American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Excerpt from Chapter 2: Team-based care: The surgeon as leader in each phase of surgical care

This is an excerpt from the Optimal Resources for Surgical Quality and Safety manual. 

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Optimal Resources for Surgical Quality and SafetyEXECUTIVE SUMMARY. Health care policymakers and professionals who have studied strategies for improving quality, safety, and reliability have increasingly found that the best way to reduce errors, complications, and variations in patient care is through a coordinated, physician-led, team-based approach. At the center of the team are the patient and his or her primary physician or surgeon.

This chapter answers the following questions:

Why do we need patient-centered, physician-led, team-based care?

What are the five phases of care?

  • Surgical preoperative evaluation and preparation phase of care
  • Immediate preoperative readiness phase of care
  • Intraoperative phase of care
  • Postoperative phase of care
  • Postdischarge phase of care

What are some specific details about the phases of care?

  • What are their beginning and endpoints?
  • Who are the core team members at each phase?
  • What are their geographic domains?
  • What work is conducted in each phase?
  • What are the surgeon’s specific responsibilities in each phase?
  • What are the key resources we can use in each phase of care?

Why do we need patient-centered, physician-led, team-based care?

Coordinated, multidisciplinary team-based treatment models have been shown to result in high-quality, safe, reliable, patient-centered, and cost-effective care. Several models of coordinated care involving the patient’s individual surgeon, anesthesia providers, primary care physicians, hospitalists, medical specialists, nurses, and allied health care professionals are in development.

The American College of Surgeons (ACS) maintains that these new models of care should be rooted in the following principles:

  • Shared decision making between the physician and the patient/family; this type of decision making is dependent on patient education and engagement, which should result in the alignment of patient-physician expectations and provision of risk-based informed consent
  • Risk stratification and reduction through the optimization of patients before an operation
  • Standardized adherence to high-reliability patient-safety standards
  • Evidence-based care to reduce variability and perioperative complications
  • Effective coordination among all health care providers involved in the patient’s surgical care

The specific roles and responsibilities of each surgical team member will be defined locally, based on population needs and the training and skills of the health care professionals involved. All models, however, must recognize that the primary responsibility for the surgical patient’s outcomes lies with the operative surgeon.

What are the five phases of surgical care?

The five phases of surgical care are as follows:

  • Surgical preoperative evaluation and preparation phase of care
  • Immediate preoperative readiness phase of care
  • Intraoperative phase of care
  • Postoperative phase of care
  • Postdischarge phase of care

What are some specific details about the phases of care?

The following sections of this chapter outline the specifics of each phase of surgical care and how a team-based approach—with the patient and operating surgeon at the core—can be applied at each stage of surgical care.