Improving the cost, quality, and safety of perioperative care: A systematic review of the literature on implementation of the perioperative surgical home

Study objective: The perioperative surgical home (PSH) is a recent innovation in perioperative care delivery that coordinates the pre-, intra-, and post-operative elements of surgical care under one organizational umbrella. Although significant research supports the efficacy of individual elements of the PSH in improving outcomes, there is not a published systematic review of the efficacy of entire PSH programs in improving patient outcomes. This article summarizes descriptions of PSH programs available in the literature and examines outcomes of original studies of PSH implementation. Design: We conducted a systematic literature review to identify relevant articles on PSH implementation and synthesize our findings. Setting: The studies included in our review took place at multiple academic and community hospitals in the United States. Patients: Patients involved in the PSH studies included surgical patients of various ages and ASA classifications in various surgical specialties. Interventions: All studies included in our review involved the implementation of a PSH program. Measurements: Outcomes examined include length of stay, postoperative recovery, readmission rates, and patient discharge destination, among others. Main results: We identified 11 studies of PSH implementation that met our inclusion and exclusion criteria. Most PSH programs described in these studies included an emphasis on preoperative education, standardization of care protocols in all phases of surgery, use of opioid-sparing multimodal analgesia, and collaborative staffing models. PSH program implementation was often associated with decreased length of stay, decreased utilization of postoperative opioids, decreased utilization of the ICU, and increased probability of discharge to home. PSH implementation was not meaningfully associated with reductions in readmission rates. Findings for cost reductions following PSH implementation were mixed. Conclusions: Early evidence indicates that through elements that emphasize care coordination, standardization, and patient-centeredness, PSH programs can improve patient postoperative recovery outcomes and decrease hospital utilization.