and complex procedures, which will require care in the acute
hospital setting. We're going to see movement of cases in both
directions to the outpatient and inpatient ends of the surgical
spectrum. The trend will involve performing cases in clinically
appropriate settings that maximize surgical efficacy, efficien-
cy, safety and cost-savings.
Big data and transparency
Pulling back the curtain on the cost and safety of surgical
care is inevitable and needed, although it has some inherent
challenges, including the reliance on data sets that are used to
judge surgical quality and outcomes. Is it possible to assess
those parameters with numbers alone? I'm not so sure.
In the past, powerful chiefs of surgery controlled quality of care by
determining which surgeons were skilled and which ones weren't,
and using their authoritative power to deal with the outliers. That
management model is no longer acceptable. We're currently trying to
establish unbiased determinations of surgeon skill and the variables
that impact surgical outcomes through the use of big data. However,
there is no perfect correlation between the outcome stories present-
ed in numbers and the care that's provided in real-world ORs.
Moving forward, we have to harness the analytical power of sur-
gical data, but must also be wary of the potential unintended con-
sequences of holding surgeons accountable for safe care through
current reporting systems and transparency practices that don't
necessarily tell the whole story.
Opioid-free pain control
When the Joint Commission identified pain as the fifth vital
sign in 2001, surgeons were told to work toward performing
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On Point
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