J U LY 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 2 1
Optimizing outcomes
Anesthesiology needs to move away from a modular perioperative approach to
an integrated patient care model built on better coordination throughout the
entire perioperative continuum, from the minute surgeons and patients meet in
clinic until 30 days after surgery. If better coordination of care is the foundation
of the PSH model, reduced variability is the keystone that holds it together.
Variability related to the patient's underlying condition is good and justified. On the
other hand, system variability has to be reduced, because a large body of research has
shown that such variability leads to errors and increased costs. To make the PSH
model work, you need a clearly defined multi-modal protocol that's addressed with
patients and fully understood by the care team well before the day of surgery. The
model is patient-centric. Patients receive education early on, consisting of much more
than a description of the case and what to expect on the day of surgery.
In addition, all stakeholders in the perioperative process have to be included in the
creation of a PSH program. That point can't be emphasized enough. Teamwork, com-
munication, change management and process improvement are keys to making it
work.
Preparing patients better for surgery is one of the most important aspects of the
PSH concept. We need to move beyond clearing patients for surgery to optimizing
them for best possible outcomes, which involves ensuring underlying disease — dia-
betes, hypertension, anemia, and frailty and delirium in the elderly — is managed as
best as possible in a standardized way. That's a very different approach to focusing on
how quickly you can get patients into the OR.
On the same page
The PSH model is inclusive and highly collaborative. Most critical is the partnership
between anesthesia providers and surgeons. It won't necessarily be easy to find com-
mon ground among your surgeons. Start by garnering agreement for the simplest com-
mon denominator. For example, I started with getting a consensus on venous throm-
boembolism prophylaxis, although that did take a month to achieve. Once you pro-
