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Building a perioperative surgical home model


By Dr. Jane C.K. Fitch
Posted: July 5, 2014 - 12:01 am ET
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Better outcomes, lower costs, more-satisfied patients. It's what we all strive for. And it's a goal that continues to elude us.

The technical advances in medicine in this country are remarkable, but our system is fragmented, with inefficiencies that create a barrier to the quality we aspire to. It's a problem that costs all of us—physicians, nurses, administrators, payers and, of course, patients and their families—and one that originates from all areas of medicine.

In primary care, the patient-centered medical home shows promise in improving patient care and producing savings. A similar system can do the same for surgery, where a large percentage of a hospital's costs are incurred, and where managing one complication, such as pneumonia, threatens the patient's outcome and can erase the thin margin from an entire surgical procedure.

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Most hospital surgery systems don't have a continuum of care that covers the perioperative period, which begins with the decision to operate and often ends well after discharge. Rather preoperative, intraoperative, postoperative and post-discharge are treated as discrete episodes of care.

Similar to the patient-centered medical home, the perioperative surgical home, or PSH, model is showing promise in several hospitals and health systems. Preliminary findings from the University of California at Irvine found improved patient outcomes and efficiencies in its PSH program. Such models are patient-centered integrated systems of perioperative care designed to reduce fragmentation, improve efficiency and standardize procedures.

A PSH can improve outcomes and reduce costs by eliminating cancellations and delays in surgery, lowering complication rates and readmissions, and reducing length of stays. Potential barriers to adoption include establishing adequate payment for services and the commitment of the organizations and their staff to substantially change how surgical care is delivered.

The American Society of Anesthesiologists is spearheading a PSH learning collaborative that will bring together more than 40 healthcare organizations nationwide this summer to define the model, pilot it and assess its benefits. Anesthesiologists are well-suited to take a leading role because of their ability to evaluate patients with a variety of risks and co-morbidities and manage them before, during and after surgery. We believe the concept will help all of us in healthcare reach our common goal.

Dr. Jane C.K. Fitch is president of the American Society of Anesthesiologists.


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