Protecting Physician Anesthesiologists From Disruption: The Perioperative Surgical Home: the RIGHT, the SMART, and the SAFE thing to do

  • Lucas, Shawn, MD
| Feb 24, 2014

Disruptive innovation is coming to operating-room-focused anesthesiology practices. That disruption will be in the form of people and technologies that will make managing an anesthetic cheaper and easier than today. When that happens, market forces will provide pressure to change who may perform anesthetics and how much they will get paid.

These disruptions already on the horizon include IBM’s Watson, the Sedasys®-automated sedation machine, nurse anesthetists, and anesthesiologist assistants . In fact, anesthesiologists may soon be removed from the preoperative evaluation process by ePREOP®, a potential disruptor to the Perioperative Surgical Home, or a similar technology.

All of these innovations are already present and beginning to affect the practice of medicine. They were pointed out at the recent ASA Practice Management Conference by Zeev Kain MD, Chair and Associate Dean at UC Irvine; Michael Hicks MD, CEO of EmCare Anesthesia Services; and others.

Although I will not go into Clayton Christensen’s theory of disruptive innovation in healthcare (a frequent topic at the conference and covered on this blog quite well by Drs.Chamberlin and Sibert), what his theory predicts is that those technologies are just some of the ones that will “disrupt,” or take over, many of the responsibilities of the current anesthetic management technology – the physician anesthesiologist.

How can we protect ourselves from this disruption and from becoming obsolete in the care of patients? There is one possibility, a solution that is not a disruptive innovation itself, but may be able to protect our specialty from some of the effects of disruption—the Perioperative Surgical Home.

It is no surprise then that the fervent emphasis at this year’s ASA Practice Management Conference was on the Perioperative Surgical Home, or PSH. Many of the speakers presented their opinions and amazing successes with a PSH from a strongly academic viewpoint. Eventually, I found myself thinking, “Well… that’s great for them, they have the people and the time to do it. Just try to make a Perioperative Surgical Home work in private practice.”

However, as I thought about it, the more I realized how important the PSH is for my practice, too. For private practice physician anesthesiologists, the Perioperative Surgical Home is not just the right thing to do, it is also the smart thing to do, and it is the safe thing to do.

What do I mean by that?

The PSH is the right thing to do because, as both surgeons and physician anesthesiologists pointed out at the conference, the management a patient receives before, during, and after surgery has implications to the patient’s health and outcome. When we standardize care of patients according to leading practices– not just in the operating room, but leading up to the operating room, after they leave the recovery room, and as their care transitions between specialists – patients’ outcomes improve. That is the right thing to do.

Standardizing care also improves the efficiency of the hospital. Increasing efficiency reduces wasted supplies and time, getting patients through their operative procedure (and home) more quickly. Anything physician anesthesiologists can do to save hospitals and patients time and money is the smart thing to do.

But how is it safer? Certainly, for a variety of reasons, it is safer for the patients to have their procedures performed within a Perioperative Surgical Home, rather than within less organized alternatives. That is not what I am talking about. Implementing a PSH is the safe thing to do for physician anesthesiologists because, not immediately, but in the foreseeable future, our role in the operating room will diminish. Implementing the PSH is the safe thing to do, because it improves the security of our specialty for ourselves and our younger colleagues.

With disruption of our specialty coming, the PSH is how we as physician anesthesiologists demonstrate our value in the care of patients. As new technologies and modes of practice develop, our intraoperative management skills will become less important and our process and people management skills, centered within our medical training and knowledge of perioperative care, will be the way we add value to the care of patients. As the PSH models of practice develop, we as community anesthesiologists must adapt and implement those elements of the PSH that will enhance our local practices.

The Perioperative Surgical Home is the future of managing patients’ care throughout their surgical experience, whether that experience is in an academic center or a community hospital. It is the right thing to do because it improves patient outcomes. It is the smart thing to do because it saves time and money. It is the safe thing for community anesthesiologists to do, because it expands the walls of our current “home,” the operating room, to include the patient’s entire surgical experience. The security of having more than a single reason for physician anesthesiologists to be involved in patient care should be obvious.

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