Perioperative Surgical Home. Meeting tomorrow’s challenges

Abstract

New healthcare models pose a variety of changes for anesthesiologists, ranging from the need to improve quality and to cost containment: as such, the concept of Perioperative Surgical Home (PSH) has been developed. Modelled after the UK's Enhanced Recovery After Surgery (ERAS), PSH takes a step further by coordinating care starting from the time a surgical decision is made for the patient to as many as 30 days postoperatively, taking a logical evidenced-based approach to judicious preoperative testing. Perioperative surgical home also relies heavily on engineering imported strategies such as the use of Lean Six Sigma methodologies, and involves active participation of all stakeholders. By comparison, ERAS is a series of well-defined clinical protocols that do not extend beyond the episode of surgical care. As an added aspect of its benefits, PSH also helps to control costs by decreasing unnecessary testing and cancellations, and allowing for more OR access by inpatients.

Implementing enhanced recovery pathways to improve surgical outcomes

“…However, with the shift in reimbursements for services to a bundle payment system, modifications in the delivery of perioperative surgical care will need to meet the demands of optimizing patient care in an environment of limited reimbursements. [ 23 24 ]…”

Rural implementation of the perioperative surgical home: A case-control study

“…The components of PSH also included patient-centered coordination programs and enhanced recovery after surgery[ 12 , 13 ]. The implementation of PSH in larger healthcare systems and academic medical institutions has shown promising results in surgical outcomes, especially in orthopedic procedures[ 9 ].…”

The Perioperative Surgical Home in Pediatrics: Improve Patient Outcomes, Decrease Cancellations, Improve HealthCare Spending and Allocation of Resources during the COVID-19 Pandemic

“…The PSH model ( Figure 1) is a continuous patient-centered approach that involves a multidisciplinary team of physicians and healthcare providers, aimed at individualized attention that begins when the decision for operative care is made and ends approximately 30 days after hospital discharge [3]. Not only does this increase coordination between physicians, but it provides a standardized, evidence-based approach to patient care [4]. This streamlined model decreases unnecessary testing and cancellations, providing greater operative room access for in-patients, and contributing to decreased healthcare costs.…”