4 Strategies to Implement a Surgical Home and Why it Makes a Difference

Reducing length of stay and reducing narcotic use for most colorectal surgery patients are early metrics showing surgical home success at two hospitals within the Kettering Health Network (KHN) in Dayton, Ohio, according to Carol Applegeet, MSN, RN, CNOR, NEA-BC, FAAN, vice president of perioperative services for the system.

Two of seven hospitals within KHN have established a surgical home for colorectal surgery patients and a third hospital in the system is preparing to launch its surgical home following these early data showing favorable outcomes.

The perioperative surgical home concept can look different across health care organizations, but it includes a shared focus on care coordination throughout a patient’s continuum of care. The goal is to improve patient experience and outcomes, while also improving operational efficiencies and resource allocation.   

“It’s so exciting to see surgeons, nurses, anesthesia providers and other members of the team working together to make sure the patient is optimized—this is an amazing change and probably the biggest thing to happen in perioperative care since minimally invasive surgery,” Applegeet says.

Understanding What a Surgical Home Can Do

Much of the focus in the surgical home model is to optimize the preoperative patient prior to surgery.

At KHN, Enhanced Recovery After Surgery (ERAS) is implemented as part of their surgical home approach. ERAS includes perioperative collaboration to prehab the patient for surgery, optimize their health on the day of surgery, provide little or no narcotics during and after the surgery, and ambulate patients immediately after surgery to improve postoperative recovery and reduce length of stay.

Anesthesiologists who had experience with a surgical home using ERAS encouraged it be established at KHN. The idea quickly gained traction among a multidisciplinary team of providers, administrators and quality and IT professionals wanting to improve perioperative care delivery, Applegeet explains.

“It all happened very quickly once everyone was on board,” she shares. “We established the need for system-wide shared order sets as one of the first important tasks for surgical home implementation. Standardizing order sets is a massive undertaking, yet within two weeks the team completed this goal.”

At the same time this was happening, KHN was preparing to launch an electronic documentation clinical pathway for colorectal surgery patients, which also has helped lay the groundwork for improved care coordination.

Moving From Idea to Implementation

Lack of knowledge and practical experience with the surgical home are two very real barriers to making it a reality, Applegeet cautions. “Many perioperative professionals don’t fully understand what the surgical home is and what it involves. There are also challenges with educating patients to understand the benefits of preoperative care and ERAS, so education for providers and patients is critical if you want to move from discussion to planning your surgical home implementation.”

Once your team is open to the idea of the surgical home, Applegeet suggests four key strategies perioperative leaders can take to get the ball rolling …

1. Be inclusive—It takes careful coordination among all members of the care team through each phase of care, as well as support staff such as hospitalists, respiratory specialists, and the surgeon’s office staff. Communication has to be well established.
2. Start small and stay focused—Start with one single service line and build your quality metrics as you go along so you know what outcomes you expect.
3. Engage senior leadership—A surgical home requires a significant investment in time, people and energy to be successful and administration has to be 100% in support of this investment.
4. Learn from others—Perioperative surgical home resources offered by the American Society of Anesthesiologists and the American College of Surgeons can be helpful adjuncts to starting your own program. Connecting with these resources also provides valuable networking opportunities in the ongoing work to sustain and improve all aspects of your surgical home.

New metrics are being added to further monitor success and areas for improvement as KHN continues to develop their surgical home model across the health system. They are beginning to formally track narcotics given, patient complications, and surgical site infections.

Appelgeet is looking forward to sharing these surgical home metrics in an education session on the topic at the AORN Leadership Summit in Nashville April 7–10. “We are eager to share our successes and learn from others who are establishing surgical homes to understand how we can optimize our approach; the PSH is poised to become the standard for perioperative care.”

Free Resources for Members

Perioperative Patient Engagement Tool Kit - Optimize the preoperative patient prior to surgery with the use of this members-only tool kit, including strategies and resources to incorporate patient engagement activities in the practice setting.

Guideline Essentials- Improve your team’s communication and other preoperative and postoperative skills with easy online implementation tools:

• Gap Analysis Tools: Tools to assess areas in which your facility may not be compliant with the guidelines.
• Policy & Procedure Templates: Ready-to-use customizable templates for developing your facility’s policies and procedures
• Competency Verification Tools: Ready-to-use customizable templates for verifying competency to meet facility requirements