Optimization includes enhancing management of chronic conditions, reducing high-risk medications, and improving mobility and nutrition. A third of admissions are post-operative hospital stays. These admissions account for approximately 48% of hospital costs. The annual surgical volume in 2015-2016 at Duke University Hospital was approximately 60,000 patients, of which 43000 are outpatients, many of whom are admitted on the day of surgery for their postoperative care. Of these, approximately 21,000 underwent phone screens prior to surgery and 22,000 were evaluated in face-to-face assessments in Pre-Anesthesia Testing Clinic (PAT) and Peri-operative Senior Health Clinic (POSH) clinics. Two important problems exist in the current high volume perioperative clinical service:

● Lack of a system-wide, streamlined automated process for rapid preoperative patient risk stratification and management by appropriate perioperative teams results in inefficiencies like case cancellations/postponement.

● Lack of timely identification and modification of surgical risk results in even more serious consequences for the patient and the health system: surgical/postsurgical complications, longer hospital stays, readmissions and general dissatisfaction among patients and family members.

This RFA project aims to deliver high-quality perioperative care with enhanced efficiency and effectiveness by appropriately matching patients to needed services based on health status and surgical risk. We aim to develop risk stratification systems that can:

1. Use patient and surgery characteristics to identify and provide the most effective optimization pathways in the perioperative period.

2. Create a tiered workflow that allows for more accurate and efficient triage to appropriate preoperative services, (e.g. phone v. face-to-face v interdisciplinary evaluation) and facilitates delivery of high-quality perioperative care at lower cost in order to make it sustainable in the era of value-based care.