Value-based Healthcare: Preoperative Assessment and Global Optimization (PASS-GO): Improving Value in Total Joint Replacement Care

Enhanced Selection of Candidates for Same-Day and Outpatient Total Knee Arthroplasty

“…The institution standard-of-care PSH anesthesia optimization process is performed before elective TKA for each patient involving a telephone screening questionnaire, a physical examination, and laboratory testing in order to assign 1 of 3 risk stratification categories each associated with a green/yellow/red color [9]. This category determines whether the patient must undergo further evaluation and risk factor management in order to be cleared for surgery.…”

Improving agreement of ASA physical status class between pre-anesthesia screening and day of surgery by adding institutional-specific and ASA-approved examples: a quality improvement project

“…No example was developed for advanced age or multiple medical co-morbidities since the department anesthesiologists did not have consensus on how these should be handled. Unlike adult patients' co-morbidities, almost all pediatric co-morbidities are not included in the ASA-approved examples AICD automatic implantable cardiac defibrillator, ASA PS ASA physical status class, BMI body mass index, CAD coronary artery disease, CKD chronic kidney disease, COPD chronic obstructive pulmonary disease, CVA cerebrovascular accident, DM diabetes mellitus, ESRD end-stage renal disease, GERD gastroesophageal reflux disease, HTN hypertension, OSA obstructive sleep apnea, PCA post-conceptual age, PVD peripheral vascular disease, SVT supraventricular tachycardia, TIA transient ischemic attack, URI upper respiratory infection (Fischer 1996;Correll et al 2006;Boudreaux and Vetter 2016;Aronson et al 2018;Vetter et al 2017;Shah and Vetter 2018). Vetter et al describe one possible process that entitled "PASS-GO" (Vetter et al 2017;Shah and Vetter 2018).…”

“…APACs utilize different types of providers, where non-anesthesia clinicians (registered nurses, nurse practitioners, physician assistants, and nonanesthesiologist physicians) screen patients that are healthy to those with only mild medical conditions, while anesthesiologists become involved with the clinical decision-making for more medically complex patients. Often, this algorithm that dictates when an anesthesiologist is consulted also includes the complexity of the surgical procedure (Vetter et al 2017;Shah and Vetter 2018).…”

Value-based Healthcare: A Novel Transitional Care Service Strives to Improve Patient Experience and Outcomes

“…In response to this major process improvement opportunity, we developed the Preoperative Assessment and Global Optimization (PASS-GO) [12] program, which delivers integrated and coordinated care across the entire surgical care continuum, from before surgery throughout at least the initial 90 days postdischarge. Briefly, our nascent PASS-GO program seeks to improve value by identifying and addressing patient risk factors prior to total joint replacement surgery.…”

“…Just like our PASS-GO Program [12], our TLC Service involves substantial process of care reengineering, demands leadership in change management, and requires additional human and operational resources. While these initiatives have worked in our setting because of a commitment to developing a learning health system model that is focused on optimizing value delivered to patients, the principles in play here are generalizable elsewhere because they have been developed and piloted in a variety of different practice settings [1,4,9].…”