Perioperative care is focused on consistent, effi- cient, 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
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
•Standardized adherence to high reliability and safety
•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. ♦
Statement on physician-led
team-based surgical care
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.