Feature
Perioperative Strides By Stacey Hilton
In a quest to be the future of the perioperative specialty and improve patient outcomes, Duke Anesthesiology took two major steps forward this year in achieving that mission; the opening of the Duke Perioperative Pain Care (DPPC) clinic and the official launch of the Duke Perioperative Medicine Fellowship, a collaboration with University College London (UCL).
Introducing Duke Perioperative Pain Care On March 6, Dr. Padma Gulur opened a first-of-its-kind clinic in the nation where the same team of pain specialists see patients before, during and after surgery with a focus on optimizing their functional recovery. “To have the ability to help patients minimize their risk of developing persistent or worsening pain after surgery is very meaningful,” says Dr. Gulur, the medical director of DPPC, a clinic she says is addressing two well-established gaps in the health care delivery system: the pre and postoperative care of patients. Studies show that certain surgeries are linked to a higher risk of patients developing ongoing pain, even after their wounds have healed, and that proper pain management can contribute to a quicker recovery and reduced hospital stay. Of the 40,000 surgeries performed annually at Duke, the Department of Anesthesiology found that only one in 10 patients who were among the top third tier of those who need the most support, benefit from the resources currently in place. Within the first three months of opening its doors, Dr. Gulur noticed a trend in preoperative care – of the patients seen at DPPC 10 days before their surgery, they noted on average, a 10 percent reduction in opioid doses preadmission and an improved observed length of stay vs. expected, compared to patients who were referred postoperatively. 4
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DUKE ANESTHESIOLOGY
“These numbers are not a perfect science, but they are a strong indication of an acknowledged need for this type of valuebased health care, and yet we are the only institution so far to implement this model of pain care. It’s a commitment we have made to improve population health.” The department’s goal of improving clinical outcomes not only includes the reduction of opioid consumption using multimodal pain management strategies, but optimizing personalized care plans for each patient at DPPC; these plans identify pain management needs prior to and following surgery that reduce the risk of developing chronic pain, allowing patients to return to full function after surgery and transition back into their community. Services at DPPC include wellness strategies, physical activity assessment and exercises, pain medication management, and behavioral coping techniques developed to align patients’ pain management and surgical goals. “As we research health care delivery models to improve patient outcomes, a key focus is to identify opportunities for improvement,” says Dr. Gulur. The new model implemented at DPPC, with assistance from Dr. Arun Ganesh, includes staffing the clinic by the same group of pain physicians that oversee the Inpatient Pain Service at Duke University Hospital; this ensures that patients’ pain control plans are coordinated and communicated to all involved physicians.
“Inpatients benefit from a continuity of care, which didn’t exist until now,” Dr. Gulur adds. “This clinic is the ideal solution because we can see patients before surgery to identify and optimize their care, follow them while they are in the hospital and then continue to provide support as needed for up to 90 days after their surgery.” While Dr. Gulur realizes that DPPC is one component of a complete population health strategy, she hopes it will be used as a model for other hospitals throughout the nation to help all surgical patients achieve their best outcomes; it has already become a regional referral for patients across the southeast. “We are the leading perioperative program in the nation, and this clinic has been one of the driving forces in achieving that goal.”
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