Region Recognized for Surgical Care Innovations

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Two Kaiser Permanente Northern California programs are honored with the NCQA Innovation Award for reducing surgical patient hospital stays by nearly 50%.

Kaiser Permanente Northern California has been recognized for transforming surgical practices by giving patients the choice to recover in the comfort of their own homes, leading to reduced hospital stays and enhancing the patient-care experience.

The National Committee for Quality Assurance selected Kaiser Permanente Northern California as the Delivery System Design award winner. NCQA’s 2019 Innovation Awards recognize organizations that implement leading-edge strategies to improve quality and value and showcase these quality accelerators. Award submissions come from 5 categories: integration of care, patient and family engagement, delivery system design, use of technology, and customer experience.

The Northern California region earned top honors for Total Joint Home Recovery (TJHR) and Surgical Home Recovery (SHR) programs. These programs are direct extensions of Kaiser Permanente’s innovative Enhanced Recovery After Surgery (ERAS) program and provide eligible surgical patients receiving a total joint replacement or other surgeries the ability to recover at home without overnight admission to the hospital. In the past 3 years, these programs have been shown to improve patient experience and acute care availability. Some of the successes include:

• Patients reported greater satisfaction and experience with the focus on recovery at home. In a survey of total joint replacement patients in October 2018, 92% reported receiving “excellent or very good” care before, during, and after surgery.

• The average length of hospital stays for total joint replacement and other surgical patients has been reduced by nearly 50%. Most surgical patients now spend 3 to 5 hours in the post-anesthesia care unit before discharge.

• Together, the 2 programs also reduced the use of 1,000 beds per month across the Northern California region, improving availability for patients with a greater medical need.

“We’re pleased to be recognized as a leader in innovation on behalf of quality and to share our practices with others across the industry,” said Janet Liang, president, Kaiser Permanente Northern California region. “The results speak for themselves with over 90% of patients reporting a positive experience with being able to return home directly after surgery.”

More specifically, Kaiser Permanente Northern California began its home recovery efforts with the total joint home recovery program in 2016 at Santa Clara Medical Center and expanded to other surgical programs in 2017. The program built upon Kaiser Permanente’s national work with Enhanced Recovery After Surgery (ERAS), which is an evidence-based program that focuses on changing standard pre- and post-operative practices — primarily no more extended fasting, staying in bed, and opioid use. In the past 3 years, ERAS has been shown to improve care for more than 20,000 surgical patients in Kaiser Permanente Northern California.

“This is a tremendous honor, and it’s a tribute to the many multidisciplinary teams that are committed to helping our patients recover from surgery in the comfort of their own homes with family and friends — which dramatically improves the patient experience,” said Richard S. Isaacs, MD, CEO, and executive director of The Permanente Medical Group. “In a period of only 34 months, the percentage of TJHR patients who recovered at home went from 12% to 82%. Moreover, after just 21 months, approximately 87% of eligible SHR patients recover at home. During these time periods, over 15 surgical procedures were added to the SHR program with no increase in adverse effects. This is Permanente Medicine at its best.”

Patients attend preoperative classes, receive early discharge planning instructions, and may even receive a home assessment prior to surgery. After surgery, a home health physical therapist visits within 24 hours of discharge for total joint surgeries and a representative of the surgical team contacts all patients within 24 hours. Patients continue to check in with the surgical team through office, phone, and video visits.

Criteria has been established to identify those patients for whom a one-night hospital admission is warranted. Surgical specialties have also identified and shared best practices for when a home recovery can achieve greater outcomes from a hospital recovery, providing a more consistent standard of care for surgical patients.

NCQA is a national, private not-for-profit organization that surveys health plans for performance in a wide range of clinical service measures, including consumer experience, prevention, and treatment. More information about the 2019 Innovation Awards can be found on NCQA’s website.

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