The Perioperative Surgical Home: Have Health Care Literacy, Family Education and Patient Empowerment Been Lost in the Shuffle of Streamlined Care?

Authors: Matthew E. Patterson, M.D. et al

ASA Monitor 05 2016, Vol.80, 26-27.

The Perioperative Surgical Home (PSH) model of care has been developed in an attempt to streamline patient recovery by providing evidence-based care and reducing care variability. Although much attention has been placed on medications, techniques and devices that can accomplish this variability reduction, we feel that an important aspect (if not the most important aspect) of these protocols is frequently ignored: patient education and empowerment. Setting realistic goals/expectations and educating the patient and family members using appropriate language and educational aids set the stage for all that follows, yet precious little literature focuses on this common-sense approach.

What literature does exist reveals varying results. A study in preoperative cancer patients concluded that face-to-face education provided more improvement on anxiety, satisfaction, knowledge and health care costs, whereas audio-visual and multimedia interventions only improved satisfaction and knowledge, and written interventions had very mixed results (Waller 2015). Preoperative patient education has also been associated with a reduced length of stay after joint arthroplasty (Jones 2011) and thoracic surgery (Madani 2015) and has been associated with reduction in total costs (Tait 2015). In contrast, a recent systematic review of orthopedic joint education concluded that preoperative education offers minimal benefit beyond decreasing preoperative anxiety (McDonald 2014). Variation in the format of education, surgical type and overall surgical care most certainly results in this reported variability.