This joint statement from the American College of Surgeons (ACS) and the American Society of Anesthesiologists was approved at the June 3–4 meeting of the ACS Board of Regents.
Perioperative care is focused on consistent, efficient, safe, high-quality, patient-centered medical care, with timely access and full functional recovery being the ultimate goal.
Optimal care is best provided by a coordinated multidisciplinary team recognizing each member’s expertise. Coordinated surgical care provides best outcomes, lowers costs, and increases patient satisfaction.
Several models of coordinated care involving the patient’s individual surgeon, anesthesiologists, primary care physicians, hospitalists, medical specialists, nurses, and other health care professionals are in development. Consistency, high reliability, and appropriate communications and handoffs remain opportunities for improvement. The evolution to optimal physician-led team-based care will improve outcomes and lower costs.
Looking forward, redesigned perioperative care models should be based on what is best for the patient, individual institutions, and practitioners and should include the following principles:
- Patient involvement with shared decision making, patient education and engagement, and alignment of expectations, including risk-based informed consent.
- Risk-stratification, risk-reduction, and optimization of patients prior to surgery, including medication reconciliation.
- Standardized adherence to high reliability and safety standards.
- Evidence-based care to reduce variability and perioperative complications.
- Effective coordination of care among all health care providers involved in the perioperative care of the patient.
- Roles and responsibilities of specialists are developed locally based on population needs and the training and skills of physicians involved. Models must recognize the primary responsibility of the operative surgeon, which includes confirming the presence of a surgical condition, verifying the need for surgical treatment, and directing or partnering with others for perioperative care.
Optimal physician-led team-based care includes a number of health care professionals, including the operating surgeon(s), anesthesiologists, hospitalists, specialty physicians, nurses, technicians, and other health care professionals. The contributions of each discipline will vary by practice and local environment. We believe this approach is best developed by the national medical specialty organizations and medical professions working together.