Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home

Abstract

The Perioperative Surgical Home is a model adopted by the American Society of Anesthesiologists to increase quality and patient safety and to decrease costs. This Special Article is about the latter topic. Using narrative review, we show that there are two principal opportunities for net cost reduction. One opportunity is to reduce unnecessary interventions that do not have potential to benefit patients (e.g., preoperative laboratory studies in healthy patients undergoing low-risk surgery and use of substantial fresh gas flows with volatile anesthetics). The other opportunity is to optimize staff scheduling, case scheduling, and staff assignment. These two are the same as the principal ways that a positive return on investment can be achieved from use of an anesthesia information management system. Three other opportunities are much less likely to achieve as large (if any) net cost reduction among all patients but may at some hospitals. These are to reduce cancellations, operating room times, and/or hospital postoperative lengths of stay.

Prolonged Operative Time to Extubation Is Not a Useful Metric for Comparing the Performance of Individual Anesthesia Providers

“…However, because the variability in the incidence of prolonged extubations was greater among anesthesia providers than anesthesiologists (P < 0.00001, WMWodds > 1,000), providing feedback to anesthesiologists should be targeted to their roles as managers ("supervisors"), less so as clinicians directly influencing the extubation times during patient care. 27 The finding of lack of managerial (economic) value in comparing individual anesthesiologists and anesthesia providers based on a clinically collected measure that combine clinical and operational features matched that which has been found for other endpoints. For example, anesthesiologists differ substantively in their patients' initial postanesthesia care unit pain scores on univariate analysis.…”

The Perioperative Surgical Home and Enhanced Recovery After Surgery: Perspectives from Two Continents

“…The PSH is itself a larger conceptual framework that includes coordination of care for the entire patient journey. PSH protocols may vary significantly between institutions, being dependent on the surgical and anaesthetic services available, and the local peri-operative environment in which it is employed [64] . Current practice in the UK, however, would not support the transfer of direct responsibility of in-patient care to the anaesthetic team as seen in the US.…”

“…As the surgeon is the first and last point of contact through the patient's journey, from initial consultation, to outpatient followup, it may be most appropriate for surgeons to lead this initiative in close partnership with anaesthetic colleagues. Being at the forefront of change may better enable surgeons to choose the services their patients require, and may be advantageous in the allocation of resources and practical support [64,65] .…”

Rebranding the Perioperative Surgical Home: Lessons From the Duke Experience

“…[8][9][10][11] They have shown impressive early successes, particularly with their implementation of a preoperative anemia clinic that has been associated with a reduction in transfusions and cost savings for their institution. Among patients screened for anemia preoperatively, 10-15% of them are referred to Duke's anemia clinic.…”