Last May Anesthesia & Analgesia featured a collection of papers on the Perioperative Surgical Home.1 These papers described implementation of the Perioperative Surgical Home at the University of Alabama,2 the University of California at Irvine,3,4 and an Enhanced Recovery after Surgery program at Duke University.5 The papers emphasize the triple aims of improving health, improving the delivery of health care, and reducing the cost of care.a Three cautionary editorials focused on the lack of data demonstrating improved outcomes or reduced costs.6–8
This issue of Anesthesia & Analgesia again includes a collection of papers on the Perioperative Surgical Home. Goeddel et al.9 from the University of Alabama explore how the Perioperative Surgical Home presents 4 ethical opportunities to: enhance patient-centered care, embrace shared decision-making, increase health literacy, and reduce futile surgery.9 Drawing on the work of Christenson et al.,10 Kain et al.11 from the University of California at Irvine point out that the Perioperative Surgical Home represents a disruptive innovation, and call on anesthesiologists to be “willing to change most everything they do except change their core values.” This is a powerful message: the status quo is over. Although the Veterans Health Administration (VA) may seem immutable, Mariano et al.12 observe that the VA Health Care System has a long history of health care innovation. The authors propose that the VA Health Care System is a platform for vetting the Perioperative Surgical Home in the largest health care system in the United States.
Ferrari et al.13 from Boston Children’s Hospital/Harvard Medical School extend the Perioperative Surgical Home to pediatric patients. Noting that children have long been cared for in a “Patient/Family-Centered Medical Home,”14 the authors suggest that the Pediatric Perioperative Surgical Home applies an established model of care to the pediatric surgical patent. The titles of 2 editorials accompanying the article from Boston Children’s conveys opposing views of their authors. Vetter15 suggests that “The Pediatric Perioperative Surgical Home: Children and Adolescents Should Not Have to Wait Again for Their Turn,” while Davis16 skeptically asks “The Pediatric Perioperative Surgical Home: The Emperor’s New Clothes?”
Kicking a hornet’s nest, Prielipp et al. (an impressive list of thought leaders) look at the future of our specialty, and conclude that, “the PSH alone is insufficient to secure our future.” In their view, “we need a national discourse about the viability of some of our current practice models, including the current models of perioperative care, pain medicine, and critical care.17 Warner and Apfelbaum,18 prior presidents of the American Society of Anesthesiologists and contributors to the American Society of Anesthesiologists vision for the Perioperative Surgical Home, do not agree. Prielipp et al.,19 along with Warner and Apfelbaum, summarize their disagreements in a thoughtful and mutually respectful dialogue. The accompanying editorial by Vetter and Pittet20 points out that any innovation, including the Perioperative Surgical Home, will only succeed by involving all stakeholders.
Discussing all aspects of the Perioperative Surgical Home is critical to our specialty. Change is coming. Either we accept responsibility for innovation, and reinvent perioperative care to improve outcomes while reducing costs, or we will be sidelined by innovations introduced by others. If you question this please read Christensen’s text on disruptive innovation.10 If that seems too difficult, then spend 15 minutes watching the slightly hyperbolic YouTube video “Humans Need Not Apply.”b The future belongs to innovators who create and introduce technology that will provide better service at reduced cost. Economics always wins.b
Our 2015 collection on the Perioperative Surgical Home has 6 Open Mind articles and 4 Editorials. Missing from this collection are data showing improved outcomes, cost reduction, or successful implementation of any of the “triple aims” of the Perioperative Surgical Home. Where are the data? Opinion, reflection, and dialogue are important. I’m pleased that Anesthesia & Analgesia has provided a forum for this dialogue. However, opinion is not a substitute for data. Open Mind submissions are not a substitute for Research Reports.
If you are currently implementing the Perioperative Surgical Home at your institution, then please consider submitting your results for the May 2016 issue of Anesthesia & Analgesia. This might be a Research Report, a Brief Report, or even a Management Case Report submitted to A&A Case Reports.21 It doesn’t matter whether your data show that the Perioperative Surgical Home works or fails. We may learn more from documenting our failures than our successes. Papers must be submitted no later than October 2015 to appear in the May 2016 issue of Anesthesia & Analgesia. This means that if your institution is currently implementing the Perioperative Surgical Home, then you need to start gathering your data today.
The experts have spoken. Next year we will “let the data speak.”c
Name: Steven L. Shafer, MD.
Contribution: This author wrote the manuscript.
Attestation: Steven L. Shafer approved the final manuscript.
Dr. Steven L. Shafer is the Editor-in-Chief for Anesthesia & Analgesia. This manuscript was handled by Dr. James G. Bovill, Guest Editor-in-Chief, and Dr. Shafer was not involved in any way with the editorial process or decision.
a Available at: https://www.asahq.org/psh. Accessed February 14, 2015.
b Available at: http://www.cgpgrey.com/blog/humans-need-not-apply. Accessed February 3, 2015.
c Attributed to Lewis Sheiner, MD, professor of Laboratory Medicine, UCSF (deceased).
1. Shafer SL, Donovan JF. Anesthesia & Analgesia’s collection on the perioperative surgical home. Anesth Analg. 2014;118:893–5
2. Vetter TR, Boudreaux AM, Jones KA, Hunter JM Jr, Pittet JF. The perioperative surgical home: how anesthesiology can collaboratively achieve and leverage the triple aim in health care. Anesth Analg. 2014;118:1131–6
3. Kain ZN, Vakharia S, Garson L, Engwall S, Schwarzkopf R, Gupta R, Cannesson M. The perioperative surgical home as a future perioperative practice model. Anesth Analg. 2014;118:1126–30
4. Garson L, Schwarzkopf R, Vakharia S, Alexander B, Stead S, Cannesson M, Kain Z. Implementation of a total joint replacement-focused perioperative surgical home: a management case report. Anesth Analg. 2014;118:1081–9
5. Miller TE, Thacker JK, White WD, Mantyh C, Migaly J, Jin J, Roche AM, Eisenstein EL, Edwards R, Anstrom KJ, Moon RE, Gan TJEnhanced Recovery Study Group. . Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014;118:1052–61
6. Dexter F, Wachtel RE. Strategies for net cost reductions with the expanded role and expertise of anesthesiologists in the perioperative surgical home. Anesth Analg. 2014;118:1062–71
7. Crosby G, Culley DJ, Dexter F. Cognitive outcome of surgery: is there no place like home? Anesth Analg. 2014;118:898–900
8. Butterworth JF 4th, Green JA. The anesthesiologist-directed perioperative surgical home: a great idea that will succeed only if it is embraced by hospital administrators and surgeons. Anesth Analg. 2014;118:896–7
9. Goeddel LA, Porterfield JR Jr, Hall JD, Vetter TR. Ethical opportunities with the perioperative surgical home: disruptive innovation, patient-centered care, shared decision making, health literacy, and futility of care. Anesth Analg. 2015;120:1158–62
10. Christensen CM, Grossman JH, Hwang J The Innovator’s Prescription: A Disruptive Solution for Health Care. 2008 New York MacGraw-Hill
11. Kain ZN, Hwang J, Warner MA. Disruptive innovation and the specialty of anesthesiology: the case for the perioperative surgical home. Anesth Analg. 2015;120:1155–7
12. Mariano ER, Walters TL, Kim TE, Kain ZN. Why the perioperative surgical home makes sense for Veterans Affairs health care. Anesth Analg. 2015;120:1163–6
13. Ferrari LR, Antonelli RC, Bader A. Beyond the preoperative clinic: considerations for pediatric care redesign aligning the patient/family-centered medical home and the perioperative surgical home. Anesth Analg. 2015;120:1167–70
14. Stille C, Turchi RM, Antonelli R, Cabana MD, Cheng TL, Laraque D, Perrin JAcademic Pediatric Association Task Force on Family-Centered Medical Home. . The family-centered medical home: specific considerations for child health research and policy. Acad Pediatr. 2010;10:211–7
15. Vetter TR. The pediatric perioperative surgical home: children and adolescents should not have to wait again for their turn. Anesth Analg. 2015;120:974–7
16. Davis PJ. The pediatric perioperative surgical home: the emperor’s new clothes? Anesth Analg. 2015;120:978–9
17. Prielipp RC, Morell RC, Coursin DB, Brull SJ, Barker SJ, Rice MJ, Vender JS, Cohen NH. The future of anesthesiology: should the perioperative surgical home redefine us? Anesth Analg. 2015;120:1142–8
18. Warner MA, Apfelbaum JL. The perioperative surgical home: a response to a presumed burning platform or a thoughtful expansion of anesthesiology? Anesth Analg. 2015;120:1149–51
19. Prielipp RC, Morell RC, Coursin DB, Brull SJ, Barker SJ, Rice MJ, Vender JS, Cohen NH, Warner MA, Apfelbaum JL. Dialogue on the future of anesthesiology. Anesth Analg. 2015;120:1152–4
20. Vetter TR, Pittet JF. The perioperative surgical home: a panacea or Pandora’s box for the specialty of anesthesiology? Anesth Analg. 2015;120:968–73
21. Shafer SL. Education and management case reports. Anesth Analg. 2014;118:915