Perioperative Surgical Home Model Research Articles

More Than a Perioperative Surgical Home: An Opportunity for Anesthesiologists to Advance Public Health.

Public health and the medical specialty of anesthesiology have been closely intertwined throughout history, dating back to the 1800s when Dr. John Snow used contact tracing methods to identify the Broad Street Pump as the source of a cholera outbreak in London. During the COVID-19 pandemic, leaders in anesthesiology and anesthesia patient safety came forward to develop swift recommendations in the face of rapidly changing evidence to help protect patients and healthcare workers. While these high-profile examples may seem like uncommon events, there are many common modern-day public health issues that regularly intersect with anesthesiology and surgery. These include, but are not limited to, smoking; chronic opioid use and opioid use disorder; and obstructive sleep apnea. As an evolving medical specialty that encompasses pre- and postoperative care and acute and chronic pain management, anesthesiologists are uniquely positioned to improve patient care and outcomes and promote long-lasting behavioral changes to improve overall health. In this article, we make the case for advancing the role of the anesthesiologist beyond the original perioperative surgical home model into promoting public health initiatives within the perioperative period.

A Rural Community Hospital’s Perioperative Surgical Home Model Compared to a Traditional Surgical System

Background: The Perioperative Surgical Home (PSH) was designed by the American Society of Anesthesiologists (ASA) to improve perioperative care through more coordinated and communicative decision-making. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas. Thus, this study compared surgical outcomes – LOS, discharge disposition, and 90-day readmission – at a rural hospital from cohorts before and after the implementation of PSH. Method: An initial model of a PSH system was initiated in a local rural hospital. This newly created clinical team and outpatient clinic retrospectively assessed total joint surgeries occurring from November 2017 to April 2018 (before PSH, n = 324) as well as from November 2018 to April 2019 (after PSH, n = 326). General linear models were used to understand the impact of PSH on rural surgical outcomes. Results: Implementing PSH had a positive impact on LOS (P-value < 0.01), discharge disposition (P-value < 0.01), and readmission (P-value = 0.03).Conclusion: Implementation of the PSH system in a rural, community hospital reduced LOS, 90-day readmission, and increased direct to home discharge. Increased clinical management standardization across internal and external stakeholders was achieved because the PSH clinic enabled a centralized navigation point for clinicians, patients, and their families to better communicate and coordinate care.

A More Efficient, Accessible, and Team-Friendly PSH

Article| September 2022 A More Efficient, Accessible, and Team-Friendly PSH Christopher Steel, MD Christopher Steel, MD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor September 2022, Vol. 86, 16. https://doi.org/10.1097/01.ASM.0000874224.72186.4b Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Christopher Steel; A More Efficient, Accessible, and Team-Friendly PSH. ASA Monitor 2022; 86:16 doi: https://doi.org/10.1097/01.ASM.0000874224.72186.4b Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: accountable care organizations, asthma-chronic obstructive pulmonary disease overlap syndrome, consultation, health personnel, perioperative care, precision, steel, fee for service payment plan, value-based care, best practice In 2014, ASA began hosting the Perioperative Surgical Home (PSH) Learning Collaborative to develop, pilot, and evaluate the PSH model. Two additional Learning Collaboratives followed, leading to iterative improvements, more data on the model's success, additional proven pathways and protocols, and more. The dedicated innovators who participated in our learning collaboratives reduced readmissions and lengths of stay, aligned with bundled payment and ACOs, and decreased episode of care costs, to name a few of the many achievements participants realized. But these champions were just the tip of the spear, innovators who established proof of concept, scaled the model across services lines, then pointed the way for other adopters to follow. The Learning Collaboratives were wildly successful in moving the needle for health care organizations, but they also presented a high bar to entry – the number of health care professionals who had meaningful access to the protocols, lessons, and outcomes... You do not currently have access to this content.

PSH Myths Worth Busting: 10 Years of Change and 6 Misconceptions

Article| July 2022 PSH Myths Worth Busting: 10 Years of Change and 6 Misconceptions Rob Shakar, MD, FASA Rob Shakar, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor July 2022, Vol. 86, 41. https://doi.org/10.1097/01.ASM.0000842108.99789.9d Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Rob Shakar; PSH Myths Worth Busting: 10 Years of Change and 6 Misconceptions. ASA Monitor 2022; 86:41 doi: https://doi.org/10.1097/01.ASM.0000842108.99789.9d Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: misconceptions In 2012, ASA introduced the Perioperative Surgical Home (PSH) as a response to the shift from volume-based to value-based health care. The society recognized that anesthesiologists would increasingly be measured by the cost-effectiveness and quality of the care they provide. We believed a patient-centric, team-based care model designed to help patients navigate through the entire surgical experience, from the decision for surgery through recovery, would meet the needs of the moment. In the decade since, the PSH has evolved, becoming more nimble, more effective, and even more resolute about improving patient outcomes, decreasing costs, increasing provider satisfaction, and enhancing patient experiences. Because the model itself is iterative, change has been an integral part of the journey. But through it all, some myths about the PSH model have persisted. Some misconceptions are grounded in where we started while others are built on a genuine misunderstanding of the model's systems, tactics, and... You do not currently have access to this content.

Loma Linda University Health Enhances Care and Outcomes with PSH Learning Collaborative

Facility Spotlight| July 2022 Loma Linda University Health Enhances Care and Outcomes with PSH Learning Collaborative Catlin Nalley Catlin Nalley Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor July 2022, Vol. 86, 42. https://doi.org/10.1097/01.ASM.0000842112.31088.bc Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Catlin Nalley; Loma Linda University Health Enhances Care and Outcomes with PSH Learning Collaborative. ASA Monitor 2022; 86:42 doi: https://doi.org/10.1097/01.ASM.0000842112.31088.bc Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: quality of care, surgical procedures, operative, work teams, consultation, leadership, perioperative care, preoperative care, perioperative medicine As health care reform continues, so does the emphasis on delivering value-based care that is both cost-effective and high-quality. With this in mind, ASA established the Perioperative Surgical Home (PSH) Learning Collaborative. Aimed at exploring the PSH model, the first collaboration occurred from 2014-2016, followed by Learning Collaborative 2.0 and Learning Collaborative 2020 in 2016-2018 and 2018-2020, respectively, With a long-time passion for perioperative medicine, Gary R. Stier, MD, FACP, MBA, CPE, saw this initiative as an opportunity to enhance the care and outcomes provided by his institution, Loma Linda University Health, whose team has been involved in the Collaborative since its inception. “Anesthesiologists offer a variety of valuable skills that can extend beyond the operating room,” he noted. “Engaging in perioperative medicine is important not only for our profession, but also for our patients and the medical community as a whole.” The PSH program developed at Loma Linda University... You do not currently have access to this content.

Quadratus Lumborum Block as a Rescue Block Following Total Hip Arthroplasty.

Total hip arthroplasty (THA) is a common surgical procedure for various hip diseases that has been associated with severe postoperative pain. A multimodal pain management regimen is a mandatory component to successful rehabilitation and patient satisfaction. By incorporating regional blocks into the perioperative surgical home model for THA, we help to achieve the “triple aim”: a better patient experience, better health care, and lower costs [1]. Traditionally, neuraxial analgesia has been the mainstay for analgesia for this set of patients. With the advent of ultrasound-guided peripheral nerve blocks such as fascia iliaca (FI) blocks, more practitioners have begun to perform the latter type of procedure. Recently, quadratus lumborum (QL) blocks have gained attention as a suitable option for analgesia for various types of surgeries, including hip arthroplasty [2]. A QL block is an ultrasound-guided fascial plane block that has been found to be easy to perform...

Jamaica Hospital Medical Center Sees Benefits with Perioperative Surgical Home Model

Facility Spotlight| November 2020 Jamaica Hospital Medical Center Sees Benefits with Perioperative Surgical Home Model Jolynn Tumolo Jolynn Tumolo Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor November 2020, Vol. 84, 44. https://doi.org/10.1097/01.ASM.0000722196.92474.39 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Jolynn Tumolo; Jamaica Hospital Medical Center Sees Benefits with Perioperative Surgical Home Model. ASA Monitor 2020; 84:44 doi: https://doi.org/10.1097/01.ASM.0000722196.92474.39 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search The patient didn't know about the ASA's Perioperative Surgical Home (PSH) model or Jamaica Hospital Medical Center's yearslong commitment to it; but he did know that his PSH team was there to support him during a particularly trying time. “He had extreme anxiety over his impending surgery and recovery,” said Stephanie Smith, RN, BSN, Director of Care Management at not-for-profit Jamaica Hospital Medical Center, Jamaica, N.Y., part of the Medisys Health Network. “One of our community care assistants was in touch with him throughout the experience, and they developed a strong therapeutic relationship. She knew when his anxiety was escalating, and he calmed down because he knew that he could pick up the phone at any time and discuss whatever questions he had.” The community care assistant walked this patient through the experience and his care pathway. Putting the patient at the center of the surgical care experience is a... You do not currently have access to this content.

Perioperative Surgical Home Model Improves Outcomes in Crohn's Disease Patients Undergoing Disease-Related Surgery.

Background To evaluate Perioperative Surgical Home (PSH) practice model implementation in Crohn's disease (CD) patients undergoing disease-related surgery. Methods A retrospective analysis of CD patients requiring disease-related surgery in the Shanghai Ninth People's Hospital was undertaken. Subjects were divided into a non-PSH group consisting of 49 patients (June 2016 to November 2017) and a PSH group consisting of 72 patients (December 2017 until May 2019). Conventional treatment was used for the non-PSH group, while in the PSH group, a standardized pre- and postoperative management routine was employed. The postoperative lengths of stay and incidences of postoperative complications were analyzed. Results There were no significant differences in demographics, reasons for surgery, preoperative BMIs, and preoperative hemoglobin between the two groups (P > 0.05). The overall incidence of complications in the PSH group was dramatically lower than that in the non-PSH group (26.4% vs. 44.9%, P = 0.035). In the PSH group, postoperative length of stay was significantly shorter than that in the non-PSH group (11.5 ± 5.7 vs. 9.0 ± 6.8, P < 0.001). Conclusions The PSH conditioning routine in CD patients undergoing disease-related surgeries suggests a trend of fewer postoperative complications and shorter lengths of hospital stay. The PSH model may have clinical advantages when applied to CD patients.

Adoption of a Perioperative Surgical Home for Adolescent Idiopathic Scoliosis Surgery Decreases Postoperative Opioid Usage

Purpose Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) has wide treatment variation resulting in unnecessary resource utilization. Significant pain following this procedure is common and opioid medications are the foundation of postoperative pain management. Opioid usage and difficulties with pain can impact mobilization, gastric motility, discharge readiness, and patient satisfaction. The Perioperative Surgical Home (PSH) model of care is one method to decrease variability and eliminate waste through standardization of care. The purpose of this study is to report the impact of implementation a PSH for AIS (PSH-AIS) …

Outcomes Following Initial Perioperative Surgical Home Integration at a Rural Community Hospital

Background: The Perioperative Surgical Home (PSH) model of care was developed to deliver value-based care that improves population health, reduces care costs, satisfies patients and gratifies providers. Rural and remote health centers have the greatest need to coordinate surgical care to improve patient access and outcomes. However, limited PSH model fidelity currently exists for rural and remote care facilities. This study integrated and assessed the PSH model within a rural, community hospital to create a system-level model to adapt/customize PSH to meet the needs of the staff, clinicians, patients, and communities served in three rural counties. The aim of this study was to assess system functionality by tracking preliminary clinical and rehabilitative patient outcomes after initial PSH implementation at a rural community hospital. Methods: An initial PSH system model was created using field-based user observations during normal clinic operations, investigator-led debriefs of staff, and longitudinal patient outcomes. This system model was created using the critical path method, bottleneck analysis and cause and effect diagramming. An initial cohort of 17 orthopedic joint replacement patients were followed from PSH enrollment to 90-days post hospital discharge to assess clinical and rehabilitative outcomes as well as to assess PSH system functionality in a rural care network. Results: The first system analysis was performed with the primary stakeholder being the patient (patient-centric). Several linked service processes form the surgical episode with inputs from a variety of stakeholders. Average length of stay decreased to 2.23 days, hospital discharge to home increased to 86% and readmissions decreased to 5.9%. Conclusion: During the system mapping process several areas were identified for improvement including information flow and duplicative work. Two primary process bottlenecks were found and included sleep apnea screening with a positive result and post-acute inpatient care scheduling. The PSH model of care is feasible in a small, rural community hospital. Patient outcome improvements demonstrate the important roles of centrally-based and proactive care management for major care episodes.

Implementing a Pediatric Perioperative Surgical Home Integrated Care Coordination Pathway for Laryngeal Cleft Repair.

The Pediatric Perioperative Surgical Home (PPSH) model is an integrative care model designed to provide better patient care and value by shifting focus from the patient encounter level to the overarching surgical episode of care. So far, no PPSH model has targeted a complex airway disorder. It was hypothesized that the development of a PPSH for laryngeal cleft repair would reduce the high rates of postoperative resource utilization observed in this population. Institutional review board approval was obtained for the purpose of data collection and analysis. A multidisciplinary team of anesthesiologists, surgeons, nursing staff, information technology specialists, and finance administrators was gathered during the PPSH development phase. Standardized perioperative (preoperative, intraoperative, and postoperative) protocols were developed, with a focus on preoperative risk stratification. Patients presenting before surgery with ≥1 predefined medical comorbidity were triaged to the intensive care unit (ICU) postoperatively, while patients without severe systemic disease were triaged to a lower-acuity floor for overnight observation. The success of the PPSH protocol was defined by quality outcome and value measurements. The PPSH initiative included 120 patients, and the pre-PPSH period included 115 patients who underwent laryngeal cleft repair before implementation of the new process. Patients in the pre-PPSH period were reviewed and classified as ICU candidates or lower acuity floor candidates had they presented in the post-PPSH period. Among the 79 patients in the pre-PPSH period who were identified as candidates for the lower-acuity floor transfer, 70 patients (89%) were transferred to the ICU (P < .001). Retrospective analysis concluded that 143 ICU bedded days could have been avoided in the pre-PPSH group by using PPSH risk stratification. Surgery duration (P = .034) and hospital length of stay (P = .015) were found to be slightly longer in the group of pre-PPSH observation unit candidates. Rates of 30-day unplanned readmissions to the hospital were not associated with the new PPSH initiative (P = .093). No patients in either group experienced emergent postoperative intubation or other expected complications. Total hospital costs were not lower for PPSH observation unit patients as compared to pre-PPSH observation unit candidates (difference = 8%; 95% confidence interval, -7% to 23%). A well-defined preoperative screening protocol for patients undergoing laryngeal cleft repair can reduce postoperative ICU utilization without affecting patient safety. Further research is needed to see if these findings are applicable to other complex airway surgeries.

Integrating perioperative medicine with anaesthesia in India: Can the best be achieved? A review.

Integrating perioperative medicine with anaesthesia is the need of the hour. Evolution of a new superspeciality called perioperative anaesthesia can improve surgical outcomes by quality perioperative care and guarantee imminent escalation of influence and power for anaesthesiologists. All original peer-reviewed manuscripts pertaining to surgery-specific perioperative surgical home models involving preoperative, intraoperative and postoperative initiatives spanning the past 5 years have been reviewed using PubMed and Google Scholar. Whether the perioperative surgical home model is feasible or still a distant dream in the Indian perspective has been analysed.

Perioperative surgical home models and enhanced recovery after surgery.

In recent years, numerous initiatives have been introduced to address changes in health-care costs, delivery methods, reimbursements, and the health-care needs of our aging population. The American Society of Anesthesiologists (ASA) defines the Perioperative Surgical Home (PSH) as a patient-centric, team-based model of care to help meet the demands of a rapidly approaching health-care paradigm emphasizing value, patient satisfaction, and a reduction in costs. Enhanced recovery pathways were initially established by a group of surgeons from Europe who formed a research group with the aim to explore the ultimate care pathway for patients undergoing colonic resections. Similar protocols were later expanded to various surgical specialties with promising outcomes. A PubMed and World Wide Web search was performed with the following key words: “ERAS®,” “enhanced recovery after surgery,” “PSH,” “perioperative surgical home,” “protocols,” “outcomes.” Articles found were published over a 20-year time range (1997-2017). In the present investigation, the most common elements of enhanced recovery protocols are reviewed. Review of how existence of a PSH model facilitates the creation of an enhanced recovery protocol and improves cost-efficiency, patient satisfaction, and clinical outcomes observed in enhanced recovery studies that are applicable to health-care systems universally is described.

Managing Prolonged Pain After Surgery: Examining the Role of Opioids

A notable minority of patients experience persistent postsurgical pain and some of these patients consequently have prolonged exposure to opioids. Risk factors for prolonged opioid use after surgery include preoperative opioid use, anxiety, substance abuse, and alcohol abuse. The window to intervene and potentially prevent persistent opioid use after surgery is short and may best be accomplished by both surgeon and anesthesiologist working together. Anesthesiologists in particular are well positioned in the perioperative surgical home model to affect multiple aspects of the perioperative experience, including tailoring intraoperative medications and providing consultation for possible discharge analgesic regimens that can help minimize opioid use. Multimodal analgesia protocols reduce opioid consumption and thereby reduce exposure to opioids and theoretically the risk of persistent use. Regional anesthesia and analgesia techniques also reduce opioid consumption. Although many patients will recover without difficulty, the small minority who do not should receive customized care which may involve multiple office visits or consultation of a pain specialist. Enhanced recovery pathways are useful in optimizing outcomes after surgery.

Anesthesia-Guided Palliative Care in the Perioperative Surgical Home Model.

Anesthesia-Guided Palliative Care in the Perioperative Surgical Home Model.

Role of the Perioperative Surgical Home in Optimizing the Perioperative Use of Opioids.

Several federal agencies have recently noted that the United States is in the midst of an unprecedented "opioid epidemic," with an increasing number of opioid-related overdoses and deaths. Providers currently face 3 population-level, public health challenges in providing optimal perioperative pain care: (1) the continued lack of overall improvement in the excessive incidence of inadequately treated postoperative pain, (2) minimizing or preventing postoperative opioid-related side effects, and (3) addressing current opioid prescribing patterns, and the accompanying problematic surge in prescription opioid diversion, misuse, abuse, addiction, and overdose. In the Perioperative Surgical Home model, anesthesiologists and other pain medicine specialists are uniquely qualified and positioned to develop, implement, and coordinate a comprehensive perioperative analgesic plan, which begins with the formal preoperative patient assessment and continues throughout the postdischarge, convalescence period. The scope and practice of pain management within the Perioperative Surgical Home should thus (a) expand to include routine preoperative patient-level pain-risk stratification (including the chronic use of opioid and nonopioid analgesics), (b) address the multitude of biopsychosocial factors that contribute to interpatient pain variability, and (c) extend and be well coordinated across all 4 phases of the surgical pain experience (preoperative, intraoperative, postoperative, and postdischarge). Specifically, safe and effective perioperative pain management should include a plan of care that is tailored to the individual patient's underlying disease(s), presence of a chronic pain condition and preoperative use of opioids, and the specific surgical procedure-with evidence-based, multimodal analgesic regimens being applied in the vast majority of cases. An iteratively evolutionary component of an existing institutional Perioperative Surgical Home program can be an integrated Transitional Pain Service, which is modeled directly after the well-established prototype at the Toronto General Hospital in Ontario, Canada. This multidisciplinary, perioperative Transitional Pain Service seeks to modify the pain trajectories of patients who are at increased risk of (a) long-term, increasing, excessive opioid consumption and/or (b) developing chronic postsurgical pain. Like the Perioperative Surgical Home program in which it can be logically integrated, such a Transitional Pain Service can serve as the needed but missing linkage to improve the continuum of care and perioperative pain management for elective, urgent, and emergent surgery. Even if successfully and cost-efficiently embedded within an existing Perioperative Surgical Home, a new perioperative Transitional Pain Service will require additional resources.

Creation and Execution of a Novel Anesthesia Perioperative Care Service at a Veterans Affairs Hospital.

Physician-led perioperative surgical home models are developing as a method for improving the American health care system. These models are novel, team-based approaches that help to provide continuity of care throughout the perioperative period. Another avenue for improving care for surgical patients is the use of enhanced recovery after surgery pathways. These are well-described methods that have shown to improve perioperative outcomes. An established perioperative surgical home model can help implementation, efficiency, and adherence to enhanced recovery after surgery pathways. For these reasons, the Tennessee Valley Healthcare System, Nashville Veterans Affairs Medical Center created an Anesthesiology Perioperative Care Service that provides comprehensive care to surgical patients from their preoperative period through the continuum of their hospital course and postdischarge follow-up. In this brief report, we describe the development, implementation, and preliminary outcomes of the service.

Improving Efficiency and Patient Experiences: The Perioperative Surgical Home Model

AORN JournalVolume 106, Issue 3 p. 249-253 Column Improving Efficiency and Patient Experiences: The Perioperative Surgical Home Model Theresa Criscitelli EdD, RN, CNOR, Theresa Criscitelli EdD, RN, CNORSearch for more papers by this author Theresa Criscitelli EdD, RN, CNOR, Theresa Criscitelli EdD, RN, CNORSearch for more papers by this author First published: 01 September 2017 https://doi.org/10.1016/j.aorn.2017.07.009Citations: 2 Editor's notes:Enhanced Recovery After Surgery is a registered trademark of the ERAS Society, Stockholm, Sweden. Six Sigma is a registered trademark of Motorola, Inc, Chicago, IL. Kaiser Permanente is a registered trademark of Kaiser Foundation Health Plan, Inc, Oakland, CA. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume106, Issue3September 2017Pages 249-253 RelatedInformation

Consensus Statement for Clinical Pathway Development for Perioperative Pain Management and Care Transitions.

The perioperative surgical home (PSH) model has been created with the intention to reduce costs and to improve efficiency of care and patient experience in the perioperative period. The PSH is a comprehensive model of care that is team-based and patient-centric. The team in each facility should be multidisciplinary and include the input of perioperative services leadership, surgical services, and support personnel in order to provide seamless care for the patient from the preoperative period when decision to undergo surgery is initially made to discharge and, if needed after discharge from the hospital, until full recovery is achieved. PSH is discussed in this consensus article with the emphasis on perioperative care coordination of patients with chronic pain conditions. Preoperative optimization can be successfully undertaken through patient evaluation, screening, and education. Many important positive implications in the PSH model, in particular for those patients with increased potential morbidity, mortality, and high-risk populations, including those with a history of substance abuse or anxiety, reflect a more modern approach to health care. Newer strategies, such as preemptive and multimodal analgesic techniques, have been demonstrated to reduce opioid consumption and to improve pain relief. Continuous catheters, ketamine, methadone, buprenorphine, and other modalities can be best delivered with the expertise of an anesthesiologist and a support team, such as an acute pain care coordinator. A physician-led PSH is a model of care that is patient-centered with the integration of care from multiple disciplines and is ideally suited for leadership from the anesthesia team. Optimum pain control will have a significant positive impact on the measures of the PSH, including lowering of complication rates, lowering of readmissions, improved patient satisfaction, reduced morbidity and mortality, and shortening of hospital stays. All stakeholders should work together and consider the PSH model to ensure the best quality of health care for patients undergoing surgery in the future. The pain management physician’s role in the postoperative period should be focused on providing optimal analgesia associated with improved patient satisfaction and outcomes that result in reduced health care costs.

Anesthesiology Residency Curriculum and Implementation of a Perioperative Surgical Home Curriculum: A Survey Study

The perioperative surgical home (PSH) is a physician-led, interdisciplinary, and patient-centered model of perioperative care that focuses on patient outcomes and comprehensive care management. Many studies to date have looked at the clinical implementation of varied PSH models with promising results discussed. There are no studies directly examining concrete plans for the various Accreditation Council for Graduate Medical Education (ACGME) anesthesiology residency programs to implement augmented PSH training into curricula. The aim of this survey study was to better assess current residency training in PSH. An 18-question survey developed by a team of research personnel familiar with the PSH was sent to all ACGME accredited anesthesiology training programs in the United States. Responses were quantified, and construct and external validity of the survey tool examined. 41% of the programs responded. 89% (95% CI 78-96%) of programs reported moderate or better understanding of the PSH. 34% (21-47%) had incorporated additional PSH training in the previous three years, and 32% (with no significant correlation to the previous group) had plans to integrate more training in the next 3 years. Overall, the surveyed program directors voiced understanding of the value of the PSH model in patient care but remained hesitant to incorporate training specific to PSH into the anesthesiology residency curricula.