Throughout our history, Duke Anesthesiology has earned a reputation for ingenuity that has become a hallmark of the department, just as beloved and familiar as Cameron Indoor Stadium, the Sarah P. Duke Gardens, or that unmistakable shade of Duke Blue that distinguishes us from other universities. The affiliation that Duke Anesthesiology has formed in recent years with Duke Regional Hospital and Duke Raleigh Hospital was born out of this culture of innovation. It serves as a perfect example of how our leaders boldly transform challenges into opportunities by finding unique approaches to advancing patient care.
“Duke Raleigh and Duke Regional are an instrumental and important part of our department,” explains Solomon “Sol” Aronson, MD, MBA, executive vice chair of the department and one of the key players who has fostered and developed this unique relationship. “Their efforts, although principally clinical, help our department fulfill its overall mission. They help us sustain the department’s resources necessary to maintain our academic and educational mission in a global way,” he says.
The first off-site group to affiliate with Duke Anesthesiology was Durham Anesthesia Associates (DAA)—a medium-sized successful private-practice organization with a 30-year history. Although the practice worked in concert with then Durham Regional Hospital, Edward G. Sanders, MD, and others in the organization knew that the DAA’s full potential could only be realized by aligning itself with a larger academic institution like Duke University. Dr. Sanders and key partners within the practice first began to discuss the creation of a formal relationship between DAA and Duke Anesthesiology in 1996 with former chair Joseph “Jerry” Reves, MD, former vice chair, Dr. Newman, and former faculty member David Lubarsky, MD, MBA. This relationship was consummated in 2007.
Today, this remarkable team is referred to as the Community Division. Dr. Sanders serves as division chief. The 20 physicians within this division are members of Duke Anesthesiology who jointly serve as community physicians. This unique affiliation allows Duke Anesthesiology and the Community Division to straddle the systems of academic and community practice, and to integrate both with the Private Diagnostic Clinic (PDC)—a for-profit professional limited liability company associated with the Duke University Health System and School of Medicine. This unique positioning has allowed both the department and the Community Division to grow significantly. The Community Division, which began as a team of 10 physicians and 40 certified registered nurse anesthetists (CRNAs) has since expanded to 20 physicians and 60 CRNAs! Together, we now provide care to several local surgeon’s offices as well as other North Carolina hospitals, including Durham’s Davis Ambulatory Surgery Center, the North Carolina Specialty Hospital, Person Memorial Hospital in Roxboro, and the Mebane Surgery Center in Mebane.
“This may be the most unique academic-community affiliation alignment in the country,” states Dr. Sanders. “Leadership in the department has allowed us to retain much of the original responsibility that we had as a private business, which allows us to continue to do what we do best.” What the Community Division does best is provide exceptional care to the local community with a unique sense of compassion.
The Community Division also contributes to the department’s global mission of education and research. Their primary emphasis is placed on the training of CRNAs. In fact, DAA physicians and CRNAs, notably Ruth Long, who was Chief CRNA at the time, partnered with faculty at Duke to lay the foundation for what is now the highly respected Nurse Anesthesia Specialty Program at Duke University’s School of Nursing.
When it was still an independent private practice, DAA sponsored a CRNA training program for many years, but the program was forced to terminate in 1994. Dr. Sanders and Ms. Long approached Dr. Reves, who was the chair of Duke Anesthesiology at the time, to discuss their goal. Like DAA, Duke once had a successful CRNA training program under the leadership of Chief Nurse Anesthetist May Hoen Muller, CRNA, but it ceased to exist after 1955. Dr. Reves agreed that a CRNA training program would be an ideal solution to help meet the overwhelming need for anesthesia care, both at Duke and across the country. The DAA and Duke University worked together for a number of years to develop a school for these highly trained nurses. Today, Duke Regional Hospital serves as the base clinical site for this nationally recognized CRNA training program.
For the past three years, Duke Anesthesiology has been responsible for managing the intensive care unit (ICU) at Duke Raleigh Hospital. Dr. Okoronkwo Ogan manages the unit. A team of PDC pulmonary medicine physicians and advanced practice providers assists him.
The relationship between the Duke Raleigh ICU and the department has benefitted both parties tremendously. The Duke Raleigh ICU team now has unrivaled access to resources, greater potential for collaboration, and unique opportunities for continuing medical education (CME). By sponsoring this unit, we have become involved in critical care anesthesia in a more inclusive way.
Like the Community Division, the Duke Raleigh team is an integral part of Duke Anesthesiology’s global mission. The team at Duke Raleigh focuses its efforts on developing innovative solutions to improve patient care through expertise in systemized information management.
The progressive service models used for our affiliation with Duke Regional Hospital and Duke Raleigh Hospital have been extraordinarily successful. “Importantly, these affiliations have demonstrated that Duke Anesthesiology can successfully align its mission with community private groups to create significant advantages for everyone,” explains Dr. Aronson. In the future, the department will continue to explore opportunities for expansion and find new ways to fulfill our mission of extraordinary care through a unique culture of innovation, education, research, and professional growth.