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BackgroundVaried and fragmented care plans undertaken by different practitioners currently expose surgical patients to lapses in expected care, increase the chance for operational mistakes and accidents, and often result in unnecessary care. The Perioperative Surgical Home has thus been proposed by the American Society of Anesthesiologists and other stakeholders as an innovative, patient-centered, surgical continuity of care model that incorporates shared decision making. Topics central to the debate about an anesthesiology-based Perioperative Surgical Home include: holding the gains made in anesthesia-related patient safety; impacting surgical morbidity and mortality, including failure-to-rescue; achieving healthcare outcome metrics; assimilating comparative effectiveness research into the model; establishing necessary audit and data collection; a comparison with the hospitalist model of perioperative care; the perspective of the surgeon; the benefits of the Perioperative Surgical Home to the specialty of anesthesiology; and its associated healthcare economic advantages.DiscussionImproving surgical morbidity and mortality mandates a more comprehensive and integrated approach to the management of surgical patients. In their expanded capacity as the surgical patient’s “perioperativist,” anesthesiologists can play a key role in compliance with broader set of process measures, thus becoming a more vital and valuable provider from the patient, administrator, and payer perspective. The robust perioperative databases created within the Perioperative Surgical Home present new opportunities for health services and population-level research. The Perioperative Surgical Home is not intended to replace the surgeon’s patient care responsibility, but rather leverage the abilities of the entire perioperative care team in the service of the patient. To achieve this goal, it will be necessary to expand the core knowledge, skills, and experience of anesthesiologists. Anesthesiologists will need to view becoming perioperative physicians as an expansion of the specialty, rather than an abdication of their traditional intraoperative role. The Perioperative Surgical Home will need to create strategic added value for a health system and payers. This added value will strengthen the position of anesthesiologists as they navigate and negotiate in the face of finite, if not decreasing fiscal resources.SummaryBroadening the anesthesiologist’s scope of practice via the Perioperative Surgical Home may promote standardization and improve clinical outcomes and decrease resource utilization by providing greater patient-centered continuity of care throughout the preoperative, intraoperative, and postoperative periods.

The aim of this work is to describe the radiographic findings of isolated trapezoid fractures and determine the utility of these findings in guiding treatment. A second aim is to heighten awareness of an uncommon sports-related injury that is often radiographically occult because of the lack of primary or overt secondary radiographic findings. A retrospective review of radiology reports at our institution from 2007 to 2010 was performed to identify isolated trapezoid fractures. Two musculoskeletal radiologists and one orthopedic hand surgeon reviewed the patient presentations, images, treatments, and outcomes of the patients' injuries. This project had institutional review board approval. We describe three patients who presented with isolated sports-related trapezoid fractures. Each patient was successfully treated with activity modification, cast immobilization, and/or surgery based on their specific radiographic findings. Isolated sports-related trapezoid fractures are rare injuries. Only one prior case report in the English literature exists. Treatment success in patients with trapezoid fractures depends upon the degree of activity modification, splint protection, and especially fragment displacement. We report the largest series to date of isolated trapezoid fractures, all of which resulted from sports participation, and we analyze the success of diagnostic and treatment interventions.

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Medical errors continue to occur and therefore represent a threat to patient safety. Quality assurance efforts and more refined research can be addressed toward areas with higher error occurrence (equipment and communication) and high risk (medication and wrong-site surgery).