Perioperative Surgical Home


EmCare’s perioperative care model is a quality-of-care initiative with a focus on transforming surgical care through interdisciplinary coordination and standardization of procedures across the continuum of surgical care. This multi-specialty initiative helps hospitals improve quality, lower costs and improve patient and provider satisfaction.

The American Society of Anesthesiologists (ASA) defines the perioperative surgical home as “a new patient-centered model designed to achieve the triple aim of improving health, improving the delivery of healthcare, and reducing the cost of care.” The ASA recommends that these goals be achieved through “shared decision making and seamless continuity of care for the surgical patient, from the decision for surgery through recovery, discharge and beyond.”[1]

Source: (American Society of Anesthesiologists, 2015)

The EmCare perioperative surgical home is designed to provide coordinated care from the time of shared decision-making for surgery through to 30 days post-discharge. It covers the preoperative phase of working with patients to optimize their condition prior to surgery, the inter-operative phase, the immediate postoperative phase and the recovery phase post-discharge. Our emphasis on collaboration, standardization of process and data analytics continue to drive improvement.

The program includes a highly-successful pre-op clinic, or Pre-Anesthesia Testing (PAT) clinic, approach supported by clinical protocols working in tandem with what we feel is the most dynamic clinical information system and technology available in the industry. Taking from the triple aim of improving the patient experience of care, addressing population health issues and reducing costs, the program engages proven resources and provides training including the High Performance OR, the Risk-free OR and High Reliability Organizing and Patient Safety Expertise.

Pre-Anesthesia Testing (PAT) Clinic

Many patients are being sent to surgery without appropriate assessment and optimization of medical conditions. In addition, surgeons may or may not order the necessary lab tests, x-rays, ECGs, or consults in order to receive clearance. Not all patients are receiving the proper pre-anesthesia evaluation and even some high risk patients are not being evaluated as recommended by the American Society of Anesthesiologists (ASA). All of these shortcomings typically result in less than optimal care and in high number of operating room (OR) case delays and cancellations.

EmCare’s PAT Clinic aims to ensure that all patients are properly prepared for surgery prior to their surgery date. Using methodologies borrowed from the manufacturing industry and other quality and process improvement techniques such as six sigma and lean process, EmCare has streamlined the processes for improving OR performance.

When the decision is made to perform surgery, the surgeon’s office scheduler will book the OR and make an appointment for the patient with the PAT Clinic. This initiates the process, established with agreed timelines and accountability from the surgeon’s office and hospital.

Process Flow

Post-Surgery Transitional Care

Many of the costly issues for hospitals occur after the surgery. Often, the hand-off of the surgical patient after post-op is to the home with well-meaning family caregivers who may not have the skills needed to keep the patient on the best path to improvement. That’s where EmCare’s innovation options for of post-surgical care can help.

Post-surgical care is managed by Evolution Health, an expert transitional care organization owned by EmCare’s parent company Envision Healthcare. Evolution Health offers solutions for care coordination with primary care providers, hospitalists and specialists. It provides transitional care management to help reduce gaps in care and enhance the patient experience. The company’s state-of-the-art Medical Command Center offers mobile integrated healthcare in homes or alternative settings using physician-led, inter-professional care teams who provide 24/7 clinical support and deploy resources as needed.

This unique system provides immediate access to licensed medical professionals capable of evaluating the patient’s current condition, then matching and deploying appropriate resources to meet patient’s needs. The expected metrics of the perioperative surgical home model include improved operational efficiency, enhanced resource utilization, reductions in LOS and readmissions, and decreased complications. In addition, the center provides data back to its partners on clinical effectiveness and financial outcomes. Participation in this new way of delivering post-operative care can help improve quality metrics, reduce costs and most of all, improve the patient experience of care.