Perioperative Surgical Home, the “Google Home” of Healthcare

Perioperative Surgical Home, the “Google Home” of Healthcare

If the digital world has Google Home, then the healthcare system has Perioperative Surgical Home, or PSH. Both are like control centers - Google Home is connected to numerous smart devices, while PSH acts as a coordinated workflow for all care providers.


Additionally, Google Home has its smart Google Assistant, Amazon has Alexa, and PSH has its own lead coordinator – the anesthesiologist.



With Google Home, music, lights, switches, doors, temperature, or anything in Google’s own Nest line-up of products and other devices, can be controlled through the home app. That’s essentially "home care" for the consumer.


Translate that to patient care and it becomes the PSH, engaging all specialists in the team care of a patient across one continuum of care.


When home devices such as heating, lighting and security systems can be controlled remotely by an app, it’s that connectivity that makes for a “smart home.”


To improve the patient experience before, during and after surgery, however, the quadruple aim of PSH - to gratify providers, improve population health, reduce care costs and satisfy patients - makes it even smarter than a home hub. 


Source: American Society of Anesthesiologists


Here are 4 reasons why PSH precedes its reputation as the “smart home” of healthcare:

Improve outcomes and the quality and safety of care.

Findings of a 2014 study proved that physician anesthesiologist-led anesthesia care teams, in the PSH model, are associated with better patient outcomes, fewer complications, less pain.


A comprehensive analysis of 152 peer-reviewed studies by researchers from Texas A&M University, and the American Society of Anesthesiologists was conducted on PSH models in the US and other countries. The findings in both intraoperative and post-operative studies concluded PSH improved patient safety, quality of care and cost-effectiveness.


ASA also noted significant positive impacts of PSH in  29 of those studies or being 82% of intraoperative studies analyzed, and 71 studies or representing  90% of postoperative studies.

Enhance the patient’s experience and reduce costs by eliminating cancellations and delays in surgery

ASA also found evidence of how PSH reduced costs in 17 of those intraoperative studies and 23 postoperative studies. “In fact, one study found eliminating unneeded tests reduced costs by as much as $112 per patient, for a total of $1.01 million over the course of the study,” according to ASA.


There was a reduction in O.R. delays, surgical cancellations and improved efficiencies found by ASA in the same study because of “real-time patient-routing systems (real-time electronic dashboards that ensure access to medical records) as one of the intraoperative components of the PSH model.”


One case study stood out in particular. After one year into their implementation of PSH, Tampa General Hospital noted a savings of $574,000 with no negative impact on surgical outcomes or efficiency because the new protocol significantly decreased the number of tests ordered for patients prior to surgery.


Preoperative tests are crucial to any surgery, with results determining the green or red light to the OR. Many delays or day-of-surgery cancellations have been blamed for the lack of preoperative tests, while most of the mounting costs of care point to having more of them.


In the multidisciplinary team-based approach of the PSH, the preop testing is reduced to just the essentials. Anesthesiologists leading the team are primarily tasked to determine and coordinate these tests as they are required in anesthesia or surgical care.


At the East Carolina Anesthesia Associates, Dr. Greg Davis managed this with a patient engagement platform that helps identify pre and post surgery issues earlier to avoid cancellations, extra-testing and added costs. Using LifeWIRE, he noted 60% fewer pre-surgery tests were required, saving $200/gov’t pay per patient and $1,000/commercial pay per patient.

Lowering complication rates and readmissions

The same study suggested that the preoperative patient education component of the PSH model was a factor for reduced readmission rates. Its Enhanced Recovery After Surgery (ERAS) programs also significantly helped reduce complications.


PSH has many elements of ERAS that help coordinate all aspects of perioperative care, according to a study on the effectiveness of perioperative surgical home at the University of California (UC) Irvine Health and other institutions.


The findings showed that using ERAS as a perioperative clinical protocol resulted in improved patient satisfaction and postoperative outcomes, and reduced risk of hospital-acquired infections.


According to Zeev N. Kain, MD, MBA, of the University of California Irvine and President of the American College of Perioperative Medicine, having a single team headed by anesthesiologists in a PSH setting ensures that best practices are applied in a consistent and standardized way to every patient undergoing surgery.


Kain noted that the continuity of care, and treating the entire perioperative episode of care as one continuum rather than discrete preoperative, intraoperative, postoperative, and post-discharge episodes, reduced the variability that increases likelihood for error and complications.


“Conceptually, the perioperative environment could be likened to a car production line, and the standardization of all perioperative procedures could result in an error-free, high-quality process,” Kain wrote.

Reducing length of stays

At the Anesthesiology 2018 annual meeting held last month, a study was presented that showed how PSH implementation improved operational efficiencies, decreased use of resources, and reduced hospital length of stay.


Two of the goals of researchers at the Beaumont Hospital, Royal Oak, MI was to decrease Emergency Department to operating room (OR) time and hospital length of stay. Using the PSH model, the time patients spent waiting to go from the ED to the OR dropped from 48 hours to 34 hours after the service line was implemented, with an associated decrease in hospital length of stay from 8.12 to 6.12 days.


Lead researcher Patrick Stafford, M.D., an anesthesiology resident at the hospital, attributed this to the role of the anesthesiologist in the perioperative surgical home.


ASA noted that reducing patients’ length of stay has cost benefits as well. Researchers found a reduction in hospital and ICU length of stay, as well as reduced variation in care among children after implementing PSH.


Researchers at the Children’s Hospital of Milwaukee, WI made comparative studies between 135 children with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass (CPB) where PSH is in use, and 150 children who had undergone similar surgery over a two-year period before PSH was introduced. By implementing PSH, researchers developed goals and measures known to help patients get out of the hospital sooner.


According to ASA, the result saw overall hospital length of stay decreased from 174 to 127 hours and ICU length of stay reduced from 75 to 73 hours.


In other cases patient education plays a crucial role after the patient’s surgery, that is part of the perioperative process of the patient-centered PSH model. This helps a lot in managing expectations and the over-expectations that patients may have related to their postoperative pain.


According to a study presented during ASA’s annual meeting in 2017, “patients significantly overestimate the anticipated amount of pain they’ll experience following surgery, which researchers say can cause unnecessary anxiety in patients.”


“We believe providers need to do a better job of counseling patients on realistic pain expectations,” ASA quoted study co-author Jaime L. Baratta, M.D., director of regional anesthesia at Thomas Jefferson University Hospital in Philadelphia .


The moment a decision to have the surgery is made is when patient education begins, and is when the opportunity arises to engage these patients earlier.


An interactive communications platform for surgical population management has proven results in this regard for ECAA. Using text messaging, emails, or any other form of digital communication, patient and providers are kept in constant contact from surgery booking to post-operative care.


As Lee A. Fleisher, MD, FACC, FAHA Department of Anesthesiology and Critical Care Perelman School of Medicine Health System University of Pennsylvania shares, “the future of anesthesiology lies in our specialty’s engagement in improving all aspects of perioperative care for the patient.”


Given their scope of work to care for the surgical patient in a medical smart home, it is in the anesthesiologists’ reflexes to embrace digital solutions.


The Perioperative Surgical Home's ability to be a “smart home” goes beyond the consistent delivery of safe, good quality care to surgical patients. Innovative as it is, clinicians – especially the anesthesiologists at its helm - need to also integrate innovative solutions, including health technologies to better lead the way for a patient-centred and coordinated care.




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