PAT & POM: Back to the Future
Marc Koch, MD MBA FASA
Anesthesiology used to have four walls around it, plus one overhead and another underfoot: the operating room.
In the late 1970s it became clear that our seeing patients prior to their surgery was a helpful part of achieving a better outcome—and it alleviated plenty of patient worry. By the mid-1990s, Pre-Anesthesia Testing Centers (PATs) were becoming more commonplace and testing grids ubiquitous. Fast forward another 20 years and its back to the future; garden variety anesthesia services might become more of a function of very deep and broad operating room skills and expertise. Today’s anesthesiologists might become Operatists, much in the same way that some internists splintered off to become Hospitalists.
Should this come to be, then the pre- and post-op functions might become more the domain of a nascent specialty, PeriOperative Medicine (POM). Perioperative Medicine picks patients up at the time of diagnosis. POM Clinicians assess, risk stratify, and develop an optimization and pre-habilitation plan that they execute—all while using evidence-based practices to diagnose, treat, optimize, and pre-habilitate patients to mitigate adverse outcomes consequential to modifiable conditions and lifestyle factors.
POM Clinicians are often experts on care coordination, patient navigation, and transitions of care management, helping to tackle acute and post-acute discharge planning preemptively and adroitly. They also have awareness, experience, or expertise evaluating and launching complex government and commercial programs such as CJR, BPCI, CIN, shadow bundles, and co-management models.
Much in the way an acute pain service is not simply about blocks and anesthesia is not about general endotracheal anesthesia (GETA), POM is not about PAT. It is an evolving specialty that will collaborate closely with surgeon and nursing teams, and carefully hand off to, and take hand-offs from, anesthesia clinicians.