PeCAN team receives UF Health Shands Quality Team Award

By Jill Pease

group photo with letters PSQW in foreground
The University of Florida Perioperative Cognitive Anesthesia Network, or PeCAN, team

The UF Health Quality Hero Awards Committee honored the University of Florida Perioperative Cognitive Anesthesia Network, or PeCAN, with a UF Health Shands Quality Team Award during a ceremony held March 26 as part of the health system’s celebration of Patient Safety Quality Week.

PeCAN was recognized for making outstanding contributions to a culture dedicated to improving patient safety, quality and the patient/family experience.

“The PeCAN team provides quality care, quality medical and research training, and pushes the envelope to develop quality evidence based translational approaches for our high-risk patients who are having ‘routine’ and more complex procedures at UF Health,” said PeCAN’s founder and director Catherine Price, Ph.D., an associate professor in the UF College of Public Health and Health Professions department of clinical and health psychology and the UF College of Medicine department of anesthesiology. “This neuropsychology clinical service within an anesthesia preoperative clinic is now recognized as a model perioperative anesthesia program by colleagues at major universities internationally.”

PeCAN is a first-of-its-kind, multidisciplinary program that seeks to identify older adults who may be at risk of developing cognitive problems after surgery so that clinicians can intervene to lessen the risk.

“The PeCAN team is focused on protecting a patient’s cognitive function in the period around a surgical procedure,” said Christoph Seubert, M.D., Ph.D., a UF professor of anesthesiology and neurosurgery. “This important work is situated between the silos of departments and hospital entities and distinguishes us among academic centers. As an anesthesiologist I put patients ‘to sleep’ for surgeries, knowing that my work cannot fully mitigate the stress that the perioperative period puts on a patient’s organ systems, including the brain. The PeCAN team is my ally in devising plans before, during and after the surgery that minimize the stress of the perioperative period on the brain and thus allow me to deliver the best care currently possible.”

PeCAN is informed by more than two decades’ worth of international research showing how presurgical cognitive and memory functions predict postsurgical complications including delirium, one of the most common complications in older adults following surgery. Delirium can lead to longer recovery times, increased dementia risk, higher mortality rates and increased health care costs.

“PECAN has been an invaluable partner to the department of surgery regarding both clinical/quality metrics as well as research funding,” said Gilbert Upchurch, M.D., the Edward M. Copeland III and Ann & Ira Horowitz Department Chair of the department of surgery. “Their ability to conduct precision medicine and then intervene both pro-actively and post-operatively on the surgical patient makes them an incredible resource for the state of Florida and our faculty.”

For UF Health Shands patients over 65 undergoing surgery, the process begins with a cognitive screening tool administered by preoperative anesthesia team members. If cognitive issues are identified, patients are referred for a follow-up brain wellness exam by an on-site licensed clinical neuropsychologist. The 90-minute appointment with the neuropsychologist includes an interview, assessment and feedback session with an intervention plan provided to the surgical team, patients, families and primary care providers. If patients experience postoperative cognitive complications, they can be scheduled with PeCAN clinical team member Benjamin Chapin, M.D., a behavioral neurologist with specialty in delirium and dementia, and an assistant professor of anesthesiology.

Mild to moderate neurocognitive difficulties can also impact patient outcomes for what are seen as routine procedures. Work by Franchesca Arias, Ph.D., an assistant professor of clinical and health psychology and PeCAN team member, has shown that patients with preoperative cognitive limitations or low education and literacy have more complications with bowel preparation for colonoscopy. 

“The PeCAN program has improved our understanding of how preoperative cognitive impairment and demographic factors impact the quality of a patient’s bowel preparation for colonoscopy, thereby potentially improving the quality of care we provide,” said David Estores, M.D., an associate professor of medicine in the division of gastroenterology, hepatology and nutrition.

PeCAN’s interventions gave a patient with Parkinson’s disease and his wife confidence and peace of mind going into a recent procedure, in which local anesthesia was given for an uncomplicated surgical procedure instead of general anesthesia, as was the surgeon’s standard practice. 

“We are so grateful for the PeCAN clinic where we voiced our concerns about potential cognitive changes using general anesthesia in a Parkinson’s disease patient,” said the patient and his wife. “The PeCAN note in his chart helped make the argument to the anesthesiologist that special attention needed to be given to the anesthesia choice before surgery.”