|
Redefining Critical Care - Anesthesiology’s Role in Innovation and System Transformationby Ranjit Deshpande, MD, MBA, FCCM
Perioperative critical care led by anesthesiology sits at a powerful intersection. Our work spans the operating room and ICU while increasingly shaping decisions at the health system. Insights from McKinsey, Deloitte, PwC, and NCQA highlight three major forces shaping the future of healthcare:
These are not abstract trends but can be considered as a framework to create concrete opportunities to lead, not only at the bedside but across entire health systems. As anesthesiologists, we are at the forefront of these innovations, shaping the future of perioperative critical care.
Technology as a Catalyst
Technology is moving quickly from promise to practice. At Johns Hopkins, an AI-driven sepsis platform reduced mortality by nearly 18% across multiple hospitals. [1] Prenosis’s Sepsis ImmunoScore became the first FDA-authorized AI-based sepsis risk tool. [2] At the same time, new wearable and device-based systems are being developed to detect deterioration hours before it becomes clinically apparent. (https://arxiv.org/html/2505.01305v1#S6) Ventilation is also evolving closed-loop modes such as INTELLiVENT–ASV can automatically adjust settings in real time, standardizing care and reducing variability. [3] Meanwhile, tele-ICU models pioneered at Mayo Clinic extend critical care expertise to rural hospitals, now layered with AI-driven analytics.
For anesthesiologist–intensivists, these technologies are more than gadgets; they are strategic levers to enhance patient safety, efficiency, and influence in hospital-wide decision-making.
Perioperative Critical Care Without Walls
Critical care is no longer confined to the ICU. Increasingly, ICU-level expertise is being brought to patients across the hospital and even into their homes. This patient-centered approach ensures that the sickest patients receive the care they need and high-risk surgical patients are co-managed on the wards with enhanced monitoring, predictive analytics, and intensivist consults. This preserves ICU capacity while extending the safety net of critical care across the perioperative continuum.
Consider a patient undergoing a liver transplant. Instead of a default ICU admission, some centers now employ step-down units equipped with remote telemetry and daily intensivist oversight. The patient remains stable, recovers faster, and avoids both ICU-associated complications and excess cost. This is what perioperative critical care without walls would look like in practice.
Hospital-at-home programs are also redefining recovery. At Mayo Clinic, the Advanced Care at Home program combines remote monitoring, daily virtual rounds, and in-home services to deliver hospital-level care in familiar surroundings. [4] Mount Sinai has implemented a similar model through its Hospitalization at Home program, which has been shown to reduce costs, improve patient satisfaction, and safely manage both surgical and medical patients outside the hospital. [5] Atrium Health’s Hospital at Home program, profiled by the AMA, goes a step further: during enrollment, paramedics assess social determinants such as housing safety and food insecurity, connecting patients with community resources to support safe recovery. [6] Together, these models illustrate a hub-and-spoke future: the ICU remains the hub for the sickest patients, while perioperative critical care radiates outward to hospital floors, emergency departments, and homes. [7]
Anesthesiologists already play central roles across specialized ICUs like cardiac, transplant, neuro, obstetric, and even organ donation management. The question is whether we will lead in reshaping the future of critical care. To remain at the forefront, we must continue to evolve, adopting models that extend our expertise beyond traditional walls and into the changing landscape of healthcare delivery.
Social and Behavioral Determinants of Recovery
Recovery after surgery and critical illness is not just a physiologic journey, it is shaped by social and behavioral realities. Atrium Health screens patients for food insecurity, unstable housing, and transportation barriers before discharge. These efforts not only improve outcomes but also align with financial imperatives as value-based contracts increasingly tie reimbursement to addressing social determinants. For perioperative critical care anesthesiologists, this is an opportunity to strengthen both patient care and our influence in system-level negotiations.
Workforce and Culture Transformation
The future of perioperative critical care depends on people. Burnout, staffing shortages, and rising patient complexity remain pressing challenges. [8] Several Innovative models are emerging, including APP-integrated teams that allow for more flexible staffing, simulation, and AI-augmented training to prepare clinicians for rare but high-stakes events, as well as automation to reduce documentation burdens. These are not just workforce fixes; they are culture shifts that help clinicians stay engaged and focused on what matters most: caring for patients.
Rethinking perioperative staffing is part of this transformation. Anesthesiologist–intensivists are accustomed to managing multiple unstable patients in the ICU and uniquely equipped to lead hub-and-spoke perioperative models where one physician supervises several rooms supported by APPs or residents. Combined with remote monitoring and AI-driven alerts, these approaches can preserve safety while improving efficiency, a model that directly mirrors the ICU.
A Call to Action
Health systems increasingly reward leaders who combine clinical excellence with operational and financial stewardship. Anesthesiologist intensivists are uniquely positioned to deliver both. By embracing technology, rethinking care delivery inside and outside the ICU, addressing social and behavioral drivers of recovery, and building resilient teams, we can transform how health systems define critical care.
We already know how to lead in the operating room and stabilize crises in the ICU. The next step is to bring that same clarity, adaptability, and leadership into the boardroom. The future of critical care will be written with us or without us. The question is whether we will choose to lead.
References
AuthorRanjit Deshpande, MD, MBA, FCCM
|
