A new model of patient-centered care has been proposed by the American Society of Anesthesiologists. Their innovative concept is called a Perioperative Surgical Home (“PSH”), which has the potential to offer significant benefits to surgical patients as well as to their medical caregivers and all stakeholders in the healthcare provision network.

Perioperative Surgical Home Overview

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The problems with customary procedures

Currently, surgical patients are placed at risk of various types of medical errors or unnecessary procedures, due simply to the fact that their care is so fragmented. Typically, different sets of providers oversee patient care during pre-operative, intra-operative and post-operative stages of the surgical case. Pre-anesthetic assessment of patients has traditionally tended to be conducted shortly before the actual surgery, and it has collected only a very limited amount of clinical information. For patients who suffer from chronic disease, this brief history-taking may overlook important issues. Furthermore, the patient’s knowledge of what to expect after the procedure is often very incomplete, and they may be unaware of their options for effective post-surgical pain management.

Other difficulties in a traditional hospital model of care arise from case delays or cancellations on the day of surgery, which lead to wasted resources and frustrated patients. Finally, after the surgery, patients may be handed off by the surgeon or attending physician to the care of junior staff members, who may be unfamiliar with the patient’s history and less skilled at perceiving the early signs of complications. Finally, a whole new communication gap often arises when patients leave the hospital after surgery and are transferred to their homes or to a rehabilitation facility. Appropriate aftercare may be neglected, resulting in a patient returning to the hospital, with negative outcomes for both patient and provider network.

How a PSH addresses these problems

At the University of Alabama in Birmingham, a prototype model PSH has been established, to facilitate research and illustrate the benefits such an umbrella-care system offers. It is similar in nature to the Medical Home model that is being proposed by primary care practitioners, and it is an multidisciplinary framework for perioperative care that is led by anesthesiologists.

“Coordinated care led by physicians throughout the surgical episode results in greater continuity of care, better decision making, improved outcomes, and reduced length of stay,” said Adriaan Epps, abeo’s director of contracting services.

The Institute of Medicine notes that the specialty of anesthesiology is responsible for a 15-fold decrease in surgical death rates between 1940 and the present. Anesthesiologists are committed to continuing their historic track record of improving patient outcomes, and the Perioperative Surgical Home puts forward a new model for their role in continuity of patient care throughout the entire surgical case.

What’s the anesthesiologist’s role?

Specific ways in which the anesthesiologists can foster quality and cost savings include:

  • Partnering with hospitals and surgeons to determine cost-effective implants and pharmaceuticals;
  • Decreasing the number of tests and consults through pre-operative evaluations performed by Pre-Anesthesia Testing (PAT) clinics;
  • Managing the selection of appropriate candidates for surgery, and
  • Reducing the rate of complications such as postoperative nausea and vomiting that increase length of stay or necessitate admission following outpatient surgery.

All of these activities are measurable.  If they are not already collecting their “value” data, anesthesiology groups should consider tracking their contributions to or reducing unnecessary spending within their health systems, including endeavors that would come under one of the bullets above.  In this way they will prepare to implement the surgical home concept if and when they become part of an ACO or other integrated delivery system.

Preoperative phase

Relying heavily on evidence-based protocols for pre-operative diagnosis and treatment, the anesthesiologist in this Perioperative Surgical Home model is able to identify and minimize the risks of the upcoming surgery. Patients may receive special preoperative therapy with anti-coagulants, beta-blockers, statin drugs, intravenous iron, or many other treatments. Their anesthesia team also presents them with accessible, detailed information about all planned procedures and provides encouragement regarding pain control available afterwards. Because of the more in-depth patient evaluation, fewer delays and cancellations occur on the day of surgery, and patients are more fully informed (and less frustrated) about the delays that can’t be avoided.

Postoperative phase

The overseeing anesthesiology intensivist coordinates postoperative care together with nurse-practitioners and a single registered nurse. Together, this team continues to provide focused care during the patient’s transfer from surgical recovery to intensive care or a standard inpatient room. Adequate attention to pain management and seamless continuity of care is shown by this University of Alabama prototype to result in far better patient outcomes. Patients’ physical and psychological health are both nurtured by this method of providing care. Later, when the patient is discharged, the Perioperative Surgical Home team interfaces with the home caregivers, answering all questions and reducing the number of readmissions.

According to BMC Anesthesiology, research has shown that recognizing the presence of post-surgical complications and responding to them quickly, is the most effective pathway for reducing surgical mortality. Having patient care overseen by anesthesia perioperativists allows for more timely response to post-surgical problems, and reduces surgical morbidity and mortality. Models such as the PSH are needed in order to bring the right kind of ongoing change to our healthcare paradigm, and to meet the outcome quality metrics that govern today’s delivery of care.

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abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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