351 - Improving Patient Optimization Prior to Surgery - Redesigning the Process
Clinical Issue: The perioperative process is complex on many levels - designing systems to improve patient flow, safety, quality of care and stakeholders' satisfaction (patients, surgeons, anesthesiologists and perioperative nurses/personnel) is crucial to the overall success of a healthcare institution and system. Evaluating and improving the performance of the entire surgical process must be completed from start to finish to achieve the desired outcome.Surgical patients are a primary source of hospital admissions, typically 55-65% on average. Insuring a high reliability process for patient evaluation prior to surgery results in reduction of day-of-surgery cancellations, redundancy of patient testing and overall length of stay. The PreSurgical Optimization Program (POP) was developed to identify and mitigate contributing co-morbidities by risk stratification early on during the preparation for surgery phase and determine the level of adequate pre-operative evaluation and/or treatment needed to safety clear patient for surgery.Description of Team:The POP program is a multi-disciplinary team, composed of specially trained Hospitalists, Nurse Practitioner and Perioperative nurses/personnel. Other subspecialty services are also available for consultation as needed, such as Cardiology, Pulmonary, Anesthesia, Pain Management, Case Management and others. Assessment/Planning/Implementation:During the patients 90 minute POP appointment, which is generally scheduled one to two weeks prior to surgery, patients undergo a comprehensive physical exam and also takes into consideration, the planned type of anesthesia that will be used, intra-operative patient positioning and post-operative considerations. If any additional testing is needed, such as ECHO, stress test, sleep apnea study, etc. the POP physicians assist in expediting, in order to obtain results prior to day-of-surgery. Treatment and optimization of any identified conditions, such as hypertension, infection, etc. are managed by the POP team, in consultation with patients primary care physician and surgeon. Nurses also provide in-depth patient education regarding preparation for surgery, medications, post-operative planning and serves as a resource for any questions/concerns. Outcome:The program was initiated in September 2017 on a limited patients, primarily focusing on total joint patients, however, extended to other scheduled in-patient and high-risk outpatient surgeries incrementally over one year. Utilization of POP for all scheduled in-patient surgeries as well as comparison of day-of-surgery cancellation rates for POP vs non-POP patients were compared. Significant variance in day-of-surgery cancellation rates were obtained: POP patient day-of-surgery cancellation rate: < 0.01% vs. non-POP patient day-of-surgery cancellation rate ranging between 3-11% between October 2018 and August 2019. Implications for Perioperative Nursing: Provides standardized, formal process to assist perioperative nurses in providing patient education/preparation for all phases of surgical care.