Newswise — April 14, 2015 – The perioperative surgical home (PSH) is an emerging approach to improve care for patients undergoing surgery, and anesthesiologists are preparing to play a key role in leading it. But how will the PSH approach affect patients, the health care system, and the specialty of anesthesiology? These urgent questions are addressed by a coalition of senior anesthesiologists in a special article published by Anesthesia & Analgesia.
Dr. Richard C. Prielipp of University of Minnesota School of Medicine, Minneapolis, and colleagues discuss anesthesiology's evolving role in the PSH era, and present an alternative view of their specialty's future—including a proposal for transforming anesthesiology training. " We believe we afford our specialty the best opportunity to thrive by intrepid resolve to change the way we educate a new generation of anesthesiologists who provide highly specialized care for individual patients, supervise the anesthetic management for all patients, generate new knowledge, and effectively coordinate care to add value to the perioperative process," they write.
The Perioperative Surgical Home—the Future of Anesthesiology?Developed as part of larger efforts to improve coordination and management of patient care, the PSH covers the full continuum of care for surgical patients—from the preoperative period, to the surgery itself, through postoperative care and after discharge from the hospital. Anesthesiologists are expected to play a key role as "integrators" of the PSH approach, and major pilot projects are underway to demonstrate its feasibility and effectiveness.
But PSH places anesthesiology at a crossroads, Dr. Prielipp and coauthors believe. While anesthesiologists have become more active in providing patient care over the years, there are questions regarding their roles and responsibilities in the PSH era. This and other trends, including the growing role of nurse anesthetists and other alternative anesthesia providers, even raises questions about anesthesiology's long-term financial viability.
While Dr. Prielipp and coauthors perceive many challenges of the PSH approach, they do not view these as "irreconcilable barriers" to its adoption. Rather, they write, "Our view is that while the PSH incorporates some important aspects of a future model of anesthesia care, it or its current iterations may not be sufficiently robust and responsive to market demands."
They outline an "alternative vision" of anesthesiology in the PSH era, highlighting the changes needed to adapt to a rapidly changing future. "The time is now for the specialty...to take a much broader perspective that incorporates, but does not let the PSH alone dominate our dialogue," Dr. Prielipp and colleagues write. In their vision, anesthesiologists will remain actively involved in managing a wide range of high-risk patients, while supervising routine care provided by nurse anesthetists and others.
The authors also propose a new approach to anesthesiology, including "broader and deeper focused" training in one of five fields: adult, pediatric, critical care, or academic anesthesiology or pain medicine. They believe this transition to anesthesiology "super-specialists" will entail "fewer but more skilled and more experienced anesthesiology graduates generated from the pool of highly resourced training programs."
Dr. Prielipp and coauthors acknowledge that such a transformation would be much more complex than adopting the PSH model. However, they write, "If implemented, our proposed paradigm for anesthesiology training represents a seismic shift in traditional education and practice."
While it is an "innovative and important" development in anesthesiology, Dr. Prielipp and colleagues believe, "the PSH alone is insufficient to secure our future." They hope their article will help to drive a "national discourse" about ways to secure the future of anesthesiology, amid the current focus on implementing the PSH model. They conclude, " We need to consider the implications of the PSH and its alternatives for anesthesiologists, health systems and, most importantly, for our patients."
Article "The Future of Anesthesiology: Should the Perioperative Surgical Home Redefine Us?" (doi: 10.1213/ANE.0000000000000711)
About Anesthesia & AnalgesiaAnesthesia & Analgesia was founded in 1922 and was issued bi-monthly until 1980, when it became a monthly publication. A&A is the leading journal for anesthesia clinicians and researchers and includes more than 500 articles annually in all areas related to anesthesia and analgesia, such as cardiovascular anesthesiology, patient safety, anesthetic pharmacology, and pain management. The journal is published on behalf of the IARS by Lippincott Williams & Wilkins (LWW), a division of Wolters Kluwer Health.
About the IARSThe International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through basic research. The IARS contributes nearly $1 million annually to fund anesthesia research; provides a forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of more than 15,000 physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia related practice; sponsors the SmartTots initiative in partnership with the FDA; supports the resident education initiative OpenAnesthesia; and publishes two journals, Anesthesia & Analgesia and A&A Case Reports.
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