Surgical Home

Placing the patient at the center of care

Facing constant pain that interfered with his ability to be active and enjoy time with his family, James McLaren was ready for surgery. But like many surgical patients, he had anxiety about the procedure and was worried about the outcomes.

He found help for both the pain and the anxiety thanks to the innovative model of care at Missouri Baptist Medical Center called “surgical home.”

“My back was pretty painful, so I was ready for surgery,” McLaren said. “I’ve been in the hospital before, but you’re always a little bit anxious before being hospitalized because you aren’t always sure what to expect.”

The surgical home model, introduced to the hospital by McLaren’s surgeon, David Robson, MD, chief of surgery at Missouri Baptist, and Sue Hanlon, RN, MBA, is a comprehensive approach that looks at all the factors affecting a surgery patient’s recovery, including nutrition, exercise and other health concerns both before and after surgery.

Treating the Whole Patient

Based on a model developed by the American Society of Anesthesiologists, the surgical home model features a surgical care coordinator who guides a patient through the surgical process.

The surgical care coordinator, either a nurse practitioner or physician’s assistant, initiates the surgical home process with a pre-operative evaluation of the patient, looking for issues that might cause complications or even postpone the surgery. The evaluation is followed by continued care during hospitalization and follow-up after discharge.

As a spine surgery patient, McLaren was led through the Surgical Home program by Christine Grither, RN, MSN, ANP-BC, nurse practitioner with the Missouri Baptist Medical Center neurosurgery, spine and ENT surgical services.

Grither began working with McLaren during the pre-surgery evaluation at the Missouri Baptist Surgical Evaluation Center where all surgical home patients undergo a complete health history, physical and any necessary tests.

“Working with Christine and having the preparation beforehand helped make me very comfortable and know what to expect,” McLaren said. “The instructions were very clear, straightforward and made the whole process much easier. She checked in on me in the hospital and then after I was discharged.

"Dr. Robson was very good. The nurses and doctors were all great, and I’m recovering well,” he added.

What it means for patients

“Surgical home is really about putting the patient at the center of care,” Grither said. “We are the one contact for patients, starting with pre-op, while hospitalized following surgery, and during post-op with at least two calls after surgery; one at one week and the second at 30 days.

“We want to ensure patients are in their best shape and able to get through surgery, while healing properly with little or no complications, and avoid readmission when possible,” Grither added.

Early success

The surgical home program, led by Dr. Robson, includes a team of 10 surgical care coordinators, as well as physicians Denish Gangasingh, MD, anesthesiologist, who oversees the surgical care coordinators, and Matthew Reuter, MD, head of Missouri Baptist hospitalists. Hospitalists manage the care of patients while hospitalized. The team meets on a regular basis to ensure the program’s success.

“We’ve built a robust surgical home program to ensure patients are in their best condition and are ready for surgery,” Dr. Robson said. “Patient-centered care and shared decision-making will improve clinical outcomes, quality of life and satisfaction.”

Since the program’s implementation more than a year ago, more than 50 patients have been identified with issues or comorbidities that led to postponement of their surgeries. These have included everything from a concern about a patient’s diabetes, a patient’s need to lose weight and the introduction of physical therapy for a patient prior to surgery. Once these issues were addressed, their procedures proceeded successfully.

Beyond surgery

Often, surgical patients require additional care because of other health concerns. Thanks to the surgical home protocols, the surgical care coordinator can help address these issues.

When it came time for southern Illinois resident Herman Haack, 77, to undergo lumbar spine fusion surgery at Missouri Baptist Medical Center with Dr. Robson, the surgical home program and Grither’s attentiveness made all the difference to Haack and his wife, Isabelle.

“I had problems with my back for quite a few years and had other procedures, but nothing lasted very long,” said Haack, who saw several specialists near his home who were unable to help. “A man from my church had been a patient of Dr. Robson and referred me to him.”

Traveling more than 100 miles to Missouri Baptist, the Haacks first saw Grither in the Surgical Evaluation Center, where a full medical history and physical were conducted. Because Haack was a former cardiac surgery patient with vertigo concerns, Grither worked to ensure she had information from all of Haack’s doctors and specialists.

“Prior to his surgery, I was able to fully assess his heart, speak to his cardiologist and his doctors at the VA,” Grither said. “Surgical Home is very important in a case like Mr. Haack’s because he had five different doctors, some private and some at the VA. A lot of times, information can get lost in the cracks if someone is not there to coordinate it.”

Able to go home after four days, Haack is recovering while getting stronger with physical therapy. And Isabelle, who is Haack’s primary caregiver and has her own health concerns, said Grither's support was invaluable.

“We couldn’t have done this without Christine. I was really glad I had a contact person whom I could call with any questions,” she said. “Everyone at the hospital was helpful. All along the way everyone would answer any questions we had.”