Format

Send to

Choose Destination
Perioper Med (Lond). 2016 Feb 5;5:3. doi: 10.1186/s13741-016-0028-1. eCollection 2016.

A perioperative consult service results in reduction in cost and length of stay for colorectal surgical patients: evidence from a healthcare redesign project.

Author information

1
Department of Anesthesiology, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA.
2
Department of Anesthesiology, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA ; Department of Biomedical Informatics, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA.
3
Division of Colon and Rectal Surgery, Vanderbilt University School of Medicine, 1161 21st Ave South, D5248, Nashville, TN 37232-2543 USA.
4
Department of Anesthesiology, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA ; Department of Biomedical Informatics, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA ; Department of Surgery, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA ; Department of Health Policy, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA.
5
Department of Anesthesiology, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA ; Department of Surgery, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA.
6
Department of Anesthesiology, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA ; Division of Neuroanesthesiology, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA.
7
Department of Anesthesiology, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA ; Department of Biomedical Informatics, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA ; Department of Surgery, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, TN 37232 USA.

Abstract

BACKGROUND:

A major restructuring of perioperative care delivery is required to reduce cost while improving patient outcomes. In a test implementation of this notion, we developed and implemented a perioperative consult service (PCS) for colorectal surgery patients.

METHODS:

A 6-month planning process was undertaken to engage key stakeholders from surgery, nursing, and anesthesia in a healthcare redesign project that resulted in the creation of a PCS to implement a coordinated clinical pathway. After Institutional Review Board (IRB) approval, data were collected for all elective colorectal procedures for three phases: phase 0 (pre-implementation; 1/2014-6/2014), phase 1 (7/2014-10/2014), and phase 2 (11/2014-10/2015). Length of stay (primary endpoint; LOS), total hospital cost, use of clinical pathway components, markers of functional recovery, and readmission and reoperation rates were analyzed. Outcomes and patient characteristics among phases were compared by two-tailed t tests and Wilcoxon rank-sum tests. Categorical variables were analyzed by chi-square and Fisher's exact tests.

RESULTS:

We studied 544 patients (phase 0 = 179; phase 1 = 124; phase 2 = 241), with 365 consecutive patients being cared for in the redesigned care structure. Median LOS was reduced and sustained after implementation (phase 0, 4.24 days; phase 1, 3.32 days; phase 2, 3.32 days, P < 0.01 phase 0 v. phases 1 and 2), and mean LOS was reduced in phase 2 (phase 0, 5.26 days; phase 1, 4.93 days; phase 2, 4.36 days, P < 0.01 phase 0 v. phase 2). Total hospital cost was reduced by 17 % (P = 0.05, median). Application of clinical pathway components was higher in phases 1 and 2 compared to phase 0 (P < 0.01 for all components except anti-emetics); measures of functional recovery improved with successive phases. Reoperation and 30-day readmission rates were no different in phase 1 or phase 2 compared to phase 0 (P > 0.15).

CONCLUSIONS:

Restructuring of perioperative care delivery through the launch of a PCS-reduced LOS and total cost in a significant and sustainable fashion for colorectal surgery patients. Based on the success of this care redesign project, hospital administration is funding expansion to additional services.

KEYWORDS:

Care redesign; Colorectal surgery; Consult service; Cost; Length of stay; Multimodal; Outcomes

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center