Managing a perioperative medicine program

Clinician perspectives on the perioperative roles and responsibilities of anesthesia, surgery, and primary care

BACKGROUND

Although high-risk older patients benefit from a multidisciplinary approach to perioperative care, the specific roles and responsibilities of the clinicians involved have yet to be adequately characterized.

METHODS

Qualitative analysis of semi-structured interviews with four anesthesia preoperative clinic providers, seven surgeons, and nine primary care providers in northern New England.

RESULTS

The analysis revealed both distinct and overlapping roles and responsibilities. Anesthesia providers were described as a "safety net" and surgeons as "captain of the ship", in charge of getting "all the ducks in a row" to avoid surgery delays and cancellations. Primary care providers saw themselves as the "quarterback", ensuring care continuity and consideration of patient psychosocial factors.

CONCLUSIONS

While all have a shared responsibility for facilitating patient-centered decision-making and a safe perioperative course, each discipline has different areas of focus and expertise. Role clarification can help optimize the distribution of responsibilities and enhance perioperative communication and collaboration.

Updates From the Other Side of the Drape: Recent Advances in Multimodal Pain Management and Opioid Reduction Among Pediatric Surgical Patients

As the management of acute pain for children undergoing surgical procedures as well as recognition of the short and long term risks of exposure to opioids has evolved, multimodal and multidisciplinary approaches using organized pathways has resulted in improved perioperative outcomes and patient satisfaction. In this 2023 symposium held at the American Academy of Pediatrics on Surgery meeting, a multidisciplinary discussion on current enhanced recovery after surgery pathways, alternate methods of effective pain control and education and advocacy efforts for opioid reduction were discussed, and highlights are included in this article.

Broadening the scope and rising to the occasion, an opportunity for anaesthesiologists to take the lead in healthcare quality & patient safety (again)

PURPOSE OF REVIEW

The landscape of healthcare is characterized by high demands and scarce human and financial resources. This calls for action in improving healthcare quality. This review shows how anaesthesiologists are the designated medical specialist to share their affinity and knowledge in quality and safety, throughout the hospital and across the care continuum.

RECENT FINDINGS

Recent studies show excellent frameworks and examples of anaesthesiologist leading the way in patient safety and quality of care.

SUMMARY

Anaesthesiologist are early adapters of patient safety. In the last decades anaesthesia has become linked with patient safety and the quality of care. With the recent transition from peroperative to perioperative care; new opportunities are emerging, expanding our professional scope. Unfortunately, the anaesthesiologist is not often positioned in a leading role in quality of care and patient safety. After a brief rise during the COVID-19 pandemic, in which anaesthesiologists were visible in the frontline in many countries, we have unfortunately disappeared from the spotlight. This review shows numerous ideas, examples, and a framework how a leading position can be realized.

Social Determinants of Health and Preoperative Care

Preoperative care exists as part of perioperative continuum during which anesthesiologists and surgeons optimize patients for surgery. These multispecialty efforts are important, particularly for patients with complex medical histories and those requiring major surgery. Preoperative care improves planning and determines the clinical pathway and discharge disposition. The role of nonmedical social factors in the preoperative planning is not well described in anesthesiology. Research to improve outcomes based on social factors is not well described for anesthesiologists but could be instrumental in decreasing disparities and advancing health equity in surgical patients.

Recognizing and Maximizing the Nexus of Perioperative Medicine and Narrative Medicine

Perioperative medicine remains an evolving, interdisciplinary subspecialty, which encompasses the unique perspectives and incorporates the respective vital expertise of numerous stakeholders. This integrated model of perioperative medicine and care has a wide-ranging set of clinical, strategic, and operational goals. Among these various programmatic goals, a subset of 4, specific, interdependent goals include (1) enhancing patient-centered care, (2) embracing shared decision-making, (3) optimizing health literacy, and (4) avoiding futile surgery. Achieving and sustaining this subset of 4 goals requires continued innovative approaches to perioperative care. The burgeoning field of narrative medicine represents 1 such innovative approach to perioperative care. Narrative medicine is considered the most prominent recent development in the medical humanities. Its central tenet is that attention to narrative-in the form of the patient's story, the clinician's story, or a story constructed together by the patient and clinician-is essential for optimal patient care. If we can view the health care experience through the patient's eyes, we will become more responsive to patients' needs and, thereby, better clinicians. There is a potential clinical nexus between the perioperative medicine practice and narrative medicine skills, which, if capitalized, can maximize perioperative patient care. There are a number of untapped educational and research opportunities in this fruitful nexus between perioperative medicine and narrative medicine.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

The influence of pharmacotherapy regimens on surgical patient outcomes is increasingly appreciated in the era of enhanced recovery protocols and institutional focus on reducing postoperative complications. Specifics related to medication selection, dosing, frequency of administration, and duration of therapy are evolving to optimize pharmacotherapeutic regimens for many enhanced recovery protocolized elements. This review provides a summary of recent pharmacotherapeutic strategies, including those configured within electronic health record (EHR) applications and functionalities, that are associated with the minimization of the frequency and severity of postoperative complications (POCs), shortened hospital length of stay (LOS), reduced readmission rates, and cost or revenue impacts. Further, it will highlight preventive pharmacotherapy regimens that are correlated with improved patient preparation, especially those related to surgical site infection (SSI), venous thromboembolism (VTE), nausea and vomiting (PONV), postoperative ileus (POI), and emergence delirium (PoD) as well as less commonly encountered POCs such as acute kidney injury (AKI) and atrial fibrillation (AF). The importance of interprofessional collaboration in all periprocedural phases, focusing on medication management through shared responsibilities for drug therapy outcomes, will be emphasized. Finally, examples of collaborative care through shared mental models of drug stewardship and non-medical practice agreements to improve operative throughput, reduce operative stress, and increase patient satisfaction are illustrated.