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Healthc (Amst). 2016 Dec;4(4):334-339. doi: 10.1016/j.hjdsi.2016.03.002. Epub 2016 Mar 19.

The Perioperative Surgical Home model facilitates change implementation in anesthetic technique within a clinical pathway for total knee arthroplasty.

Author information

1
Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
2
Departments of Anesthesiology and Public Health, Weill Cornell Medical College, New York, NY, USA.
3
Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA.
4
Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA.
5
Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: emariano@stanford.edu.

Abstract

BACKGROUND:

The challenge of knowledge translation in medical settings is well known, and implementing change in clinical practice can take years. For the increasing number total knee arthroplasty (TKA) patients annually, there is ample evidence to endorse neuraxial anesthesia over general anesthesia. The rate of adoption of this practice, however, is slow at the current time. We hypothesized that a Perioperative Surgical Home (PSH) model facilitates rapid change implementation in anesthesia.

METHODS:

The PSH clinical pathways workgroup at a tertiary care Veterans Affairs hospital embarked on a 5-month process of changing the preferred anesthetic technique for patients undergoing TKA. This process involved multiple sequential steps: literature review; development of a work document; training of staff; and prospective collection of data. To assess the impact of this change, we examined data 6 months before (PRE, n=90) and after (POST) change implementation (n=128), and our primary outcome was the overall proportion of spinal anesthesia usage for each 6 month period. Secondary outcomes included minor and major complications associated with anesthetic technique.

RESULTS:

Over a period of one year, there was an increase in the proportion of patients who received spinal anesthesia (13% vs. 63%, p<0.001). For the following year, 53-92% of TKA patients per month received spinal anesthesia. There were no differences in major complications.

CONCLUSION:

Rapid and sustained change implementation in clinical anesthesia practice based on emerging evidence is feasible.

IMPLICATIONS:

Perioperative Surgical Home model may facilitate rapid change implementation in surgical care.

LEVEL OF EVIDENCE:

Cohort study, Level 2.

KEYWORDS:

Change implementation; Clinical pathway; Knee Arthroplasty; Outcomes; Perioperative Surgical Home; Spinal

PMID:
28007227
DOI:
10.1016/j.hjdsi.2016.03.002
[Indexed for MEDLINE]

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