Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
J Arthroplasty. 2021 Jun;36(6):1849-1856. doi: 10.1016/j.arth.2020.12.054. Epub 2021 Jan 9.
Our institution previously initiated a perioperative surgical home initiative to improve quality and efficiency across the hospital arc of care of primary total knee arthroplasty and total hip arthroplasty patients. Phase II of this project aimed to (1) expand the perioperative surgical home to include revision total hip arthroplasties and total knee arthroplasties, hip preservation procedures, and reconstructions after oncologic resections; (2) expand the project to include the preoperative phase; and (3) further refine the perioperative surgical home goals accomplished in phase I.
Phase II of the Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies project ran from July 2018 to July 2019. The evaluated arc of care spanned from the preoperative surgical consult visit through 90 days postoperative in the expanded population described above.
Mean length of stay decreased from 2.2 days to 2.0 days (P < .001), 90-day readmission decreased from 3.0% to 1.6% (P < .001), and Press-Ganey scores increased from 77.1 to 79.2 (97th percentile). Mean and maximum pain scores and opioid consumption remained unchanged (lowest P = .31). Annual surgical volume increased by 10%. Composite changes in surgical volume and cost reductions equaled $5 million.
Application of previously successful health systems engineering tools and methods in phase I of Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies enabled additional evolution of an orthopedic perioperative surgical home to encompass more diverse and complex patient populations while increasing system-wide quality, safety, and financial outcomes. Improved process and outcomes metrics reflected increased efficiency across the episode of care without untoward effects.
III Therapeutic.
本机构此前启动了围手术期外科之家计划，以提高初级全膝关节置换术和全髋关节置换术患者的医院整体护理质量和效率。该项目的第二阶段旨在：（1）将围手术期外科之家扩大到包括翻修全髋关节置换术和全膝关节置换术、髋关节保健康复手术以及肿瘤切除后的重建手术；（2）将项目扩展到术前阶段；（3）进一步完善第一阶段实现的围手术期外科之家目标。
骨科手术和麻醉学外科改进策略项目的第二阶段从 2018 年 7 月至 2019 年 7 月进行。评估的护理范围从术前手术咨询访问到上述扩展人群的术后 90 天。
平均住院时间从 2.2 天缩短至 2.0 天（P<.001），90 天再入院率从 3.0%降至 1.6%（P<.001），Press-Ganey 评分从 77.1 分提高至 79.2 分（97 百分位）。平均和最大疼痛评分以及阿片类药物消耗量保持不变（最低 P=0.31）。年度手术量增加了 10%。手术量和成本降低的综合变化相当于 500 万美元。
在骨科手术和麻醉学外科改进策略的第一阶段应用先前成功的卫生系统工程工具和方法，使骨科围手术期外科之家得以进一步发展，涵盖更多样化和更复杂的患者群体，同时提高了系统范围的质量、安全和财务结果。改进的流程和结果指标反映了整个治疗过程中的效率提高，而没有不良影响。
III 治疗性。
