Creating a Pathway for Multidisciplinary Shared Decision-Making to Improve Communication During Preoperative Assessment - 02/11/18

Doi : 10.1016/j.anclin.2018.07.011

Timothy D. Quinn, MD ^a,^b,^⁎ , Piotr Wolczynski, MD ^c, Raymond Sroka, PharmD, MD ^a,^b, Richard D. Urman, MD, MBA ^d
^a Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 77 Goodell Street, Suite 550, Buffalo, NY 14203, USA
^b Department of Anesthesiology, Critical Care and Pain Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA
^c Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 462 Grider Street, Buffalo, NY 14215, USA
^d Department of Anesthesiology, Perioperative and Pain Medicine, Center for Perioperative Research, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA

^∗Corresponding author. Department of Anesthesiology, Critical Care and Pain Medicine, Roswell Park Comprehensive Cancer Center, 3rd Floor, Clinical Sciences Building, Elm & Carlton Streets, Buffalo, NY 14263.Department of Anesthesiology, Critical Care and Pain MedicineRoswell Park Comprehensive Cancer Center3rd FloorClinical Sciences BuildingElm & Carlton StreetsBuffaloNY14263

Résumé

Shared decision-making (SDM) is essential for high-quality surgical care. Barriers to SDM exist in clinical practice but there is evidence these obstacles can be overcome. SDM requires clinician and patient engagement. Though patients may indicate understanding, deficits in decision making may persist based on language, age, or educational barriers. Multidisciplinary decision-making before surgery is an opportunity for anesthesiologists and other perioperative professionals to improve surgical care. The authors present an example of a successfully implemented pathway for high-risk surgical patients at a tertiary care center, leveraging the preoperative anesthesia evaluation.

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Keywords : Perioperative medicine, Shared decision-making, Preoperative anesthesia evaluation, Appropriateness, Multidisciplinary team, High-risk, Anesthesiology, Quality improvement