Before Surgery
The Preoperative Evaluation and Planning Center (PEPC) at UCLA is more than a preoperative assessment clinic. We strive to improve the outcome and reduce the risk of complications for each individual patient who needs surgery or an interventional procedure. The goal of the PEPC, since its establishment in 2014, is to be the first step in achieving the “triple aim” of providing better care, reducing costs, and improving the overall health of UCLA’s patients.
Our team includes physicians, nurse practitioners, nurses, and support staff. We screen almost 20,000 cases, and perform in-person evaluations for about 500 patients per year. The care is patient-centric, and we use a comprehensive managed approach toward care coordination, shared decision-making, patient education, risk stratification, and optimization of the patient’s medical condition before surgery or any invasive procedure. The PEPC enables our operative services to provide high-quality, coordinated care. Put simply, we help ensure that each patient receives the right care, at the right place, and at the right time.
Studies have shown that early preoperative preparation and management of patients by an anesthesiologist-led, integrated preoperative team can be associated with decreased perioperative complications, shorter length of stay, better pain control, and improved patient satisfaction. We are taking this concept one step further by implementing “prehabilitation” efforts – a multi-year project to create and develop interventions based on the unique needs of each patient population. These interventions are designed to address and optimize:
- Anemia
- Cardiopulmonary function
- Cognitive function
- Chronic pain
- Diabetes
- Duration of fasting
- Frailty
- Malnutrition
- Medication optimization
- Smoking cessation
- Stress, anxiety, and depression
- Weight management
Our first partners in this endeavor have been UCLA colorectal surgeons, orthopedic surgeons, and urologists, and we are coordinating perioperative care consistent with our Enhanced Recovery After Surgery (ERAS) initiatives. Moving forward, our plan is to develop and strengthen partnerships with colleagues in geriatrics, internal medicine, hematology, nutrition, pharmacy, physical therapy, social work, and surgical scheduling. We are focused on aligning current systems within UCLA Health, piece by piece, across multiple disciplines, centering around the patient. As another example of the PEPC’s potential, it is being considered as the locus for preoperative health care initiatives such as penicillin-allergy testing.
The PEPC is designed to be the hub for care coordination and communication with the patient and all the patient’s healthcare providers. Patients who may benefit from preoperative interventions are identified at the time of surgical scheduling. A comprehensive preoperative plan of care, based on pathways designed to address individual patient risk factors and specific surgical procedures, is prescribed for each patient in collaboration with the surgeon and the UCLA Accountable Care and Primary Care Innovation Model team. A “nurse navigator” helps in the assessment, and actively monitors each patient’s progress. The nurse navigator coordinates and facilitates care to ensure that each patient’s unique preoperative needs are met. The PEPC coordinates any changes to the surgical schedule with the surgeon’s office, the operating room staff, and the patient as needed.
After surgery, the patient’s transition from perioperative care back to primary care may be accompanied by potentially dangerous lapses in care and communication. Soon the PEPC will also assist high-risk patients with post-acute care planning by collaborating with social workers within the UCLA Health System. In developing patient-centered, value-based care paradigms, our intent is to enhance UCLA’s competitive advantage, to help with the transition from a fee-for-service payment system to a value-based system that is consistent with future alternative models of payment, and to make UCLA the preferred center for tertiary and quaternary care in southern California.
Physicians
Director: Victor Duval, MD
Faculty: