Peri-Operative Medicine Service for High-Risk Surgery Project (POM-SHIP)

Purpose of the Project

In improving the quality of life and reducing post-operative complications for high-risk surgical patients, the POM-SHIP project will involve the implementation and development of a Peri-Operative Medicine team service. Vetter et al (2014) explain that this intervention will recognize patients who are at high-risk earlier, prioritizing patients by devoted follow-ups during their hospital stays, and improvement of communication within the multi-disciplinary team. The peri-operative medical care will not only help patients but surgeons too to perform timely and successful procedures. Serious post-operative complications are occurring in more than 15% of patients undertaking major surgery (Kash, Zang, Cline, Meneser, & Miller, 2014). The complications can have a long lasting effect on long-term survival and health-related quality of life. Therefore, the POM-SHIP will reduce the post-operative complications and death in New York Community Hospital.

The New York Community Hospital is in Brooklyn, NY, and is a surgical and general medical hospital. It is designated at Stroke Centre and the regional office is in New York Metro in New York City. This hospital has 127 medical and surgical beds and 7 intensive care beds. It has a multi-specialty in ambulatory services making peri-operative medical care a necessity (Community Health Network, 2017).  Fragmented and varied care plans undertaken by various practitioners are exposing surgical patients to expected care lapses, increasing the chances of operational accidents and mistakes, resulting in unnecessary care. This project will assist in the reduction of complication to patients during operation as well as increase the performance and efficiency of surgeons. Moreover, some patients die during surgical procedures, some that are preventable using POM-SHIP.

Benefits of the Project

According to Cannesson and Kain (2015), the POM-SHIP is patient centered, innovative, surgical continuity health care model which will incorporates shared decision making. The POM-SHIP will include achieving healthcare outcome metrics, impacting on surgical mortality and morbidity, comprising failure to rescue, increasing the benefits of the Perioperative Surgical care to the specialties, incorporating the perspective of the surgeon, providing a comparison with the hospitalist model of perioperative care, establishing necessary data collection and audit, and assimilating comparative effectiveness research into the model. In improving surgical mortality and morbidity a more integrated and comprehensive approach is mandated in managing surgical patients. According to Zeez and Maxime (2014), the “perioperavist” of the surgical patients plays an important role during the compliance with broader process measures sets, therefore becoming a more valuable and vital patient provider, payer perspective and administrator.

A robust perioperative database will be created within the POM-SHIP to present new opportunities for population level research and health services. The POM-SHIP intention is not replacing the responsibilities of the surgeon in the patient care, but rather to leverage the abilities of the whole perioperative care team providing care to the patient. Therefore, the project will involve trainings to the perioperative teams in order to expand experience, skills and knowledge to the team.  This project will create strategic added value for the patients/ payers and the health system. The added value will strengthen the surgeons’ position as they negotiate and navigate in the face of infinite options while decreasing the fiscal resources. A Perioperative Surgical Home (PSH) will be installed in the facility in the implementation of POM-SHIP. This PSH will be physician-led, team-based system, interdisciplinary, and patient-centered.

The project will broaden the perioperative teams practice scope via POM-SHIP which will improve clinical outcomes, promote standardization and decrease the utilization of resources by providing greater continuity of patient-centered care throughout the postoperative, intraoperative and preoperative periods. The project will integrate the three recognized phases of care, the preoperative, intraoperative and postoperative phases. It will reduce the project cost in its aim to achieve the key healthcare metrics by linking payment to quality via “value-based purchasing” and “pay-for-performance” models. Establishing data collection and audit is fundamental to the objectives and the goal of this project which will overcome the present medical informatics difficulties in the facility.

Target Population

The target population of this project is the preoperative team, patients, the facility administration, and the patients’ families. The preoperative team will be actively engage in every phase of the project from its installation to its implementation. Surgeons and nurses who will be in the team are required to use the POM-SHIP in reducing complications and morbidity. They will end up with timely and effective procedures.

Patients are the most fundamental target in the project. Their health will be enhanced by reducing postoperative complications or deaths that occur during surgeries. The families of the patients are also a target group because the health of their patients will be guaranteed during the surgery procedure. The last target is the health facility and its administration that will also be trained on the advantages of the project as it will be in their day to day life. The key stakeholders of this project will be from anesthesia, nursing, and surgery departments.

Cost of the Project

The total budget for the project is $7500 which is inclusive of the perioperative equipment, trainings and installation of the Perioperative Surgical Home (PSH) system in the health facility.

• $5000 will be used in the purchase of all equipment necessary for the project during the installation of Perioperative Surgical Home (PSH).
• $1250 is for the trainings for the key stakeholders and the perioperative team.
• $1250 is for installation and minor costs involved in the project.

Evaluation of the Program

The program will be evaluated in continuous phases. The first phase which is pre- evaluation will be before the commencement of the project. The next phase will be during the start of the project, followed by the third phase which is during the middle of the implementation phase. Lastly is the post implementation phase which will be quarterly evaluations after the project has been enacted in the facility. In future, we have plans of including another evaluation phase that will include an educational tool and initiative to engage patients concerning goal-directed instead of time-based discharges.

Conclusion

In the United States, the perioperative care is often fragmented and costly. Therefore, there is need for restructuring to assist in improving care coordination, access, outcomes, and quality while reducing or restraining cost. This is one reason why the New York Community Hospital, a medical and surgery facility wants to install the POM-SHIP to reduce post-surgery complications and mortality rates. The project will work with the intention of improving surgical care for individual experience, reducing the per-capita cost of surgical care, and improving health of a distinct surgical population. The Perioperative Surgical Home constructed in this project which will be physician-led, team-based system, interdisciplinary, and patient-centered of coordinated care for the surgical and procedural care will be the model to redesign healthcare in this facility.

“Executive Summary Feedback Form”

To the Manager of New York Community Hospital,

I will appreciate your feedback on the above proposal of installing the Peri-operative medicine service for high-risk surgery project (POM-SHIP) in New York Community Hospital as described in the proposal above. I will appreciate your feedback on the following prompts.

1. Do you believe the proposal would be approved if formally proposed?
2. What are some strengths and weaknesses of the proposal?

Thank you.

Reference

Cannesson, M., & Kain, Z. (2015). The perioperative surgical home: an innovative clinical care delivery model. Journal of clinical anesthesia, 27(3), 185-187.   

Community Health Network. (2017). The Community Health Network http://www.chnnyc.org/?gclid=Cj0KEQiA88TFBRDYrOPKuvfY2pIBEiQA97Z8MWeR3_Gxqvk_l3hLhMRR3W094WSAqvPvIXD0myIY9s8aAt0s8P8HAQ

Kash, Zang, Cline, Meneser, & Miller,. (2014). The Perioperative Surgical Home (PSH): A Comprehensive Review of US and Non-US Studies Shows Predominantly Positive Quality and Cost Outcomes. Milibank Quarterly, 92(4). http://dx.doi.org/10.1111/1468-0009.12093

Vetter, T. R., Boudreaux, A. M., Jones, K. A., Hunter Jr, J. M., & Pittet, J. F. (2014). The perioperative surgical home: how anesthesiology can collaboratively achieve and leverage the triple aim in health care. Anesthesia & Analgesia, 118(5), 1131-1136.

Zeez, & Maxime,. (2014). 1st Annual Periotiv Surgical Care Summit. Department Of Anethesiology And Periotive Care School Of Medicine. Retrieved from http://www.anesthesiology.uci.edu/psh2014.shtml