Cline Kayla M, Clement Viviane, Rock-Klotz Jennifer, Kash Bita A, Steel Christopher, Miller Thomas R
Mays Business School, Texas A&M University, 4113 TAMU, College Station, TX, USA.
Department of Anthropology, Texas A&M University, 340 Spence Street, College Station, TX 77843.
J Clin Anesth. 2020 Aug;63:109760. doi: 10.1016/j.jclinane.2020.109760. Epub 2020 Apr 11.
The perioperative surgical home (PSH) is a recent innovation in perioperative care delivery that coordinates the pre-, intra-, and post-operative elements of surgical care under one organizational umbrella. Although significant research supports the efficacy of individual elements of the PSH in improving outcomes, there is not a published systematic review of the efficacy of entire PSH programs in improving patient outcomes. This article summarizes descriptions of PSH programs available in the literature and examines outcomes of original studies of PSH implementation.
We conducted a systematic literature review to identify relevant articles on PSH implementation and synthesize our findings.
The studies included in our review took place at multiple academic and community hospitals in the United States.
Patients involved in the PSH studies included surgical patients of various ages and ASA classifications in various surgical specialties.
All studies included in our review involved the implementation of a PSH program.
Outcomes examined include length of stay, postoperative recovery, readmission rates, and patient discharge destination, among others.
We identified 11 studies of PSH implementation that met our inclusion and exclusion criteria. Most PSH programs described in these studies included an emphasis on preoperative education, standardization of care protocols in all phases of surgery, use of opioid-sparing multimodal analgesia, and collaborative staffing models. PSH program implementation was often associated with decreased length of stay, decreased utilization of postoperative opioids, decreased utilization of the ICU, and increased probability of discharge to home. PSH implementation was not meaningfully associated with reductions in readmission rates. Findings for cost reductions following PSH implementation were mixed.
Early evidence indicates that through elements that emphasize care coordination, standardization, and patient-centeredness, PSH programs can improve patient postoperative recovery outcomes and decrease hospital utilization.
围手术期外科之家（PSH）是围手术期护理提供方面的一项新举措，它在一个组织框架下协调手术护理的术前、术中和术后各个环节。尽管大量研究支持PSH的各个要素在改善结局方面的有效性，但尚未有已发表的关于整个PSH项目在改善患者结局方面有效性的系统评价。本文总结了文献中可用的PSH项目描述，并考察了PSH实施的原始研究的结局。
我们进行了一项系统的文献综述，以识别关于PSH实施的相关文章并综合我们的发现。
我们综述中纳入的研究在美国的多家学术和社区医院开展。
参与PSH研究的患者包括不同年龄和美国麻醉医师协会（ASA）分级的各个外科专科的手术患者。
我们综述中纳入的所有研究都涉及PSH项目的实施。
考察的结局包括住院时间、术后恢复情况、再入院率和患者出院去向等。
我们识别出11项符合我们纳入和排除标准的PSH实施研究。这些研究中描述的大多数PSH项目都强调术前教育、手术各阶段护理方案的标准化、使用阿片类药物节省型多模式镇痛以及协作人员配置模式。PSH项目的实施通常与住院时间缩短、术后阿片类药物使用减少、重症监护病房（ICU）使用减少以及出院回家的可能性增加相关。PSH的实施与再入院率的降低没有显著关联。PSH实施后成本降低的结果不一。
早期证据表明，通过强调护理协调、标准化和以患者为中心的要素，PSH项目可以改善患者术后恢复结局并降低医院利用率。
