Cognitive recovery
Roughly one in four
Patients aged 60 and over with measurable cognitive decline in the first week after major non-cardiac surgery. About one in ten at three months.
For health systems and surgical centers
Perioperative Health, built into every surgical episode.
PERIOME partners with health systems and surgical centers to co-design, pilot and study connected perioperative programs: understanding patients earlier, supporting preparation, carrying context into surgery and following recovery after discharge. It starts with one service line.
The problem, in practice
Excellent operations, a fragmented episode.
Surgery, anesthesia and ERAS pathways are among medicine's real accomplishments. The episode around them is still assembled by hand, and the patient often carries the pieces.
- Fragmented informationHistory, instructions, test results and what the patient reports live in different places. No single view follows the patient from scheduling to recovery.
- Readiness that goes unseenClearance is documented. Whether the patient is ready, and what changed after the visit, usually is not.
- Preparation nobody confirmsInstructions vary by surgeon, site and visit. Whether a medication was held or a carbohydrate drink was taken is often learned on the morning of surgery.
- Issues that surface lateThe clearance that slipped or the instruction that never reached the patient tends to appear on the day of surgery, when it is hardest to fix.
- Teams carrying it by handPre-admission and nursing teams chase calls, reminders and questions one patient at a time.
- Recovery and measurement that stop at dischargeRecovery at home is rarely followed against the patient's starting point, so programs have little longitudinal data to improve on as accountability for the whole episode grows.
Accountability now reaches past the operating room.
The clinical case for preparing patients is decades old, and ERAS already reaches the days before an operation. What has changed is accountability: Medicare's Transforming Episode Accountability Model became mandatory in January 2026, and value-based contracts are moving the same way.
When a program is accountable for the whole episode, the weeks before surgery and the weeks after discharge become part of the program.
CMS TEAM
- 188 Markets where participation is mandatory, January 2026 through December 2030.
- 30 days After hospital discharge, counted in each surgical episode.
Source · Centers for Medicare & Medicaid Services
Where the episode is felt
Discharged is not the same as recovered.
Outcomes have many causes; the patient's condition around the operation is one of them. ERAS established the evidence for structured pathways. What remains is operational: delivering preparation before the patient arrives, knowing what they actually did, and following recovery after discharge.
Throughput
PACU time and discharge
Recovery variability extends PACU time, delays discharge and adds nursing load where throughput drives program economics.
After discharge
The weeks at home
Recovery continues at home, where it is hardest to follow against the patient's own starting point.
Perioperative neurocognitive disorder figures (studied at the time as postoperative cognitive dysfunction): ISPOCD and Monk et al.
Operate the episode
See every journey, not only the case.
Coordinate active episodes, surface unresolved work, follow recovery, and understand how the program is performing across the full surgical window.
Perioperative command center
Active surgical episodes across the health system
- Active episodes
- 186Across 4 facilities
- Surgery within 7 days
- 4712 with open work
- Open actions
- 298 due today
- Recovery follow-up
- 516 flagged for review
- Connected sources
- 94%Of active episodes
Episode workqueue
Ordered by surgery date and unresolved work| Patient | Procedure | Surgery | Journey | Current attention | Owner | Action |
|---|---|---|---|---|---|---|
| Eleanor ReedMRN 482910 | Total knee · Right | 18 Nov · 14 days | Prepare | Hematologic follow-up | Periop RN | |
| Marcus HillMRN 550217 | Colectomy | 21 Nov · 17 days | Prepare | Home support incomplete | Navigator | |
| Linda EvansMRN 601144 | Lumbar fusion | 24 Nov · 20 days | Understand | Functional trend changed | Physical therapy | |
| Daniel ParkMRN 332817 | Total hip | 25 Nov · 21 days | Prepare | Medication reconciliation | Pharmacy | |
| Sofia RamirezMRN 702449 | Hysterectomy | 09 Nov · 5 days | Care | Readiness review due | Anesthesia |
Program watch
Today- 8Actions due today
Orthopedics, colorectal and gynecology.
- 6Recovery paths to review
Function or symptoms outside the planned path.
- 3Source gaps
External laboratory results awaiting reconciliation.
- 1Implementation note
West Campus begins total-joint enrollment Monday.
Episode summary
6 connected sources- Readiness profile
- Progressing5 of 6 domains on plan
- Planned pathway
- ASCSet by the surgical team
- Planned stay
- Same dayOvernight contingency available
- Recovery destination
- HomeSupport confirmed
Current attention
Hematologic follow-up before the readiness review.
Mobility plan needs final confirmation.
| Domain | Current state | Trend | Most recent signal | Source |
|---|---|---|---|---|
| Functional reserveMobility · capacity | On plan | Stable | Sit-to-stand baseline recorded | Functional measures |
| CardiorespiratoryCapacity · symptoms | On plan | Stable | No exertional symptoms reported | Patient-reported · EHR |
| HematologicHemoglobin · iron | Requires review | Improving | Repeat studies due 12 Nov | Laboratory |
| MetabolicGlucose | On plan | Stable | Home readings within plan | EHR · patient-reported |
| NutritionIntake · protein | On plan | Stable | Preparation days completed: 13 of 14 | Morton |
| Patient experienceQuestions · engagement | On plan | Stable | No open questions | Morton |
Perioperative Intelligence summary. Functional reserve is preserved and home support is confirmed. Hematologic follow-up is the current attention: repeat studies are due before the readiness review. The mobility plan remains open.
Open workflow
3 actions- Repeat CBC and iron studies
Results before the readiness review.
Owner: Carla Moore, RN · Due 12 Nov - Finalize mobility plan
Assistive device and home route.
Owner: Leo Brown, PT · Due 13 Nov - Medication acknowledgment
Patient reviews the plan in Morton.
Owner: Patient · Due 15 Nov
Connected sources
Last update- EHR chart
- 4 min ago
- Laboratory
- Yesterday
- Medication record
- 2 h ago
- Patient-reported data
- Today
- Functional measures
- 07 Nov
- Morton engagement
- Today
Preparation plan
2 complete · 3 open| Step | Owner | Status |
|---|---|---|
| Multidomain baselineFunction, nutrition, symptoms, support | PERIOME team | Complete · 07 Oct |
| Preparation plan and timingDaily plan timed to the operation | Morton | Complete · 08 Oct |
| Hematologic pathwayRepeat studies and clinician review | Carla Moore, RN | Due 12 Nov |
| Mobility preparationAssistive device and home route | Leo Brown, PT | Due 13 Nov |
| Readiness reviewClose open work; prepare the handoff | Anesthesia | Planned 16 Nov |
Morton patient experience
Today- Preparation days completed
- 13 of 14
- Today’s priority
- Mobility session
- Last check-in
- 08:12
- Open questions
- None
Day-of-surgery handoff
Prepared from the full episodeWhat arrives with the patient. What was completed, what changed since the preoperative visit, what remains open, and the baseline that recovery will be measured against.
| Handoff element | Status | Last verified | Responsible |
|---|---|---|---|
| Preparation completion | 2 of 5 steps complete | Today 08:12 | Perioperative RN |
| Hematologic follow-up | Results pending | Yesterday | Perioperative RN |
| Medication plan | Awaiting acknowledgment | Today 07:40 | Pharmacy |
| Patient questions | None open | Yesterday | Morton |
| Recovery destination | Home with spouse | 07 Nov | Navigator |
Recovery plan
Measured against her own baselineFollow-up
Planned- First check-in
- Day 1 · Morton
- Symptoms, intake, mobility
- Day 3
- Function vs. baseline
- Days 14, 42, 90
- Recovery destination
- Home
Episode measures and learning record
Builds as the episode progressesOne continuous record. Baseline, preparation, the day of surgery, recovery and patient experience stay connected, so the episode can inform the next patient’s care and governed program learning.
- Baseline
- Recorded07 Oct
- Preparation
- In progress2 of 5 steps
- Recovery measures
- PlannedDay 1 through day 90
- Learning record
- OpenCloses at day 90, with consent
Program operations
Total joint program · adoption, workflow and coverage by facility
Enrollment by facility
Share of scheduled episodes enrolled| Facility | Episodes | Enrolled |
|---|---|---|
| Northstar ASC | 72 | 92% |
| Central Hospital | 58 | 84% |
| Riverside ASC | 22 | 76% |
| West Campus | 34 | 61% |
Infrastructure coverage
By site- EHR patient and procedure data
- 4 of 4 sites
- Laboratory results
- 4 of 4 sites
- Medication record
- 3 of 4 sites
- Morton enrollment
- 86% of episodes
- Recovery follow-up
- 78% of episodes
Episode volume
12 weeksProgram observations
Perioperative Intelligence- WorkflowPlan completion is highest when enrollment happens three or more weeks before surgery.
- RecoverySix current journeys are outside the planned recovery path and queued for clinician review.
- ImplementationMedication-record connection is the next West Campus milestone.
What PERIOME is building
One connected model for the whole episode.
PERIOME is building the infrastructure to connect each step of the surgical episode around the patient. Some of it runs in a founding implementation today; the rest is being built. Each line says which.
- Understand patients earlierA structured baseline from the day surgery is scheduled, captured through Morton. In pilot.
- Identify preparation opportunitiesWhat is still modifiable in the time that remains, surfaced while there is time to act. Readiness measurement is in development.
- Support preparationDay-by-day guidance timed to the operation, with the PERIOME Protocol as the first structured intervention. Morton in pilot; the Protocol opens with its first production run.
- Carry context into surgeryWhat changed, what was completed and what is still open, summarized for the team. Being built in PERIOME OS.
- Follow recovery after dischargeCheck-ins and patient-reported recovery after the patient goes home. In pilot through Morton.
- Structured information for improvementCohort reporting on preparation, patient experience and recovery against measures agreed in advance. Part of every founding implementation.
Founding implementation
A clear path from first conversation to a decision on the evidence.
A founding PERIOME implementation is run like any clinical program evaluation. Scope and commercial terms are set with each institution; there is no fixed package.
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Sponsor and champion
An executive sponsor and a clinical champion own the program inside the institution.
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Service line and cohort
Choose one surgical service line and a defined patient population to start.
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Scope and governance
Agree the intervention scope, clinical governance and how it fits existing workflow.
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Permissions and data
Set data permissions and handling, through the institution's legal and compliance review.
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Implement
Patients are introduced at visits they already attend: the surgeon's office, primary care clearance, pre-admission clinic or pre-anesthesia evaluation. No EHR build to begin.
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Measure
Track the patient, workflow and recovery indicators agreed in advance.
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Review
Leadership reviews a cohort report and decides, on the evidence, whether expansion is justified.
Measures, reporting, data permissions and any data sharing are agreed in advance and go through each institution's legal and compliance review. A founding implementation evaluates delivery and patient experience; PERIOME makes no claim that it will change clinical or financial outcomes.
Operational lift
PERIOME carries the operational load.
An implementation should not compete for IT roadmap, capital or clinical staff. PERIOME runs the patient-facing work; the institution provides sponsorship, clinical leadership and access to the visits patients already attend.
PERIOME handles
- Patient enrollment and onboarding
- Protocol fulfillment timed to each operation
- Day-by-day guidance through the surgical window
- Post-discharge recovery follow-up
- Data capture across the cohort
- Patient experience measurement
- Cohort reporting to program leadership
- A direct-purchase option for patients, where appropriate
The institution provides
- An executive sponsor and a clinical champion
- Access to the preoperative visits patients already attend
- Legal, compliance and data review before launch
- Agreed data access, where permitted
The Council
Building the standard with the field.
PERIOME is convening the Perioperative Health Council: clinicians from across the surgical journey, scientists, health system leaders and operators who have built clinical infrastructure at scale. Its work is to define the measurement, evidence and implementation standards the discipline will need.
A program that adopts Perioperative Health early helps shape it. The Council is independent of PERIOME's products and does not endorse them.
About the CouncilStart here
Discuss a founding implementation.
Tell us about your program: the service line you have in mind, your surgical volume and what matters most to your leadership. We will come back with a scoped next step.
- Routed to the team that scopes implementations.
- An answer either way: a scoped next step, or an honest no.
- Handled under our privacy policy. Please do not include patient information.
Message received.
Our team reviews every request personally and follows up to schedule a time to talk.
Start the conversation
No patient enters surgery unknown.
A founding implementation begins with one service line and a conversation with your leadership team.
Discuss a founding implementationA new standard for the oldest promise in medicine: that the patient comes first.