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Any student who has rotated in anesthesiology has seen firsthand the number of moving parts involved in surgical care; this process begins with the decision to have surgery and extends until the postoperative period, with any number of nurses, physicians and other providers contributing to care along the way. In recent years, the American Society of Anesthesiologists has looked into deficiencies in surgical care and found that there are plenty of opportunities to decrease variability in the surgical process, minimize avoidable adverse events, improve communication and coordination among health care providers, and ultimately create a more cohesive and positive experience for surgical patients. The result of this research is the creation of a patient-centered, multidisciplinary model of patient care known as the Perioperative Surgical Home (PSH).
The primary goal of PSH is to achieve a triple aim of better patient experience, better health care, and lower cost of care for all patients undergoing surgery and invasive procedures. The transition into surgical care can often disconnect patients from their regular health care providers, which is why the PSH process begins from the moment the decision to have surgery is made and coordinates decision-making between all members of the care team. Effective preoperative planning is intended to reduce unnecessary testing, optimize risk prior to surgery, and provide multidisciplinary support to the patient.
In the O.R., an evidence-based approach is intended to lead to a more standardized operative course, with a goal of decreasing discrepancies in care and optimizing positive outcomes. When surgery is complete, the PSH process continues into coordinating postoperative care as well as discharge and follow-up planning. Overall, the goal is to maintain a patient-centered approach to what can be an intimidating and busy process.
The natural role of anesthesiologists in this process is clear: they are present when the patient arrives to have surgery, during the entire operative course and well into the recovery period. While PSH is a multidisciplinary system, it relies heavily on physician leadership to maintain effective communication, planning and patient advocacy. As students planning to enter the field of anesthesiology, it is paramount for us to recognize this future direction of perioperative care and cement our role as the coordinating body for this system of care. We will not only be part of the implementation of this care model but also responsible for critical review and quality improvement as potential problems and limitations become evident. Overall, this model has provided a framework for an improved process of patient care that will ultimately be of greater benefit to patients and providers alike.
To learn more about PSH, visit https://www.asahq.org/psh.
posted spring 2017
