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phase. For example, the College is in the process of
developing a quality manual, which, in part, outlines
the surgeon’s responsibilities at each phase of surgical patient care.
The College has a Committee on Perioperative
Care, which sponsors several educational sessions
at the Clinical Congress. At the 2014 meeting, for
example, the committee presented sessions on the
relationship and role of the surgeon in designing and
implementing accountable care organizations and on
perioperative patient safety. This committee also has
developed position statements in the past and will be
issuing an updated Statement on Sharps Safety and has
developed a new version of the Statement on Surgical
Technology Training and Certification.
Furthermore, Sanjay Mohanty, MD, the ACS/Amer-ican Geriatrics Society (AGS) James C. Thompson Geriatric Clinical Scholar, is developing a set of best practices for the perioperative care of geriatric patients.
Dr. Mohanty, a general surgery resident at Heny Ford
Hospital, Detroit, MI, has been using data from the
ACS National Surgical Quality Improvement Program
Geriatric Pilot Project to generate the guidelines.
In addition, the College’s Evidence-Based Decisions
in Surgery program offers a range of clinical practice
guidelines. A module specific to perioperative care is
currently in development.
College Fellows also are closely involved in the
work being carried out by quality collaboratives. For
example, the Washington State Chapter of the ACS is
part of the state’s Surgical Care Outcomes Assessment
Program (SCOAP), which has established a Strong for
Surgery initiative. This effort is aimed at identifying
and evaluating evidence-based practices to optimize
the health of patients before surgery. As of Decem-
ber 2014, the SCOAP Strong for Surgery program was
active in 49 Washington hospitals and clinics repre-
senting 200-plus surgeons. More than 4,000 patients
have been screened using the checklists and other
instruments that the Strong for Surgery program has
developed.† Among other tools, Strong for Surgery
has developed guidelines to screen for malnutrition,
lists of lab tests for risk stratification, and processes for
screening for supplements. Presently, Strong for Sur-
gery is creating best practices for perioperative glucose
control, generating checklists to screen for medication
use, evaluating best practices for opioid minimization,
and developing recommendations for preoperative
smoking cessation. The College is working to bring
these important programs forward.
Surgeons must lead
The delivery of perioperative care is more complex
today than ever, and the evidence is mounting to
show that all members of the health care profession
need to be as attentive to this stage of surgical care
as any other. Although surgical care has evolved
from a system in which the surgeon oversees every
aspect of operative readiness and care to a system in
which multidisciplinary teams are working together to provide optimal care, it is still the surgeon who
must be accountable for the care his or her patient
receives. It is part of our contract with society as
trusted health care professionals. We must never
allow perioperative care to be considered someone
else’s responsibility. ♦
Presently, the College is involved in a number of efforts to
establish protocols for surgeons to lead the OR team and patient
through the perioperative care phase.
†Strong for Surgery. 2015: Looking Forward to More Remarkable Milestones. Available at: www.becertain.org/strong-for-surgery/strong-for-surgery-blog. Accessed February 24, 2015.