The American Society of Anesthesiologists is pleased to announce the formation of a learning collaborative of health care organizations (HCOs) to improve the care of surgical patients through the implementation of the Perioperative Surgical Home (PSH). This new patient-centered model is designed to achieve the triple aim of better health, better healthcare, and reduced expenditures through shared decision-making and seamless continuity of care for the surgical patient, from the moment surgery is planned through recovery, discharge, and the first 30 days afterward.
Too often, perioperative care plans are variable and fragmented. Surgical patients may experience lapses in care, duplication of tests, and operational mistakes and accidents. Costs rise, complications occur, physicians and other healthcare team members are frustrated, and the patient and family endure a lower-quality experience of care.
New approaches are needed that provide better service, cost less, and focus on the patient as the center of care. The new PSH model will emphasize physician-led, collaborative care of the surgical patient, with cost-effective integration of non-physician practitioners, during all phases of the perioperative continuum:
• Prompt engagement with the patient once the decision for surgery is made
• Early assessment and triage of patients via email communication or telephone contact
• Further evaluation of complex patients via pre-procedure clinic or telemedicine
• Evidence-informed clinical protocols for preoperative testing and medical optimization (e.g. diabetes and hypertension control, anemia, pain management)
• Patient education and counseling to reduce anxiety, increase participation, confirm understanding of instructions, and ensure timely arrival
• Initial post-discharge transitional care planning and caregiver education
• Reduced cancellations and delays through consensus on the clinical criteria for proceeding with elective surgery
• Reduced variation in intraoperative care with systematic implementation of best practices for nursing, anesthesia and surgical management
• Standardized selection of materials and implants
• Integrated postoperative care from the PACU to the ICU and/or inpatient unit
• Integrated pain management including regional and multimodal analgesia
• Standardized postoperative clinical care protocols and pathways
• Prevention of complications such as hospital-acquired infections, venous thromboembolism
• Coordination and communication of post-discharge plans; education of patients and caregivers
• Follow up for the first 30 days after discharge.
Health care organizations participating in the learning collaborative will implement the PSH model as a process that will vary across local practice environments but adhere to the principles outlined above. The common goal will be to assess whether the new PSH model is superior to current conventional perioperative care via comparative effectiveness research (CER) to evaluate qualitative and quantitative outcomes:
• Enhanced patient-centered care of the surgical patient: pain control, satisfaction, return to full activity or employment, quality of life
• Greater clinician adherence to evidence-informed guidelines and pathways
• Improved quality and safety of perioperative care
• Reduced hospital readmissions of surgical patients
• Reduced overall cost and superior value.
One way to measure value in healthcare is to examine patient outcomes achieved per dollar expended. Value-based payment rewards physicians and practitioners who deliver the best overall care at the lowest cost, and who minimize complications. As the PSH redesigns the healthcare delivery model, it provides an ideal opportunity for participating HCOs to develop a bundled payment model that moves away from traditional fee-for-service and aligns incentives in the payment system to improve quality and efficiency while creating cost savings.
Physician anesthesiologists will be key contributors to the success of the PSH model as experts in preoperative evaluation, optimization of coexisting disease prior to surgery, pain management, and post-anesthesia care. However, current payment structures create barriers to applying this hard-earned knowledge and systems expertise across the continuum of perioperative care. Breaking down these barriers will allow anesthesiologists to work with other physicians and healthcare practitioners during all phases of surgical care, improving safety, quality, and efficiency.
HCOs interested in participating in the PSH learning collaborative are invited to submit a preliminary letter of intent to the ASA. The process of identifying a convener for the learning collaborative is currently underway. The convener will review all letters of intent and determine further criteria for the selection of participating HCOs. The 1-2 page letter of intent may address the goals that the HCO wishes to target by participating in the PSH, and include information such as:
• General description of facility: number of beds, number and mix of surgical cases
• Electronic health record systems already in use
• Experience with prior collaboratives
• Participation in registries such as AQI, NSQIP, STS, MPOG
• Quality measures currently tracked (SCIP, TJC, PQRS)
• Membership in healthcare organizations such as IHI, VHA, UHC, Advisory Board
• Potential physician champions (anesthesiologist, surgeon, and/or hospitalist) and staff members for a PSH project team
• Any current tracking and reporting of surgical outcomes relating to quality, cost, and patient experience.
Your letter of intent may be sent by email to Celeste Kirschner at firstname.lastname@example.org.
To learn more about the PSH learning collaborative, please visit our webpage at www.asahq.org/PSH