“Perioperative surgical home” – We are not out of the woods yet. What has to be done to make this concept viable?

At this stage the “Perioperative Surgical home” (PSH) is just another attempt to reestablish a leading role of Anesthesiology in perioperative management. In order to implement this concept multiple issues must be acknowledged and corrected. Among the most important is formal training of anesthesiologists in the area of communication, leadership and business management. The Department of Anesthesiology at Montefiore Medical Center has developed and implemented a four step approach to a resident's education in perioperative management. The FIRST step is offered to CA-1 and PGY-1 residents and introduces shared leadership as an effective model for teamwork in the contemporary operating room. The SECOND step enhances the surgical residents’ understanding of anesthesiologist's approach to perioperative process. This experience facilitates optimization of the preoperative patient, improves OR efficiency and interpersonal relationships among perioperative staff members. The THIRD step allows CA-3 residents to receive a hands-on experience in managing an operating room's daily activities in real time. Residents become more confident in coordinating the entire perioperative process. The Fourth step is a Perioperative Management Fellowship. It consists of comprehensive training in medico-legal and business aspects of OR/Perioperative management. In its current form, this fellowship is offered exclusively to anesthesiologists, but it is our belief that a unilateral approach to OR management training which fails to incorporate advanced surgical residents will be challenged to reach its most optimal level. This is why it would be ideal to offer the same training in advanced OR management to senior surgical residents.