All this led many academic departments to implement anesthesia clinics that would pre-screen patients to ensure they were appropriate candidates for the proposed surgical procedure. Especially in the outpatient environment, the expectation was that such pre-screening would minimize same-day cancelations and increase the effectiveness and productivity of outpatient surgery centers. The PSH aimed to improve quality, safety, patient satisfaction and cost efficiency through collaboration among all perioperative stakeholders. Given the implementation of better intraoperative monitoring technology and the ability to develop much more substantive clinical databases, the approach held great promise to enhance the role of anesthesia and increase its value and relevance to all types of surgical facilities.
Many an ASA meeting featured speakers prepared to extol the value of a PSH approach. Many university anesthesia practices established what was referred to as the anesthesia clinic, a dedicated venue devoted to a review of the patient’s chart and the identification of any specific risk factors that might impact surgery. Eventually, most hospitals recognized the value of such clinics and significant financial resources were devoted to their maintenance. Here’s how one anesthesia publication characterized the concept:
Eventually, the ASA proposed a new paradigm of standardized, evidence-based perioperative strategies called PSH. The PSH was an innovative surgical care model supported with continuous care and shared decision-making. The PSH was characterized as a patient-centered and physician-led, multidisciplinary, team-based system of coordinated care that guided the patient through the entire surgical experience. An anesthesiologist-perioperativist was paired with nurse practitioners to provide consistently more focused and integrated postoperative patient care from the recovery room through the ward to post-discharge care. Moreover, the PSH team worked closely with acute pain services to assess the patient’s pain and manage it effectively. They also planned pain management in advance so opioids, if required, could be timely converted from intravenous to oral formulations. This continuous care enhanced satisfaction by greater familiarity and reduced anxiety of the patients and their families.
While the PSH idea made sense intuitively, implementation proved challenging, for the following reasons:
- It required broad institutional buy-in from surgeons, administrators and other specialties
- It was resource-intensive and difficult to standardize across diverse practice settings
- Staffing was challenging (it takes qualified, experienced providers to evaluate pre-operative patients, which is expensive)
- Ownership and leadership were often debated among specialties
In response to these barriers, the ASA shifted focus to a more practical and scalable model: the perioperative medicine clinic (PMC). The PMC is typically preoperative in scope, focusing on:
- Medical optimization of surgical patients (e.g., managing comorbidities)
- Risk stratification
- Prehabilitation
- Patient education and care coordination
This transition makes more sense because PMCs are easier to implement within existing hospital infrastructure. They also highlight anesthesiologists’ strengths in perioperative risk management and medical optimization. Furthermore, they deliver measurable improvements in outcomes, cost savings and patient readiness for surgery—all being aligned with value-based care initiatives. Finally, they allow flexible integration into existing workflows without requiring total system redesign, like the PSH.
In short, while the PSH laid the ideological groundwork, the PMC offers a more focused, feasible way for anesthesiologists to lead and improve perioperative care in today’s healthcare environment.