Home surgical recovery program proves value.

HHC HomeMed has provided home surgical recovery services since 1987. Out of this extensive experience, the AdvantiSurg[R] program was developed to target surgical procedures that generally require a three- to five-day hospitalization. The goals of the program are to:

* Decrease or eliminate hospital postsurgical recovery

care for certain categories of elective surgery.

* Provide a high-quality recovery care option with high

patient and physician acceptance and satisfaction.

Patients admitted to the program receive all postoperative care in the comfort of their homes. Services include pre-and postoperative screening and counseling; preparation of the surgical patient and in-home caregivers; nursing staff skilled in postoperative care; pain management; antibiotic and/or intravenous therapy; fluid hydration; ongoing assessment of recovery; and timely reporting to the surgeon of all appropriate information. In addition, services geared to meet the needs of managed care are incorporated in the program, including ongoing education and training of administrative and medical staff, collection and analysis of utilization management data, and a program of continuing quality assurance.

Surgeries that have been performed using the AdvantiSurg[R] home recovery system include ACL repair; bilateral hernia repair; shoulder and/or knee reconstruction; TURP; abdominal/vaginal hysterectomy; mastectomy; plastic surgery, including mammoplasty and extensive facial or abdominal reconstruction; laparoscopy; ligament and tendon repairs; tonsillectomy; anorectal procedures; and open and laparoscopic cholecystectomy.

Results

More than 600 patients have received postsurgical care through the program. Patients ranged in age from 26 to 84, the average being 58. Most patients (72 percent) went home the same day as the surgery, completely avoiding hospitalized recovery. Virtually all patients admitted to the program returned home after surgery in a private vehicle. All postsurgical complications were managed in the home and consisted primarily of nausea and postanesthesia headache. Complications of this type occurred in 4 percent of patients. No program patients required readmission to the hospital.

Patients referred to the program but not admitted did not participate for a variety of reasons, including cancellation or rescheduling of surgery, no caregiver in the home, patient or family refused home recovery, surgical complications, patient refused surgery, recovery care not required, surgeon elected not to discharge to program, and other miscellaneous factors.

As part of a continuing quality assurance program, all patients were sent questionnaires. A response rate of 29 percent was realized. In all areas of evaluation, patients gave the program marks of good to excellent.

A most significant outcome of this study was average length of hospital stay for these surgical procedures compared to those for home recovery. For patients admitted to the AdvantiSurg[R] program, inpatient bed days were reduced by 89 percent.

The program has consistently met its primary goals. It has decreased inpatient lengths of stay and, in appropriate cases, completely eliminated inpatient recovery care. The low incidence of complications, the absence of readmissions, and high patient satisfaction support the conclusion that the program is a high-quality alternative to inpatient recovery.

Julia Sherman, RPh, is Vice President and Paul F. Scholtes, JD, MS, is Chairman and CEO of Home Hospital Corp., Los Angeles, Calif. Gary Goldstein, MD, is Senior Vice President, FHP, Inc., and Claire Petrotta, RN, is Director, Home Recovery, Los Angeles Region, FHP, Inc.