儿科环境中的围手术期外科之家：初步结果。

Perioperative Surgical Home in Pediatric Settings: Preliminary Results.

作者信息

Thomson Karen, Pestieau Sophie R, Patel Janish J, Gordish-Dressman Heather, Mirzada Ariana, Kain Zeev N, Oetgen Matthew E

机构信息

From the *Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Health System, Washington, DC; †George Washington University School of Medicine and Health Sciences and Research Center for Genetic Medicine, Children's National Health System, Washington, DC; ‡Medical Princeton Internship in Civic Service, Children's National Health System (Princeton University), Washington, DC; Departments of §Anesthesiology and Perioperative Care, ∥Pediatrics, and ¶Psychiatry, University of California, Irvine, California; and #Division of Orthopedic Surgery and Sports Medicine, Children's National Health System, Washington, DC.

出版信息

Anesth Analg. 2016 Nov;123(5):1193-1200. doi: 10.1213/ANE.0000000000001595.

DOI:10.1213/ANE.0000000000001595

PMID:27749348

Abstract

BACKGROUND

The Perioperative Surgical Home (PSH) is a patient-centered, team-based approach that aims to improve the value of perioperative care. We implemented a PSH for patients with adolescent idiopathic scoliosis who were undergoing posterior spinal fusion at Children's National Health System. We hypothesized that this PSH would improve patient surgical outcomes and reduce hospital length of stay (LOS).

METHODS

A multidisciplinary group created evidence-based protocols for the preoperative, operative, postoperative, and postdischarge care of this patient population. After a 5-month design and training period, PSH for spinal fusion was implemented in March 2015, with reduction in LOS as the primary outcome measure. Anesthesia comanagement of patients additionally allowed a new pathway for patients to recover in the postanesthesia care unit and reduce intensive care unit utilization. Patients before and after the implementation of the PSH were compared on clinical and efficiency metrics.

RESULTS

The spinal fusion PSH achieved the primary outcome measure by a significant reduction in LOS. Care improvement was illustrated by achievement of the secondary outcome measure of reduced perioperative transfusion.

CONCLUSIONS

The PSH model presented a ready structure that proved successful at our institution for patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion.

摘要

背景

围手术期外科之家（PSH）是一种以患者为中心、基于团队的方法，旨在提高围手术期护理的价值。我们在儿童国家卫生系统为接受后路脊柱融合术的青少年特发性脊柱侧凸患者实施了PSH。我们假设这种PSH将改善患者的手术结局并缩短住院时间（LOS）。

方法

一个多学科小组为该患者群体的术前、术中、术后和出院后护理制定了循证方案。经过5个月的设计和培训期后，脊柱融合术的PSH于2015年3月实施，以缩短住院时间作为主要结局指标。对患者进行麻醉共同管理还为患者在麻醉后护理单元恢复提供了一条新途径，并减少了重症监护病房的使用。对实施PSH前后的患者在临床和效率指标方面进行了比较。