Left to Right: Drs. Stephen M. Klein (Chief), Karen C. Nielsen, Michael L. Kent, and M. Steve Melton
It is often said that history repeats itself. Early leaders who championed the establishment of an independent Department of Anesthesiology faced immense resistance. Few thought that they could succeed after cutting the cord from the Department of Surgery in 1971. Nevertheless, over time, Duke Anesthesiology has become one of the most successful anesthesiology departments in the world.
Twenty-seven years later, in 1998, a similar scenario played out when some of Duke’s most respected surgeons, anesthesiologists, nurses, and staff joined forces to form a stand-alone Ambulatory Surgery Center (ASC). Current Ambulatory Division chief, Stephen Klein, MD, was a member of the small team to embark on this ambitious new mission. The team, he admits, was a bit nervous upon arriving at the ASC. “The operating rooms were empty,” he explains, adding, “everything had to be organized from scratch.” Furthermore, when the ASC opened its doors to the public, it was greeted with a case volume 20% higher than predicted. The ASC team met the challenge head-on. And, just like Duke Anesthesiology, the ASC has since enjoyed a history of success.
Much of this success can be credited to the introduction of a new model of care in which a dedicated perioperative team, comprising anesthesiologists, surgeons, and highly trained nurses, works together to make the patient experience seamless. From the outset, ASC faculty and staff have treasured this spirit of teamwork that crosses all service lines. The four faculty within the Department of Anesthesiology who work at the ASC—Dr. Klein, Karen C. Nielsen, MD, M. Stephen “Steve” Melton, MD, and Marcy S. Tucker, MD, PhD—consider themselves not only a division, but members of the broader ASC team.
This unique model has withstood the test of time. Even as the center itself has grown from six operating rooms to nine, and the number of patients seen has steadily increased, the ASC faculty and staff have continued to provide quality services and compassionate care, quickly transitioning patients in and out so that they can return home to their families and a normal lifestyle as quickly as possible.
Furthermore, leaders in this division have pioneered a number of techniques that have now become standard procedure at Duke and, in some cases, worldwide. The Ambulatory Division’s first chief, Susan Steele, MD, played an instrumental role in Duke’s transition from using primarily general anesthesia to using regional anesthesia (RA). The move to the ASC provided Dr. Steele with the perfect opportunity to implement RA in an ideal patient population.
Dr. Steele, along with Roy Greengrass, MD, also developed the Duke-Braun Continuous Catheter System. With this technology, the ASC became the first center in the U.S. to send patients home with catheters and pain pumps to manage postoperative pain. Furthermore, Dr. Greengrass is internationally known for discovering new applications for paravertebral nerve blocks (first used in the 1920s and 1930s) to facilitate better recovery for breast procedures, enabling complex surgeries such as mastectomies to be performed in an ambulatory setting. In 2002, the ASC performed one of the first ambulatory joint arthroplasty procedures, proving once again that such extensive procedures can be carried out successfully on an outpatient basis with carefully coordinated teamwork and attention to pain control.
Since its inception, the ASC has methodically recorded patient outcomes information in a center-wide database now containing close to 100,000 patient encounters. With this knowledge at their fingertips, the future of research for the Ambulatory Division is full of exciting potential. By integrating this data with new information derived from cutting-edge technologies, such as ultrasound and sophisticated cerebral imaging, Ambulatory Division faculty are identifying, often for the first time, valuable long-term patient outcomes that result from ambulatory procedures. Currently, Dr. Melton is championing this field of study, which will remain a strong area of focus in the future.
Another exciting area of future development is found in the division’s fellowship program, which has blossomed in recent years under Dr. Nielsen’s care. “She has built a solid framework for the fellowship program,” explains Dr. Klein, “and she continues to expand it every year—it’s never static, she is constantly working to see how she can improve it.” Trainees who complete the highly acclaimed fellowship program in ambulatory and regional anesthesia receive an unrivaled education in RA with a strong focus on the outpatient setting.
Time and time again, history has demonstrated that change is never an easy process. The Ambulatory Division’s openness to change and a wholehearted commitment to its mission of continuously improving patient care have made this division’s story an important chapter in the evolving history of Duke Anesthesiology.