Ad­vanc­ing a med­i­cal home for sur­gi­cal ser­vices

Modern Healthcare - - COMMENT - By Dr. Jane C.K. Fitch Dr. Jane C.K. Fitch is pres­i­dent of the Amer­i­can So­ci­ety of Anes­the­si­ol­o­gists.

Bet­ter out­comes, lower costs, more-sat­is­fied pa­tients. It’s what we all strive for. And it’s a goal that continues to elude us.

The tech­ni­cal ad­vances in medicine in this coun­try are re­mark­able, but our sys­tem is frag­mented, with in­ef­fi­cien­cies that cre­ate a bar­rier to the qual­ity we as­pire to. It’s a prob­lem that costs all of us—physi­cians, nurses, ad­min­is­tra­tors, pay­ers and, of course, pa­tients and their fam­i­lies—and one that orig­i­nates from all ar­eas of medicine.

In pri­mary care, the pa­tient-cen­tered med­i­cal home shows prom­ise in im­prov­ing pa­tient care and pro­duc­ing sav­ings. A sim­i­lar sys­tem can do the same for surgery, where a large per­cent­age of a hospi­tal’s costs are in­curred, and where man­ag­ing one com­pli­ca­tion, such as pneu­mo­nia, threat­ens the pa­tient’s out­come and can erase the thin mar­gin from an en­tire sur­gi­cal pro­ce­dure.

Most hospi­tal surgery sys­tems don’t have a con­tin­uum of care that cov­ers the pe­ri­op­er­a­tive pe­riod, which be­gins with the de­ci­sion to op­er­ate and of­ten ends well af­ter dis­charge. Rather pre­op­er­a­tive, in­tra­op­er­a­tive, post­op­er­a­tive and post-dis­charge are treated as dis­crete episodes of care.

Sim­i­lar to the pa­tient-cen­tered med­i­cal home, the pe­ri­op­er­a­tive sur­gi­cal home, or PSH, model is show­ing prom­ise in sev­eral hos­pi­tals and health sys­tems. Pre­lim­i­nary find­ings from the Univer­sity of Cal­i­for­nia at Irvine found im­proved pa­tient out­comes and ef­fi­cien­cies in its PSH pro­gram. Such mod­els are pa­tient-cen­tered in­te­grated sys­tems of pe­ri­op­er­a­tive care de­signed to re­duce frag­men­ta­tion, im­prove ef­fi­ciency and stan­dard­ize pro­ce­dures.

A PSH can im­prove out­comes and re­duce costs by elim­i­nat­ing can­cel­la­tions and de­lays in surgery, low­er­ing com­pli­ca­tion rates and read­mis­sions, and re­duc­ing length of stays. Po­ten­tial bar­ri­ers to adop­tion in­clude es­tab­lish­ing ad­e­quate pay­ment for ser­vices and the com­mit­ment of the or­ga­ni­za­tions and their staff to sub­stan­tially change how sur­gi­cal care is de­liv­ered.

The Amer­i­can So­ci­ety of Anes­the­si­ol­o­gists is spear­head­ing a PSH learn­ing col­lab­o­ra­tive that will bring to­gether more than 40 health­care or­ga­ni­za­tions na­tion­wide this sum­mer to de­fine the model, pi­lot it and as­sess its ben­e­fits. Anes­the­si­ol­o­gists are well-suited to take a leading role be­cause of their abil­ity to eval­u­ate pa­tients with a va­ri­ety of risks and co-mor­bidi­ties and man­age them be­fore, dur­ing and af­ter surgery. We be­lieve the con­cept will help all of us in health­care reach our com­mon goal.

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