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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe opening session of the 2014 annual meeting of the American Society of Anesthesiologists addressed game-changing \u201cdisruptive innovations\u201d that challenge the health care status quo. This article discusses the concept of a perioperative surgical home, a patient-centered, team-based approach for providing coordinated and accessible health care focused on quality and reduced costs.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERisks \u0026amp; Complications\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERisks \u0026amp; Complications\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAnesthesiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe face of medicine is changing rapidly in the United States and abroad. The opening session of the 2014 annual meeting of the American Society of Anesthesiologists (ASA) addressed game\u2013changing \u201cdisruptive innovations\u201d that challenge the health care status quo. Although change provides risk and is rarely a comfortable process, the transformations currently occurring in medicine also present opportunities for anesthesiologists to assume leadership in the new paradigms that are unfolding, because of the unique role their discipline occupies in perioperative patient care. A central concept of these new paradigms is called the perioperative surgical home (PSH). The concept of a \u201cmedical home\u201d has been proposed as a patient\u2013centered, team\u2013based approach for providing coordinated and accessible health care focused on quality and reduced costs. Applying this concept to a surgical setting has led to the creation of the PSH model, an idea that has gained considerable traction within the ASA. This model places anesthesiologists at the head of a health care process that seeks a better patient experience, improved outcomes, and reduced costs of care.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESpeakers at the opening session provided real\u2013world examples of recent PSH successes supporting their assertions that the changing health care paradigm offers extraordinary opportunities for physician anesthesiologists to become the perioperative leaders of the future. Jason Hwang, MD, MBA, PolkaDoc, Sunnyvale, California, USA, led off the session by warning the audience that changes for payment models are on the horizon that shift more risk onto anesthesiologists and create threats to physician autonomy, as health care systems and payers attempt to manage decision making. Dr Hwang drew analogies to the current situation in health care with examples from the history of information technology (IT), in particular the transition that occurred when mini\u2013computers, as represented by Digital Equipment Corporation, were supplanted by the personal computer (PC). Dr Hwang said that Certified Registered Nurse Anesthetists and automated conscious sedation devices are symptoms, not the cause, of disruptive innovation. The cause is complacency with the status quo.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDiscussing solutions to the challenges facing anesthesiologists, in further analogy to the computer market, Dr Hwang contrasted the modular approach seen in the assembly of PCs with the Apple\u0027s integrated system. Dr Hwang said that the PSH represents an example of an integrated approach, as opposed to the traditional patient care silos. As with transformative change in other industries, the core is providing what customers want, which in health care means continuing to improve quality of care and outcomes, but also increasing value. Delivering on the promise of the PSH means coordinating care teams that collaborate with other types of providers. Sounding a cautionary note, Dr Hwang said that in some instances, the optimal set of components that provide the best possible solution may not include an anesthesiologist.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EMark Warner, MD, Mayo Clinic College of Medicine, Rochester, Minnesota, USA, expanded on the PSH concept, detailing it as a physician\u2013led, team\u2013based care model. The anesthesiologist\u0027s role is to help lead the team in providing better patient care. The ASA has helped to expand the role of the anesthesiologist for decades, making the PSH concept a natural extension of those efforts. In terms of disruptive innovations, Dr Warner said that truly great organizations are willing to change just about anything in order to improve\u2014except their core values. There are 2 core values held by anesthesiologists. The first is an unrelenting commitment to 2 types of patients, that is, those who are critically ill and those who are faced with acute and chronic pain, including those undergoing procedures. The second core value is a compelling commitment to always improve the safety and the care of patients. Everything else, including where care is provided, how it is provided, and how anesthesiologists are recognized for that care, is likely to change. Driving this change, said Dr Warner, is the growing belief in the United States that physician skills are not required in anesthesia care of most patients, evidenced by 17 states having opted out of physician oversight of anesthesia care. Anesthesiologists must be prepared to adapt to the changing environment.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EZeev Kain, MD, MBA, Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA, delivered the perspective of an academic department with \u201cperioperative\u201d in its name. Presenting real\u2013world examples of PSH successes, Dr Kain offered suggestions on why anesthesiologists need to incorporate the elements of the PSH into their own practices. Dr Kain agreed with the previous speakers that anesthesiology needs to move from a modular perioperative approach to a methodology that is more integrated, and he identified PSH as an integrated delivery care model. The major underlying tenet of PSH is better coordination of care across the entire perioperative period, said Dr Kain, from the initial meeting of a patient with a surgeon until 30 days after discharge. Reducing variability and standardizing care is key, as variability leads to errors and increased costs. The work environment is inclusive and collaborative, especially in regard to the partnership of anesthesiologists with their surgeon partners, but also with every other group that interacts with the patient, including nurses, hospital aides, IT, and hospital administration.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EDescribing the PSH as patient centric, Dr Kain said that the biggest conceptual change for anesthesiologists in PSH is the delivery of care during the postoperative period. Postoperative complications (pneumonia, urinary tract infection, delirium, etc.) represent a huge contribution to health care costs, with each of these complications adding on average costs, with each of these complications adding on average10000 to the hospital bill. Another impact from better postoperative care is reduced readmission rates, now as high as 8% to 10%. Dr Kain drew parallels to Darwin\u0027s comments that survival of the fittest meant survival of those best adapted to their environment. The environment for anesthesiology is undergoing dynamic change, such that the future of the discipline hangs in the balance. Dr Kain concluded his talk with a warning to the audience that if as anesthesiologists they did not become more involved in the preoperative and especially postoperative stages of treatment in their own practices, they might \u201cgo the way of the dinosaurs.\u201d\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/40\/10\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the Anesthesiology 2014 American Society of Anesthesiologists presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-597186844\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the Anesthesiology 2014 American Society of Anesthesiologists presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/40\/10\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/40\/10\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/40\/10\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15103\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the Anesthesiology 2014 American Society of Anesthesiologists presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/40\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzomhp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzomhp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}