In 2007, the Institute for Healthcare Improvement introduced “Triple Aim for Populations,” an approach to optimize health system performance by improving 1) patient experience, 2) patient health and 3) healthcare costs simultaneously. Over the past few years, the anesthesiology community has honed in on this “triple aim” framework, applying it to surgical processes with an approach called the Perioperative Surgical Home (PSH).
The Perioperative Surgical Home
The ultimate goal of the PSH model is to better coordinate care through the entire surgical continuum. Operating rooms struggle with a multitude of inefficiencies and expense multipliers stemming from lack of coordination, from duplication of services, clinical variation and medical errors. The PSH approach aims to eliminate these inefficiencies—and achieve the triple aim—through a “patient-centered, physician-led, multidisciplinary and team-based system of coordinated care” (American Society of Anesthesiologists). In the PSH, surgical teams lead patients through a personalized and evidence-based surgical program that mitigates the risk of unnecessary pre-op testing, unforeseen errors or complications, and readmission. As the name implies, PSH-modeled surgery plans are perioperative—they begin at the decision of whether to have surgery, follow the patient through the entire procedure, and continue through the 30 days following the surgery.
This past summer, the American Society of Anesthesiologists (ASA) formed a PSH learning collaborative, in which 41 health care organizations from across the country analyzed the PSH model in an effort to develop a “road map” for other providers to follow. The anesthesiology society’s interest in the PSH model stems from the fact that the system focuses on the interconnectedness of each phase of surgery—a process that anesthesiologists are acutely aware of.
Anesthesiologists at the Helm
Too often, surgical plans are fragmented, with insufficient communication between parties responsible for pre-operative activities, intra-operative care, immediate post-operative care and discharge. Because anesthesiologists already play a role in all of these phases, the PSH provides the opportunity for a natural evolution from the traditional OR anesthesiologist to a perioperative physician.
Though surgeons are often the “face” of the surgical team to a patient, anesthesiologists are uniquely positioned to bridge the gap between providers and play a larger role in the coordination of surgical care. In the planning phases, anesthesiologists have the training and knowledge-base of general health management and comorbidities that surgeons are less focused on. They are also present during the surgery itself, unlike the patient’s primary care physician. Their involvement continues in post-surgery, where anesthesiologists are responsible for much of the pain management and care. Having a consistent point person throughout the surgical continuum improves the patient experience and ensures the care is as efficient and streamlined as possible. The ASA sums it up as follows:
Physician anesthesiologists will be key contributors to the success of the PSH model as experts in preoperative evaluation, optimization of coexisting disease prior to surgery, pain management, and post-anesthesia care. However, current payment structures create barriers to applying this hard-earned knowledge and systems expertise across the continuum of perioperative care. Breaking down these barriers will allow anesthesiologists to work with other physicians and healthcare practitioners during all phases of surgical care, improving safety, quality, and efficiency.
Sheridan Best Practices
Pending the payment model overhaul the ASA advocates for, Sheridan Healthcare has established two anesthesiologist-led processes that work to achieve the triple aim goal and the PSH model. In our next blog post, we will outline the two initiatives—Kaizen lean management and Sheridan’s guided pre-admission testing process ClearPATh—as examples for anesthesiology departments to draw from.