The Perioperative Surgical Home Model

July 6, 2015

By the EMP Quality Department

The Perioperative Surgical Home (PSH) model of care has been the subject of much discussion. The American Society of Anesthesiologists (ASA) has created an annual PSH conference, devoted much of the ASA Annual Meeting to discussion of the PSH model, and has launched a learning collaborative of 44 organizations to explore best practices in a PSH. This collaborative effort is part of a culture shift occurring in anesthesiology toward a recognition of the need for anesthesiologists to expand our role as perioperative specialists. Since the perioperative period represents 50% to 60% of the costs and profits for healthcare systems, the opportunities for gains are significant. Anesthesiologists are uniquely positioned to be leaders in this process.

The Perioperative Surgical Home is a model of patient care that is analogous to the Patient-Centered Medical Home, but for surgical patients instead of primary care. It is a physician-led, team-based collaboration with anesthesiologists, surgeons, and healthcare organizations to optimize patient care in the perioperative period. The goals of a PSH are improving population health, increasing the safety and quality of care for individual patients, decreasing the costs of care, and eliminating waste.

The Perioperative Surgical Home model is designed to achieve:

  • Optimization of patients’ preoperative physiologic status, increasing patient preoperative education, and increasing patient engagement in their care
  • Elimination of administrative waste and unnecessary labs and testing
  • Standardization of perioperative management of specific surgical procedures such as total joint replacement, cardiac surgery, or colon resections through developing care pathways
  • Reduction of the cost of care through standardization of supplies and implants
  • Integration of perioperative pain management led by the anesthesia team
  • Coordination of discharge planning and rehabilitation to decrease length of stay, readmission rates, and facilitate patients’ return to full activity

The PSH model is data driven and requires, not only providing the highest quality evidence-based care possible, but, also being able to quantify and demonstrate this quality to facilities, surgeons, and patients. Data collection and analytic capabilities are paramount to success. Our nation’s healthcare system is moving away from the traditional fee-for-service compensation model toward rewarding value and quality. Perioperative care coordination will be a key factor in allowing for growth and success under these changes.

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