June 24, 2015 marked the last clinical day of the UCSF Ambulatory Surgery Center (ASC). The center cared for approximately 125,000 patients during almost 28 years of operation.
The Beginnings
Around 1984, when outpatient surgery was in its adolescence, UCSF decided to design and develop a unit specifically for its growing population of surgical outpatients. Perioperative leadership appreciated that the main operating room's physical layout, workflow and administrative structure hindered efficient, cost-effective and patient-centered care. The unit would be on hospital grounds, but physically separate from the main operating rooms. Neal Cohen and Anthony Wagner, a hospital administrator, led the redesign of 12,000 square feet on the plaza level of the Ambulatory Care Center.
I was stationed at San Francisco General Hospital – where I had been tasked with developing an outpatient unit – when then Department Chair Ron Miller asked if I would be interested in applying to become medical director of the new unit.
One of the unit’s founding principles was to appreciate and continually earn the trust of patients and families who chose to have their care in the ASC. Our focus on service reflected an understanding that this care was delivered through a multitude of surgeons, ophthalmologists, pediatricians, internists, dermatologists, hematologists, oncologists, psychiatrists, pathologists and dentists. When someone needed care we tried not to hide behind the end of a shift, the end of block time or the threat of being over budget.
Preoperative, intraoperative and postoperative staff all worked under a single administrative structure. Post-Anesthesia Care Unit nurses became competent in conscious sedation and operating room (OR) nurses rotated through the preoperative process. I remain extremely proud that practices put into place by the nursing staff, support staff and anesthesiologists served and continue to serve as a model for all UCSF perioperative venues. We put the fun into functional!
Many Accomplishments
I am also proud that we pushed the limits of outpatient surgery by caring for patients that most other outpatient units wanted nothing to do with, such as those with cognitive disabilities, extremes of age and the seriously infirm. Our safety record was also a source of pride in that our unplanned admission rate was better than the benchmarks for the day and there were no deaths in the unit throughout its entire existence. We were unusually blessed to have long-term relationships with some of the most vulnerable patients and we strove to make such patients and families feel that our home was their home.
The ASC was also the first clinical site in the United States to routinely use the Laryngeal Mask Airway (LMA) and was one of the early adopters of propofol. UCSF programs that originated in the ASC include the in-vitro 
fertilization program, sports medicine, laser therapy in dermatology, electroretinography and auditory evoked potentials for children, dentistry for people with different abilities and outpatient electroconvulsive therapy (ECT).
Education of anesthesia residents focused on the care of the surgical outpatient and included:
- Use of the LMA family of products
- Management of ECT
- Care of the pediatric patient, including parental presence for induction and regional anesthesia
- Monitored anesthesia care
- Care of those with mental disabilities
- Regional anesthesia for sports medicine
- Efficiency
- Working in small groups with professionalism and good communication
Medical students were present in the Surgery Center from the beginning, as were learners from the UCSF School of Dentistry.
I must acknowledge the expertise and contributions of the over 250 individuals who served as ASC staff. Whether one greeted patients to make them feel at home, helped ready them for surgery, cared for them in the OR, applied one's skills to keep them safe and comfortable throughout, helped them recover, escorted them to the car, kept the instruments sterile and organized, kept the place clean, managed supplies and implants or provided the “manpower” to keep the place going – you played a vital role. I also acknowledge the many surgeons who earned our respect and admiration for their skills and, dare I say, friendship. I also acknowledge the scores of anesthesia faculty, CRNAs, residents and students who not only provided exemplary care, but also contributed to the education of scores of learners.
Anesthesiologists who played a prominent role in the ASC include Fred Orkin, Barbara Gold, Gregg Garbin, Walter Way, Jeff Swisher and Laura Siedman. For almost a decade Laura provided leadership, professionalism and unrivaled expertise along with a dedication to the care of the thousands of children who came through the ASC. She served as Medical Director for its last three years.
I also must acknowledge Ron Miller for his vision and support of the Surgery Center and me for over 22 years. Michael LeBoff must be recognized for the many years he literally stood next to the residents and faculty during induction and single-handedly managed anesthesia supplies and equipment— his workroom was second to none. A number of nurses also figure prominently in the success of the Surgery Center— Betty Yalich, Deborah Frase, Catherine Win and George Gomez. George defined the ASC as its Patient Care Manager for many years. The example he set in professionalism, ethics and dedication to the unit and the institution remain unrivaled to this day.
The ASC represents virtually my entire academic and clinical life at UCSF. I think about the tens of thousands of patients I had the privilege to care for, the poignancy of illness and the grace that patients and families demonstrated in dealing with, at times, unspeakable adversity. I am indebted to all the professionals that gave the ASC its deserved reputation. Most cherished are the learners. My legacy is the small role I played in helping medical students and residents appreciate our noble specialty.
Please send any comments or a description of a Surgery Center memory to [email protected].