Healthcare around the world is changing. In the United States, healthcare reform has been focused on achieving the “triple aim". This triple aim encompasses 3 goals: improving the patient experience, reducing costs of care, and improving population health. The Perioperative Surgical Home (PSH) is a conceptual model introduced by the American Society of Anesthesiologists that may serve as an integrator to help hospitals achieve the triple aim. PSH is defined as “a patient-centered, physician anesthesiologist-led, multidisciplinary team-based practice model that coordinates surgical patient care throughout the continuum from the decision to pursue surgery through convalescence.” Pain medicine is woven throughout the three main elements of the PSH: preoperative preparation, intraoperative care, and postoperative recovery and rehabilitation.
See the 2,456 pharmacies on the National E-Pharmacy Platform
Pain Medicine's Role in Enhancing Surgical Care
1. @EMARIANOMD
Pain Medicine and the
Pathway to Better
Surgical Care
Edward R. Mariano, M.D., M.A.S.
Professor of Anesthesiology, Perioperative & Pain Medicine
Stanford University School of Medicine
Chief, Anesthesiology and Perioperative Care
Veterans Affairs Palo Alto Health Care System
2. @EMARIANOMD
Financial Disclosures
None currently.
Past (>1 year): Halyard Health, B Braun –
unrestricted educational program funding
paid to my institution
The contents of the following presentation
are solely the responsibility of the speaker
without input from any of the above
companies.
15. @EMARIANOMD
Perioperative Surgical Home (PSH)
“a patient-centered, physician
anesthesiologist-led, multidisciplinary team-
based practice model that coordinates
surgical patient care throughout the
continuum from the decision to pursue
surgery through convalescence.
Mariano, et al. A&A 2015;120:1163
Kain, et al. A&A 2014;118:1126
23. @EMARIANOMD
Patient Experience
Patients are surveyed using the Hospital
Consumer Assessment of Healthcare
Providers and Systems (HCAHPS)1
32 questions
Publicly reported 4 times a year2
HCAHPS is administered to a random
sample of adult inpatients between 48
hours and six weeks after discharge
1. http://www.hcahpsonline.org
2. http://www.hospitalcompare.hhs.gov
25. @EMARIANOMD
“Unlike current questions, which ask about
the efficacy of pain treatment, the new set
will focus on the communication between
doctor and patient about pain.”
http://www.nytimes.com/2016/08/05/health/pain-treatment-
hospitals-emergency-rooms-surveys.html?_r=0
33. @EMARIANOMD
Primary Care
Conservative mgmt
failed
Surgery considered as
treatment option
Preop Consult
Initiated by primary care
E-consult or phone consult
to anesthesiology
Alternative treatments
considered
Establish common preop
“ready” criteria:
http://www.becertain.org/st
rong_for_surgery/hospitals
Referral to
Surgeon
Patient evaluated
Images/tests reviewed
Decision Made to
Proceed with
Surgery
Preop Visit
Review protocols and
instructions
Focus on education and
preview of OR experience
Day of Surgery
Surgery proceeds as
scheduled; or
surgery is cancelled
Rethink Preop Preparation