Lancaster General Health’s Perioperative Surgical Home is a care coordination program with a mission to improve patient outcomes, experience and safety, along with keeping care affordable by reducing waste and improving efficiency for physicians and staff. 

Fernando A. Gutierrez, M.D.

The PSH program, previously known as the Pre-anesthesia Clinic, expanded in early 2017 to encompass perioperative coordination of care. Fernando A. Gutierrez, M.D., now serves as Medical Director of the program, which began under the leadership of Nicholas L. Rockwell, M.D.

Dr. Gutierrez, of Anesthesia Associates of Lancaster, said before the PSH program, the process to ensure that patients were ready for surgery was much more cumbersome. In some cases, this led to the need to delay surgeries, inconveniencing patients and surgeons.

Since the PSH program’s inception, a streamlined process, technology improvements and additional personnel have led to greater efficiency and improved communication, coordination of care and patient safety, he said.

“Our purpose is to gather as much information as possible on a patient’s health situation to ensure that they are optimized to undergo the procedure,” he said. “In the past, we often found ourselves working against the clock. Now we can navigate much more nimbly through the process of preparing patients for surgery.”

The PSH staff includes Dr. Gutierrez, manager MJ Bresch, an additional anesthesiologist and two nurse practitioners, as well as a team of registered nurses, schedulers and unit clerks. The service covers most scheduled surgical procedures at LGH, Women & Babies Hospital and the Suburban Pavilion, averaging about 75 cases per day.

Previously, physicians received a paper summary of any potential concerns or recommendations for a patient, such as additional pre-op testing, Dr. Gutierrez said. Due to the comparative inefficiency of the process, physicians often received this information just before surgery.

“Before the EMR, this was all done with paper charts, which was inefficient and added some degree of error,” he said. “It would inconvenience surgeons and patients when surgeries had to be delayed.”

Now the PSH team is exclusively dedicated to perioperative coordination of care. Five schedulers match surgeons’ schedules with OR space and equipment availability. About a dozen registered nurses call patients, asking key questions meant to identify any red flags before surgery.

A PSH physician or nurse practitioner then reviews the information, identifying additional red flags and addressing any potential problems. The surgeon now typically receives accurate and concise data about a week before surgery.

The improved process catches some near-misses and minimizes surprises that could lead to a last-minute need to reschedule a surgery, Dr. Gutierrez said. The program has actually cut down on pre-op testing, without affecting outcomes, and initial data shows a positive impact on post-surgical outcomes.

“Before we had so little time,” he said. “Now we have time to really look into cases, and a multidisciplinary team of people dedicated to thinking about care coordination and doing the legwork necessary to ensure that a comprehensive, patient-centered plan is in place prior to the patient presenting for a surgery or procedure.”

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