The Inaugural Perioperative Surgical Home (PSH) Summit—A Transformative Vision

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  • Alem, Navid, MD
| Aug 04, 2014

The energy inside the main ballroom at the Balboa Bay Resort on June 7 was unparalleled. The authority of the occasion was undeniable, as international experts in perioperative medicine came together for what promised to be a moment of transformation for medicine. What was this moment? What was this tectonic movement that resulted in the anesthesia and medicine community as a whole buzzing afterwards?

Unlike most conferences, where participants have a clear idea of what to expect months in advance, many arrived uncertain of what they were about to hear. The early chatter in the hotel corridors made it apparent that most participants started the weekend with only an abstract understanding of what the “PSH Care Model” even means. Over the next two days, through a diverse array of modalities, this would be addressed. Ultimately, summit attendees would be leaving with specific and practical approaches that they could take back to their own institutions to improve the quality and safety of patient care while reducing cost.

This inaugural summit, hosted by the University of California, Irvine (UCI), Department of Anesthesiology & Perioperative Care on June 7–8, 2014, provided 345 participants from 10 nations the conceptual framework and evidence-based data for this new model of patient care that promises to improve the quality and safety of surgery. Data presented at the summit succinctly demonstrated that the PSH model increases patient satisfaction while reducing costs, complications, recovery times, and length of stay in the hospital.

Zeev Kain, MD, MBA, co-director of the event, said it best in his opening comments, quoting the greatest hockey player of all time, Wayne Gretzky: “A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.” He went on to illustrate the so-called “burning platform”—the idea that unless people are faced with a compelling reason to change, they will hold on to the status quo with tenacity, regardless of whether the status quo is perceived as positive or negative. He made clear that the current state of health care delivery is undeniably a “burning platform” that presents a compelling reason to question the status quo, and to be prepared to embrace transformational change.

The PSH Care Model is innovation at its finest. By definition, it is a patient-centered, physician-led, multidisciplinary and team-based system of coordinated care. Via personalized and evidence-based care plans, it guides the patient through the entire surgical continuum from decision on the need for surgery to discharge from a medical facility and beyond. The care pathway is mapped out by the medical professionals from surgeons to anesthesiologists to nurses to medical device specialists to rehabilitation therapists, providing complete continuity of care as well as standardization of practices to enhance patient safety. The cornerstone of the PSH model is collaboration among all care providers in each phase of the surgical episode, with comprehensive “transitions of care.” Other principles include heavy emphasis on diversified patient education tools, the use of evidence-based practices, and thorough preparation for optimal clinical outcomes.

There were many summit highlights, starting with the keynote speaker, Henrik Kehlet, MD, PhD, of Rigshospitalet, Copenhagen, Denmark, who stated, “Enhanced recovery pathways optimize health outcomes and resource utilization.” Dr. Kehlet is a true innovator, having pioneered “fast-track” surgery in 1999; he has produced more than 200 publications on the subject. Michael (Monty) Mythen, MD, MBBS, FRCA, elucidated the European analogue to the PSH model by discussing the widespread successes of “Enhanced Recovery After Surgery” (ERAS). He provided a vivid description of how ERAS was one answer to the imperative need for health care reform in Great Britain.

Michael Schweitzer, MD, MBA, and Peter Dunbar, MB, ChB, MBA, reinforced the gravity of the summit in explaining how the “PSH Model” is a strategic initiative of the American Society of Anesthesiologists (ASA). This was followed by a riveting talk provided by Daniel Cole, MD, First Vice President of the ASA. He emphasized that the ASA recognizes that innovation must occur within the patient’s episode of surgical/procedural care, and a new model of perioperative care must be developed in our patients’ best interests. Mervyn Maze, MD, MB. ChB, provided key insights on bundled payments and the PSH.

The summit also provided several practical insights on improving patient outcomes in the perioperative setting. Dr. Mythen led a discussion on resuscitation fluids in the surgical forum. A prominent leader on perioperative fluid management, Maxime Cannesson, MD, PhD, co-director of the summit, followed this with a talk on the importance of incorporating technology into the PSH, including the most up-to-date evidence on goal-directed therapy. Offering a glimpse of the numerous ramifications of the PSH, Aryeh Shander, MD, MFCCM, FCCP, described patient optimization and improved outcomes with evidence-based blood management techniques. Girish Joshi, MD, MB, BS, outlined the use of multimodal pain management and its assimilation into the PSH.

Informative talks included a “nuts and bolts” session with UCI anesthesiologists Scott Engwall, MD, MBA, Leslie Garson, MD, and Shermeen Vakharia, MD, MBA. The trio presented a detailed discussion of just how to set up a PSH in an academic practice. Mark Schneider, MD, MBA, of Anesthesia Service, P.A., in Wilmington, Del., provided information on bringing such a model together in the private practice realm. He asserted that, despite the notion that a private practice may not have the same resources as an academic center, creating a sustainable PSH care model is feasible. At roundtable discussions, attendees were able to individually question the various leading experts.

A constant presence during the weekend was Stan Stead, MD, MBA, the ASA’s Vice President for Professional Affairs, who discussed the economics of the PSH as well as his perspective on the current and future state of health care economics as a whole. In the latter parts of the summit, Dr. Zeev Kain and another pioneer at the forefront of the PSH concept, Keith (Tony) Jones, MD, introduced change management concepts as a critical element to success. They wrapped up the conference by recapping their respective experiences with the PSH at UCI and the University of Alabama.

Ran Schwarzkopf, MD, MSC, an orthopedic surgeon at UCI, illustrated the current situation with a picture of a dinosaur. “Look what happened to them. … We cannot become extinct by being stagnant. The time for change is here.”

Although reactions to the PSH model range from skepticism to optimism, it clearly provokes interest: The summit quickly reached the maximum occupancy of the Balboa Bay Club. In fact, the summit registration website, prior to June 7, boldly proclaimed, “Conference Is Sold Out! No On-site Registration Available!” UCI and the ASA are looking for a larger venue for next year, one that will host upwards of 1,000 attendees, for what now will surely be the Annual Perioperative Surgical Home Summit.

Daniel Cole, MD, and Zeev Kain, MD, MBA, also contributed to this article.

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