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首页> 外文会议>Human Factors and Ergonomics Society Annual Meeting >Outcomes Following Initial Perioperative Surgical Home Integration at a Rural Community Hospital
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Outcomes Following Initial Perioperative Surgical Home Integration at a Rural Community Hospital

机译：在农村社区医院的初始围手术期外科家庭融合之后的结果

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Background: The Perioperative Surgical Home (PSH) model of care was developed to deliver value-based care that improves population health, reduces care costs, satisfies patients and gratifies providers. Rural and remote health centers have the greatest need to coordinate surgical care to improve patient access and outcomes. However, limited PSH model fidelity currently exists for rural and remote care facilities. This study integrated and assessed the PSH model within a rural, community hospital to create a system-level model to adapt/customize PSH to meet the needs of the staff, clinicians, patients, and communities served in three rural counties. The aim of this study was to assess system functionality by tracking preliminary clinical and rehabilitative patient outcomes after initial PSH implementation at a rural community hospital. Methods: An initial PSH system model was created using field-based user observations during normal clinic operations, investigator-led debriefs of staff, and longitudinal patient outcomes. This system model was created using the critical path method, bottleneck analysis and cause and effect diagramming. An initial cohort of 17 orthopedic joint replacement patients were followed from PSH enrollment to 90-days post hospital discharge to assess clinical and rehabilitative outcomes as well as to assess PSH system functionality in a rural care network. Results: The first system analysis was performed with the primary stakeholder being the patient (patient-centric). Several linked service processes form the surgical episode with inputs from a variety of stakeholders. Average length of stay decreased to 2.23 days, hospital discharge to home increased to 86% and readmissions decreased to 5.9%. Conclusion: During the system mapping process several areas were identified for improvement including information flow and duplicative work. Two primary process bottlenecks were found and included sleep apnea screening with a positive result and post-acute inpatient care scheduling. The PSH model of care is feasible in a small, rural community hospital. Patient outcome improvements demonstrate the important roles of centrally-based and proactive care management for major care episodes.
机译：背景：开发了围手术期外科家庭（PSH）护理模型，以提供基于价值的护理，从而提高人口健康，降低了护理费用，满足患者和满足提供者。农村和远程健康中心最需要协调手术护理以改善患者的访问和结果。然而，有限的PSH模型保真度目前存在农村和遥控设施。本研究综合并评估了农村社区医院内的PSH模型，以创建一个系统级模型，以适应/定制PSH，以满足三个农村县的工作人员，临床医生，患者和社区的需求。本研究的目的是通过在农村社区医院初次PSH实施后跟踪初步临床和康复患者结果来评估系统功能。方法：在正常诊所运营期间使用基于现场的用户观测，研究人员领导的员工和纵向患者结果来创建初始PSH系统模型。使用关键路径方法，瓶颈分析和原因和效果图创建该系统模型。初始坐在17名骨科关节置换患者的初始队列均持续到90天后医院出院，以评估临床和康复结果，以及评估农村护理网络中的PSH系统功能。结果：第一个系统分析是用初级利益攸关方进行的患者（以患者为中心）进行。几个链接的服务流程形成了来自各种利益相关者的投入的外科集发作。平均停留时间减少到2.23天，医院向家庭排放量增加到86％，再生减少到5.9％。结论：在系统映射过程中，确定了几个区域以改进，包括信息流和重复工作。发现了两种主要过程瓶颈并包括睡眠呼吸暂停筛选，具有阳性结果和后急性住院护理调度。 PSH护理模型在一个小型农村社区医院中是可行的。患者结果改进展示了基于集中的和主动护理管理的重要作用。

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