Perioperative Care: Evolving Role for Hospitalists

by Rachel E. Thompson, MD, MPH, SFHM

With healthcare evolving from volume to value and from episodes of care to care for populations, many are looking at how to redesign our expensive surgical care models. Nearly a quarter of all hospitalizations in the United States are for a surgical procedure, and these are twice as costly as medical hospitalizations. This January, CMS rolled out the first official bundled payment program for joint replacement at 75 hospitals. Anesthesiologists are increasingly becoming involved earlier in the perioperative process and looking to be a primary player in building the Perioperative Surgical Home.

Currently, 87% of hospitalists actively engage in co-management of surgical patients. Hospitalists are integral to the perioperative process—assessing risk for medical complications, planning for perioperative care, developing programs aimed at risk reduction for preventable complications and early identification and intervention for unavoidable complications and guiding quality improvement efforts, including planning for frequent hand-offs and transitions.

In the spring of 2015, SHM commissioned a Perioperative Care Work Group to detail a framework of the comprehensive care provided by hospitalists in the perioperative period. The members of this group are experts in perioperative medicine from leading medical centers. The group defined a key underlying principle – focus everything we design, build, and measure on the patient – the patient is at the center of all we do.

The group defined the perioperative period as beginning with the time of decision to undergo surgery and extending through to the time of postoperative functional recovery. Hospitalists play a variety of roles in all phases, in collaboration with surgical and anesthesia colleagues. Specific roles for hospitalists largely depend on the local environment. Thus, implementing programs necessitates:

  • An in depth knowledge of existing local systems and roles;
  • A collaborative designs that build from areas of strength in the local setting; and
  • Meaningful measures to be developed and tracked, and used to guide continuous process improvements.

This year at Hospital Medicine 2016 (HM16) we have several opportunities for engaging in learning and discussing perioperative program development. On Sunday March 6, join us for the perioperative medicine pre-course, Spy into Perioperative Medicine, directed by Drs. Kurt Pfeifer and Barbara Slawski. On Wednesday morning March 9, HM16 presents the Co-Management and Perioperative Track featuring Updates in Perioperative Medicine, Controversies in Perioperative Medicine and Secrets of the Operating Room.

While at HM16, if you want to grab a coffee and talk or learn more email me at [email protected]

Design our systems to support patients throughout the stressful life experience of surgery.

 

Dr. Rachel Thompson, MPH, SFHM currently serves as an Associate Professor in the Department of Medicine at the University of Nebraska Medical Center, where she has been recruited to lead the new Section of Hospital Medicine. She earned her bachelor's degree from Amherst College summa cum laude. She completed medical school and residency at the University of Washington. In 2014, she completed her the University of Washington’s Executive MPH and in 2015 she completed the University of Washington Certificate Program in Patient Safety and Quality.

Prior to being recruited to the University of Nebraska Medical Center, Dr. Thompson founded the Medicine Consult Service in 2003 at Harborview Medical in Seattle, King County’s safety-net hospital and the region’s Level I trauma center. She developed the Medicine Operative Consult Service that provides comprehensive perioperative care for high-risk patients. She has significant experience with program development, education and in quality and safety.

You can follow Dr. Thompson on twitter @RThomsponMD.

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