When everyone is on the same page, every patient receives the same
level of care and outcomes improve.
• Enhanced Recovery After Surgery (ERAS) protocols. Introduced
about 10 years ago, this model encompasses 22 specific clinical ele-
ments that are optimized for patients. ERAS has been associated with
marked reduction in post-op length of stay and complication rates in
multiple facilities.
• The Perioperative Surgical Home (PSH). This increasingly popu-
lar and innovative clinical model encompasses all elements of patient
care from the day a surgery is scheduled until 30 to 60 days post-op.
This model has been shown to result in decreased lengths of stays,
reduced readmission rates and an improved patient experience — the
key elements of value-based care.
I've led a number of highly successful implementations of the ERAS-
PSH models in both university and community hospital settings. In one
study, we implemented the PSH model in more than 2,000 patients
undergoing ambulatory laparoscopic cholecystectomy
(osmag.net/yrv7tv). The perioperative surgical home group had coor-
dinated care among all providers before, during and after their surger-
ies.
Before patients came into the facility for surgery, they attended a
pre-op clinical visit that included lab tests, medication optimization
and tips for healthy lifestyle changes. On the day of surgery, patients
were given oral analgesics in pre-op. During and after the procedures,
the anesthesia team focused on using multimodal analgesics and
reducing the use of opioids. The study found that patients following
the pathways outlined in the PSH model had decreased total lengths
of stays, lower incidence of PONV and experienced less pain after sur-
gery.
Despite that type of success, there are still challenges that make the
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