Perioperative Surgical Home

The perioperative surgical home (PSH) model is a novel treatment paradigm in which the anesthesiologist serves as the coordinator of care from the preoperative to perioperative phase. In effect, the PSH model aims to increase efficiency in the care continuum by appointing an anesthesiologist to lead the episode of care, in contrast to the traditional team-based model.

Early results of the application of the PSH model were encouraging, with institutions such as UC Irvine and University of Alabama exhibiting promising results. At Irvine, a PSH for primary joint replacement surgery was associated with decreased readmission rates throughout 30 days post-surgery, a significant result[1]. Furthermore, sites like the University of Alabama have reported lower healthcare costs and increased efficiency in allocation of resources after the integration of PSH, a venerable result for any healthcare system[2].

In response to the success of early stage studies, research institutions have elected to include PSH models as a potential framework for research and practice. The Ochsner Health System in New Orleans is an example of such an institution[3]. Physician researchers at the Ochsner Health System recently developed a modified PSH model in which the main case team was comprised of orthopedic and anesthesiology specialists. Practitioners met on a weekly basis to discuss specific patients, and therapy was provided via a de-escalation of care paradigm. At the end of the recovery period, it was found that cases on the PSH model were associated with improved outcomes and lowered costs. Specifically, length of stay decreased from 2.86 to 1.91 days after the integration of the PSH model. Moreover, total direct costs were lower in the PSH group as compared to control, with a total savings of several hundred dollars per patient. In total, the study represents a shift towards increased value per patient — getting patients into and out of the hospital quickly and efficiently, with maximum cost savings and the absence of any corresponding decrease in quality of care.

The success of this study further supports the impact that anesthesiologists can have as physician leaders. The anesthesiologist has expertise in multiple domains of patient care, and as such possesses the ability to assess a clinical situation and recommend an optimized course of action. As the healthcare field moves towards an emphasis on value-based care, anesthesiologists will prove to be invaluable leaders in PSH model applications as well as further optimized models of care.

Update: The American Academy of Physical Medicine and Rehabilitation officially endorsed the PSH model on October 12, 2017[4], further supporting the increased importance of PSH as a viable and efficient model for integration into healthcare institutions nationwide.

[1] http://www.anesthesiology.uci.edu/psh.shtml

[2] https://bmcanesthesiol.biomedcentral.com/articles/10.1186/1471-2253-13-6

[3]http://www.anesthesiologynews.com/Clinical-Anesthesiology/Article/08-17/Perioperative-Surgical-Home-Model-Shows-Benefits-in-Primary-TKA/42089/ses=ogst?enl=true

[4]https://www.aapmr.org/news-publications/member-news/member-news-details/2017/10/12/aapm-r-endorses-the-american-society-of-anesthesiologists-(asa)-perioperative-surgical-home-(psh)-model

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