Leadership roles within and beyond the perioperative domain
Over the past few years, the concept of the Perioperative Surgical Home (PSH) — a healthcare delivery model in which an anesthesiologist coordinates care from the initial decision to have surgery through 30 days post-discharge — has gained momentum in the anesthesiology community. In fact, a recent study (abstract S-150) from the University of California, Irvine - one of the pioneering institutions of the PSH model - found nationwide agreement that anesthesiologists’ coordination of care using the PSH model will help reduce healthcare costs by improving processes and patient outcomes.
The study, which went out to 6,000 randomly-selected members of the American Society of Anesthesiologists and garnered 883 responses, found that more than half of respondents believed anesthesiologists should coordinate patient care from scheduling to hospital discharge (60%), and that coordination of preoperative (81%) and postoperative (64%) care should become standard. Because anesthesiologists have always been involved in the planning stages, operation and post-operative care, serving as the coordinator, or “air traffic controller,” of the perioperative experience is a natural extension of their role and an important leadership opportunity for anesthesiology providers.
Anesthesiologists’ coordination of perioperative care improves a number of critical hospital quality metrics. Respondents to the UC Irvine study agreed that anesthesiologist coordination of care would improve outcomes (89%) while reducing costs (82%), hospital length of stay (81%) and readmission rate (73%). Anesthesiologists have the training and knowledge required for pre-operative planning, surgical experience and post-operative pain management and care expertise — this broad and holistic perspective leads to better patient outcomes. It also helps to reduce waste in the form of unnecessary testing. More pre-op tests lead to more information, but not necessarily meaningful or useful information. More testing can also lead to false positives which may cause same-day surgery cancellations and become a burden on a patient as it may require even more unnecessary testing.
Day-of surgery cancellations can cost a facility almost $3,000 per patient. With 90 percent of surgery cancellations taking place just before a patient enters the OR, hospitals stand to benefit from implementing strategies that reduce cancellation rates. Same-day cancellations are also one of the biggest patient and surgeon dissatisfiers, so limiting their instances can help improve patient and staff satisfaction. Having the anesthesiologist serve as a consistent point person throughout the surgical continuum improves the patient experience as well.
Beyond the patient’s care and experience, the PSH, a physician-lead team-based model, can improve staff satisfaction. Assigning the surgical coordination role to anesthesiologists helps to clearly define responsibilities among the various departments involved in an operation. The anesthesiologist serves as an interdepartmental point person, improving communication and teamwork.
As hospitals explore new care delivery and payment models, administrators envision and expect broader involvement from anesthesiologists. Healthcare reform has created a need for the optimization of resources. In addition to the larger role provided by the PSH model, anesthesiologists can take part in broader hospital initiatives like staffing & process improvements, interdepartmental pain management and nausea & vomiting initiatives, and more. Hospital administration and anesthesiology leadership should work collaboratively to identify areas where clinical and managerial operations could be strengthened by anesthesiologists’ expertise. Review our one-pager on enhancing anesthesiologists’ value to hospitals for ideas.