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KEY POINTS

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KEY POINTS

  1. Anesthesiologists, as perioperative physicians, must appropriately and effectively utilize consultants to improve surgical outcomes for the patient.

  2. Effective and appropriate use of consultants is a medical necessity to optimize the chronic medical conditions associated with an aging patient population undergoing more invasive surgery.

  3. Recognition of coexisting disease states requiring optimization prior to surgery is key to determining when consultations are needed.

  4. Anesthesiologists are responsible for perioperative risk stratification, anesthetic technique, and management of the patient in the perioperative period.

  5. Communication among care providers is essential to be effective and influence patient outcomes.

  6. When referring a patient for consultation, ensuring that a clear and direct question has been asked can help improve the quality of the consultation.

  7. Development of preoperative evaluation clinics may streamline the preoperative evaluation process and minimize unnecessary consultations.

  8. Anesthesiologists have a unique skill set that can be utilized in the perioperative period to improve pain control, fluid management, and postoperative nausea.

  9. Development of perioperative guidelines in concert with consultant professional organizations such as the American College of Cardiology/American Heart Association (ACC/AHA) will help determine when consultations are necessary.

  10. Development of the perioperative surgical home model of care will continue to advance the role of anesthesiologists as consultants in the perioperative period.

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INTRODUCTION

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Anesthesiologists, as perioperative physicians, must appropriately and effectively utilize consultants to improve surgical outcomes for the patient. The ongoing shift in demographics as the world’s population is aging has resulted in older and sicker patients presenting for more invasive surgery. The number of Americans aged 65 years or older is expected to increase from 40 million in 2010 to 55 million in 2020 and 72 million by 2030.1 Improved anesthetic care, surgical techniques, with more effective drugs and increasingly standardized care algorithms have improved patient safety and have decreased the number of catastrophic intraoperative events. This new “safety” perception perhaps has led to an increase in chronically ill, high-acuity patients being deemed operable candidates by their surgeon.2 Regardless of the cause, more such complex patients present for surgery requiring anesthesia.

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The anesthesiologist is responsible for preparing these increasingly complex patients for surgery. This involves the assessment of perioperative risk, the determination of the need for changes in management to optimize medical management of the patients’ comorbidities before surgery, and finally the identification of cardiovascular and other conditions that require longer-term management or postoperative care in the intensive care unit (ICU).

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Another factor that has to be taken into account is that health care in the United States is transitioning from the historic fee-for-service model to an outcomes-based model. Consequently, anesthesiologists are being faced with the pressure to contain costs and improve quality and outcomes by optimizing patient care and by avoiding adverse events, thus favorably affecting length of stay and cost per case. Anesthesiologists are increasingly focused on reducing harm caused by the delivery of care. This new health ...

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