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Peri-operative care pathways: re-engineering care to achieve the 'triple aim'

Grocott, MPW; Edwards, M; Mythen, MG; Aronson, S; (2019) Peri-operative care pathways: re-engineering care to achieve the 'triple aim'. Anaesthesia , 74 pp. 90-99. 10.1111/anae.14513. Green open access

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Abstract

Summary: Elective surgical pathways offer a particular opportunity to plan radical change in the way care is delivered, based on patient need rather than provider convenience. Peri‐operative pathway redesign enables improved patient experience of care (including quality and satisfaction), population/public health, and healthcare value (outcome per unit of currency). Among physicians with the skills to work within peri‐operative medicine, anaesthetists are well positioned to lead the re‐engineering of such pathways. Re‐engineered pre‐operative pathways open up opportunities for intervention before surgery including shared decision‐making, comorbidity management and collaborative behavioural change. Individualised, risk‐adapted, intra‐operative interventions will drive more reliable and consistent care. Risk‐adapted postoperative care, particularly around transitions of care, has a significant role in improving value through peri‐operative medicine. Improved integration with primary care providers offers the potential for minimising errors around transitions of care before and after surgery, as well as maximising opportunities for population health interventions, including lifestyle modification (e.g. activity/exercise, smoking and/or alcohol cessation), pain management and sleep medicine. Systematic data collection focused on quality improvement is essential to drive continuous clinical improvement and will be enabled by technological development in predictive analytics, systems modelling and artificial intelligence.

Type: Article
Title: Peri-operative care pathways: re-engineering care to achieve the 'triple aim'
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/anae.14513
Publisher version: https://doi.org/10.1111/anae.14513
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Anesthesiology, pre-operative assessment, peri-operative medicine, surgical care pathways, prehabilitation, process re-engineering, POPULATION HEALTH, ENHANCED-RECOVERY, SURGERY, MEDICINE, HOME, VARIABILITY, MANAGEMENT, OUTCOMES, GOAL
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10098919
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