"Patients received stock prescriptions for pain medications at dis-
charge because there was no infrastructure in place to assess their
condition and adjust their care plan," says Padma Gulur, MD, execu-
tive vice chair of operations and performance at Duke Anesthesiology.
"We saw a real opportunity to examine the surgical episode of care
and explore ways we could do better."
Two years ago this month, she helped launch a perioperative pain
care clinic with the goal of personalizing post-op pain management,
minimizing the use of opioids, reducing the amount of time patients
spend in recovery and increasing their overall satisfaction. Her large
health system had the means and need — it treats 60,000 surgical
patients each year — to launch a dedicated post-op pain clinic, but you
can implement a similar program on a smaller scale. The key is to focus
on the unique pain management needs of your patients weeks before
procedures instead of relying on a cooker-cutter approach on the day of
surgery that's often ineffective and unsafe.
From start to finish
Dr. Gulur and a team of anesthesiologists, who are fellowship-trained in
pain management, run Duke's clinic. A member of the team meets with
patients as soon as possible after surgeries are scheduled and is available
to support their recoveries for up to 90 days post-op.
During pre-op appointments, they ask patients about their health
histories, lifestyles, medication use and expectations of surgery and
recovery. It's during those initial meetings with patients that they
establish personal connections, learn about their specific pain man-
agement needs and begin implementing the 3 essential elements of
the program:
• Medical. Dr. Gulur says chronic opioid users must be gradually
weaned off of the painkillers before surgery because it's often neces-
M A R C H 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 1 7
