


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4 Key Findings on the PPACA and Medicaid Enrollment 



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