Harrison Tyrone G, Ronksley Paul E, James Matthew T, Brindle Mary E, Ruzycki Shannon M, Graham Michelle M, McRae Andrew D, Zarnke Kelly B, McCaughey Deirdre, Ball Chad G, Dixon Elijah, Hemmelgarn Brenda R
From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn).
Can J Surg. 2021 Jul 23;64(4):E381-E390. doi: 10.1503/cjs.002020.
Perioperative medicine is changing rapidly, and with this change comes the opportunity to improve upon current models of care delivery and integration within the health care system. Perioperative models of care are structured or conceptual arrangements for surgical patients before, during and after their surgery. Models of care such as the Perioperative Surgical Home and Enhanced Recovery After Surgery pathways are increasingly used to guide the structure of perioperative care delivery with an aim to improve patient outcomes and experience in Canadian settings. In this narrative review, we summarize the origins of these perioperative models of care. They are fundamentally different in scope and level of evidence. Both models have potential benefits and limitations to their broad implementation in our health care system. As currently developed, both models are limited in their application to patients with chronic disease. We discuss how these models of care can be used to develop integrated horizontal and vertical perioperative pathways in a Canadian setting. Such integration is a potential solution that will improve their applicability to patients with medically complex conditions and in times when health care systems are under pressure. We describe this approach using the example of patients with kidney failure receiving dialysis.
围手术期医学正在迅速变革，随着这种变革而来的是改进当前医疗服务模式以及在医疗保健系统内进行整合的机遇。围手术期护理模式是针对手术患者在手术前、手术期间和手术后的结构化或概念性安排。诸如围手术期外科之家和术后加速康复路径等护理模式越来越多地被用于指导围手术期护理服务的结构，旨在改善加拿大环境下患者的治疗效果和就医体验。在这篇叙述性综述中，我们总结了这些围手术期护理模式的起源。它们在范围和证据水平上存在根本差异。这两种模式在我们的医疗保健系统中广泛实施都有潜在的益处和局限性。就目前的发展情况而言，这两种模式在应用于慢性病患者时都存在局限性。我们讨论了如何利用这些护理模式在加拿大环境中开发综合的横向和纵向围手术期路径。这种整合是一种潜在的解决方案，将提高它们对病情复杂患者的适用性，以及在医疗保健系统面临压力时的适用性。我们以接受透析的肾衰竭患者为例描述这种方法。
