This year, we have increased the visibility and delineated leadership responsibilities for the Subspecialty Division Directors in the Department of Anesthesiology. This group of individuals has worked diligently to enhance patient care and to help define and address issues that are specific to the subspecialties in our adult practice.
I thought it would be helpful to share with the Department, at large, all of the recent work of the Divisions. These accomplishments have been due to the great work of the leaders in these Divisions, as well as all of our faculty members, residents, CRNAs and CAAs who have participated in the outstanding patient care that we have been able to deliver.
Below, you’ll find a synopsis from each Division.
– Kathy Lauer
Cardiac
Director: Dr. Chris Plambeck
This has been a banner year for cardiac volume at FMLH with the revamping of the cardiac program under Dr. Paul Pearson. The addition of Drs. David and Lyle Joyce started the increase in volume. Subsequent addition of Dr. Lucian (Buck) Durham and, most recently, Dr. Goya Raiker has further contributed to this clinical growth. We welcomed Dr. Lonnie Dye from fellowship, and will welcome Dr. Octavio Falcucci, the incoming CVICU Director, who will join the cardiac group part time in October. Initiatives for the cardiac division have included standardization of reporting of TEE studies for this year and appropriate staffing and call coverage.
Volumes for Cardiac Surgery:
Critical Care
Interim Directors: Dr. Soo Kim/Dr. Justin Tawil
As the Cardiac Division has been busy, so has the Critical Care Division, and setting a high practice level noted by our hospital and enterprise senior leadership. Our admission volumes have increased commensurately. Due to this, we have added a CVICU day faculty position to enhance patient care and safety. This has been met with success and satisfaction from the Division members. We look forward to the arrival of Dr. Octavio Falcucci in October from Penn State as the Director of Critical Care. We are also adding four other intensivists to our Division over the course of these next couple of months: Dr. Michael Fierro, Dr. Jessica Zenga, Dr. Matthew Jeranek and Dr. Christy Idichandy.
General
Director: Dr. Rachel Budithi
This year in the General Division, we have had a lot of interest in partnering with the Department of Surgery to enhance patient care with the implementation of Enhanced Recovery after Surgery (ERAS) protocols and standardization of the care of patients through protocol development. These currently include Bariatric surgical and pancreatic cancer surgery pathways. The protocols can be found on A-Net. We are currently working to define and standardize the pathway for patients undergoing hepatic resections currently.
Neuroanesthesia
Director: Dr. Suneeta Gollapudy
This year we welcomed Dr. Bill Gross as an instructor/fellow in neuroanesthesia. He has an ambitious educational agenda that includes journal club, a revised curriculum and creation of a weekly topic bank to ensure standardization of teaching during the resident rotation. Also planned are podcasts of educational topics for just in time learning. He will be involved in one-on-one teaching of residents when he is in the OR. Clinically, we will work toward protocol and standardization for management of patients having spine surgery at FMLH.
OB Anesthesia
Director: Dr. Meredith Albrecht
MCW OB anesthesia continues to provide care at two sites: Froedtert Birth Center (FBC) and Ascension St. Joe’s Hospital (SJH). FBC has continued to see growth with a yearly delivery total of 3,050 and a monthly average of 250. There is an expectation of continued growth due to the hiring of new OB providers. SJH, after an initial fall-off in volume in January 2017, has stabilized with about 2,100 deliveries a year and a monthly total of 173. Due to the expansion of volume at FBC we have added staff including FBC2 (an additional day attending on weekdays) and a CAA shift in the evenings. The additional staff has allowed us to effectively manage the increased volume. We are excited to have added Dr. Steve Ropers and a fellow, Dr. Sarah Hall, to our team.
We have also gained a group of committed faculty from our “general” group who both take call and help with day work shifts. This group has greatly increased our scheduling flexibility. We have started working on some multidisciplinary projects including TeamStepps (to improve communication and patient safety at FBC) and ERAS for C-sections (starting at both sites). We are also working on starting some OB anesthesia research projects. For resident education, we have switched the principle training/orientation site to FBC, where we now have a daily weekday lecture. We have pulled one senior resident out of SJH (replaced with CAA) to allow for more educational opportunities elsewhere. We have added a SAA rotation to FBC. We have also learned to be creative with the nationwide local anesthetic shortage. We look forward as a team to the challenges ahead.
Pain Management
Director: Dr. Sarah Endrizzi
The Pain Management group has welcomed Drs. Tochi Umanakwe, Christopher Yopp and Omar Dyara. These faculty members will have some time dedicated to the FMLH ORs as well as growing the footprint of Pain Management in the new Drexel and Mequon clinics.
A multidisciplinary group is being led by Dr. Amit Singh to address deficiencies in the care of inpatients at FH with chronic pain, and developing an inpatient pain service. Areas of improvement are numerous, including patients with palliative care needs and cancer pain management. Other procedural planning includes education for referring physicians and coordination with the RAAPS service.
Regional Anesthesia/Acute Pain
Director: Dr. Karin Madsen Drescher
On the RAAPS team, there have been initiatives centered on education and orientation that include use of the Anesthesia Toolbox, RAAPS workshops, enhanced orientation, faculty lead daily PBLDs, and trouble-shooting guidelines developed by the faculty. Also, the RAAPS team welcomed both Drs. Groth and Owolabi as fellows this year. There will be a fellow assigned each day on the RAAPS team at FMLH and one each Tuesday at CMH.
The RAAPS team has also been integral in the implementation of the ERAS initiatives with GYN, General/Hepatobilary and Bariatric teams and is planning on developing ERAS initiatives with other services such as Plastic and Thoracic surgery.
Transplant
Director: Dr. Brent Boettcher
Our transplant volume and opportunities usually increase over the summer and this year has been the same. Our team is growing with the addition of Dr. Krystal Weierstahl. There have been a couple of initiatives that occurred this year:
- The commitment of the Transplant Anesthesia team to be present for all Transplant Selection Committee meetings (Tuesdays from noon – 1 p.m.). These meetings are critical to the integrity of the selection process as noted by not only all in the process but also those in the organization.
- The implementation of a formal consult by the anesthesia team prior to liver or combined liver kidney transplants. This is to fulfill the UNOS recommendation to have the anesthesiologists document the full evaluation that is completed in all cases.
Trauma
Director: Dr. Olga Kaslow
Trauma service continues to be busy. The trauma team is working on three current initiatives:
- Esophageal warming device. In-service for the trauma anesthesia attendings started on 7/25. The device is a soft probe that is warmed by the Blanketrol warmers in the room in an effort to minimize hypothermia in this vulnerable population.
- Neuro-trauma room set up standardization. The project members engaged pharmacy, nursing staff, front desk and anesthesia tech support to create a standard process and set up to facilitate the start of anesthesia for neuro-trauma procedures.
- TEG: ongoing project. The goal is to start assessment of coagulation in all trauma patients within their first minutes of arrival to the hospital in order to guide subsequent therapy. The workflow is being evaluated and piloted.