The perioperative surgical home: What’s in a name?

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to

Our institution, like countless others across the country, has been working to institute processes to achieve the “triple aim” of improving the quality of health care, increasing patient satisfaction, and reducing the cost of providing that care.

As chair of my anesthesiology department, a number of our faculty were intrigued by the perioperative surgical home (PSH) concept — a surgical process in which patient-centered, physician-led, team-based coordinated care spans the entire surgical experience, from the decision to have surgery to discharge and beyond — spearheaded by the American Society of Anesthesiologists.  Utilizing the PSH model to consistently apply evidence-based best practices in the perioperative period shows promise in achieving the “triple aim” in the perioperative continuum of care.

However, as we engaged our surgical colleagues, as well as our C-suite administrative leaders to implement these processes at our institution, we found that considerable energy and time was being expended in defining who “owned” the process.  Was this an anesthesiology-driven process?  Was it surgery-driven, more frequently referred to as enhanced recovery after surgery (ERAS)?  Was it both?  Was it neither?

These conversations were an important initial step as we embarked upon this venture, and they were largely collegial and productive.  Although the commitment to substantially improve the delivery of surgical care was there, it seemed that we were having difficulty getting out of the starting gate, stuck in neutral determining which department would drive the process.

As I was reflecting on these challenges, it occurred to me that we needed to define it as an institutional, rather than departmental initiative. To that end, we arrived at a name for our PSH model: Optimal Surgical Utilization with Minimal Complications and Cancellations (OSUWMC2).  Not coincidentally, its new moniker bore a remarkable resemblance to our beloved medical center’s name: Ohio State University Wexner Medical Center (OSUWMC).

Although seemingly a simple and superficial act, creating a name that clearly reflected the breadth of the initiative helped crystallize the process for all of us. Our newly named process was clearly one that belonged to all stakeholders in perioperative care: surgeons, physician anesthesiologists, administration, nursing, pharmacy, IT and others readily jumped on board.  We recently started enrolling our initial patients in our OSUWMC2 initiative, and we are optimistic that we are on target to hit the “triple aim.”

I am aware that there are a number of institutions that have successfully implemented this process under the PSH name; others have achieved success calling it an ERAS process.  I wouldn’t begin to suggest that such institutions rename their process to something that doesn’t incorporate PSH or ERAS.

However, I am aware that there are other medical centers challenged in moving forward, in part due to similar challenges we experienced over the question of departmental ownership. If you find yourself in this latter cohort, I urge you to have your next step entail crafting a name that clearly reflects the multidisciplinary nature that is essential to the success of this process.

No matter what the name, the PSH model can help all of us in health care reach our common goal.

Ronald L. Harter is an anesthesiologist.

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