Re-designing the pathway to surgery: better care and added value
Re-designing the pathway to surgery: better care and added value
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DOI：
10.1186/s13741-017-0065-4
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发表时间：
2017-06-20
影响因子：
2.6
通讯作者：
Levett, Denny Z. H.
中科院分区：
文献类型：
--
作者：
Grocott, Michael P. W.;Plumb, James O. M.;Levett, Denny Z. H.
在手术前进行彻底的路径重新设计的部分原因是医疗保健系统的压力，而医疗保健系统的压力又是在资源严格有限的情况下需求不断增长的结果。这种情况往往会推动革命性的而非渐进式的变革。目前的术前评估方法通常在手术前几周进行，但往往仅在手术前几天进行，导致围手术期医生失去了改善患者护理的机会。基于以患者为中心、路径驱动的围手术期医学愿景重新设计这一流程，为利用这一机会提供了一种手段。这篇综述探讨了变革的驱动因素、路径重新设计提供的机会，并提出了多种在术前路径中增加价值的策略，每一种策略都通过围手术期医生和患者之间的早期参与来促进：协作决策、协作行为改变、有针对性的合并症管理以及包括外科学校在内的手术的期望管理和心理准备。
The case for radical pathway re-design before surgery is in part driven by healthcare system pressures which are in turn the result of continuously rising demand in the face of tightly constrained resources. Such circumstances tend to drive revolutionary, rather than incremental, change. The current approach to preoperative assessment, that typically occurs in the weeks leading up to surgery, but is all too often only a few days before surgery, results in a lost opportunity for perioperative physicians to improve patient care. Re-engineering this process based on a patient-focused, pathway-driven vision of perioperative medicine offers a means of exploiting this opportunity. This review explores drivers for change, the opportunity offered by pathway re-design, and suggests a variety of strategies to add value in the preoperative pathway, each of which is facilitated by early engagement between perioperative physician and patient: collaborative decision-making, collaborative behavioural change, targeted comorbidity management as well as expectation management and psychological preparation for surgery including surgery schools.