Fusion Anesthesia Solutions
What is the Perioperative Surgical Home?
The American Society of Anesthesiologists explains the Perioperative Surgical Home model where the patient’s experience of care is coordinated by a physician-led, interdisciplinary team. The expected metrics includes improved operational efficiencies, decreased resource utilization, a reduction in length of stay and readmission, and a decrease in complications and mortality-resulting in a better patient experience of care.
The goal of this model is to provide patient centric care coordinated by a team, for each patient to get the right care, in the right place, at the right time, with better patient satisfaction, fewer complications, and decreased costs. PSH focuses on the patient (rather than the disease or procedure) from the time the surgery decision is made, through 30+ days after discharge, and beyond. With data collection, analysis and reporting, the PSH model can strive for continuous quality improvement and provide the best care for the patient.
This chart from the American Society of Anesthesiologists shows the coordinated effort between the Hospital Management Team, the Anesthesia Management Team, and the Surgery Management team and what it can look like. Perioperative Surgical Home Model coordinates the care amongst many systems, including administration, human resources, laboratory, pharmacy, physical therapy, radiology, and more.
Anesthesia in the Perioperative Surgical Home Model
As PSH coordinates roles among many teams and systems, the Anesthesiologist team is a central part of this model. Since the anesthesiologist’s role includes working with the patient pre-op, during, and after the surgical procedure, they are central to the continuation of care and transitioning between pre-op, surgery, and post-op. The anesthesia team must work very closely with the surgeons inside and outside of the operating room, and then also help transition the patient into the care of the primary perioperative physician. The anesthesiologist’s expertise, skills and knowledge can be an asset and applied across the PSH model.
Healthcare in 2021
Amid the COVID-19 pandemic, healthcare in general looks different than it did 18 months ago. The PSH Model has created unity in an otherwise confusing situation. Having the PSH Model in place prior to the pandemic created structure to help the focus remain on the patient.
Hospitals that had already implemented the Perioperative Surgical Home model were seeing a higher standard of care for patient safety, improved coordination between hospital systems, efficiency, reduced cost of care, reduced complication rate, decreased length of stay, improved overall satisfaction of surgeons, anesthesiologists, nurses and patients, and improved quality research.
Let’s rewind- If you had a magic crystal ball in 2019 and knew that the COVID pandemic would occur, are all those items listed above things that you would want in place? Of course! The structure that the PSH model has provided has been a major guiding force while navigating through 2020 and the beginning of 2021.
Anesthesiologists Role in 2021 in the Perioperative Surgical Home Model
While many doctors have switched to telehealth, Anesthesiologists have not/cannot. Anesthesia must be administered in person, in the Operating Room. But many of their peers or other systems in their PSH Model might be working from home or administering Telehealth.
Adding in the concern for COVID (both from the hospital and doctor’s perspective, as well as the patients concern), maintaining a patient-centric care system this year is vital.
What does this mean for the anesthesiologist?
Your healthcare organization must continue to:
- Establish leadership in the care team
- Asses the patient’s current condition
- Understanding “prehabilitation” to optimize the patient’s health status
- Coordinate transitions of care
Some of these items might take more coordination, since some are in the hospital, some are at home, and some are remote.
Make sure to continuously measure before, during, and after:
- Patient outcomes:satisfaction, improved or full return to functional status
- Internal efficiency outcomes:delays, cancellations, length of stay
- Clinical and safety outcomes:complications, readmissions, post-acute functional status
- Economic outcomes:total cost of the episode of care, resource utilization
- Continuous quality improvement:trends over time, satisfaction of stakeholders
Maintaining the PSH model will continue to improve patient care and decrease costs within your practice, which is something all doctors and anesthesiologists should strive for.
The PSH model aligns with many of the goals outlined in various value-based payment models and can be good choice for those looking to truly implement quality rather than “checking the boxes” just to avoid a Medicare penalty. (See our eBook on Quality Reporting Models and if your practice really needs to implement APM or MIPS for financial reasons.)
To learn more, view these additional resources:
- On-Demand Webinar:Perioperative Surgical Home Learning Collaborative: Leveraging the PSH Model
- Fact Sheets, White Papers, and Other Resources:From the American Society of Anesthesiologists
- Journal Article:The Perioperative Surgical Home as a Future Perioperative Practice Model from the Anesthesia and Analgesia Journal
- Web Article:10 Things to Know about Setting Up a Perioperative Surgical Home from Becker’s Hospital Review
- Case Study Summary:What are the Benefits of the Perioperative Surgical Home? from the American Academy of Orthopaedic Surgeons