Using preoperative clinics to improve outcomes

  • Deconstructing Silos: Solving Perioperative Problems by Establishing Patient-centered Management of Disease (PN202)
  • 7-8 a.m. Saturday
  • BCEC 109AB

Anesthesiologists are expanding their perioperative role to improve patient care. A Saturday session will explore how they can establish preoperative clinics to proactively manage complex medical problems that contribute to risk in the operating room.

“Anemia portends a greater likelihood of transfusion, which increases the risk for an adverse outcome. We’ve developed a process for recognizing and optimizing anemia patients before they come to the surgical arena,” said session moderator Solomon Aronson, M.D., M.B.A. He is the Executive Vice Chair of the Department of Anesthesiology at Duke University Health System.

Solomon Aronson, M.D., M.B.A.

The Duke University Anesthesiology Perioperative Enhancement Team (POET), in collaboration with Duke Pre-admission Testing Clinic and the Center for Blood Conservation, established a Preoperative Anemia Clinic (PAC) in 2014. By recognizing and treating preoperative anemia, the POET preoperative anemia clinic has contributed to reducing transfusions in high-risk patients who would have likely required transfusion, Dr. Aronson said.

The Duke PAC helps to advance the perioperative medicine agenda to diagnose and treat anemia before surgery. That helps reduce the clinical risk and the financial liability associated with anemia and subsequent perioperative blood transfusion. Dr. Aronson will speak about the longitudinal data the PAC has been tracking at Duke since 2014.

“I will share specific logistics and operational steps that we’ve undertaken to set up an anemia clinic — a quick snapshot of how to replicate our process,” he said of his presentation.

Since 2014, Duke has launched dozens of preoperative optimization clinics for the management of other conditions, such as diabetes and pain.

“Our preoperative optimization clinics undergo a development plan that is similar to the formulaic process that we created to set up our anemia clinic,” Dr. Aronson said.

Peter M. Schulman, M.D., an Associate Professor of Anesthesiology and Perioperative Medicine at Oregon Health & Science University in Portland, will contribute to the discussion of the expanding role of anesthesiologists in the perioperative setting. He will explain where to begin when establishing a perioperative arrhythmia service.

The final speaker will be Shannon Hersey, M.D., Vice Chair of Operating Room Management at the Medical College of Wisconsin in Milwaukee. She will explain her institution’s perioperative preparation in the ambulatory medicine setting.

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