Anesthesiology

Sheridan Healthcare has been supplying anesthesia services to hospitals and ambulatory surgery centers for nearly 60 years. We are more experienced than any other anesthesia provider in the country, and we’ve retained our first clients since 1953.

We work toward increasing the use of operating rooms and reducing overall hospital expenses. Access to an operating room is facilitated through better capacity management, efficient turnover, availability of coverage and improved on-time starts. Often, increased OR volumes, coupled with the collaborative working relationships our teams foster, result in the highest approval ratings from surgeons and hospital administrators.

Our locally based teams are comprised of full-time, board-certified or board-eligible anesthesiologists, CRNAs and AAs (anesthesiologist assistants). Learn more about our anesthsia management services.

Read our anesthesiology-related posts:

23 March2017

The Role of Professional Development in Physician Engagement

Sheridan’s Chief Quality Officer Gerald Maccioli, MD, MBA, FCCM sees physician engagement as essential for all stakeholders. He spoke with Becker’s ASC Review recently about the value of investing in comprehensive professional development opportunities for physicians to keep them engaged. 

“We all want the quadruple aim—which includes a satisfied population of physicians,” he said in the Q & A. “If engagement isn't developed, you are never going to get to that. It will always be a push and pull rather than a rolling together phenomenon.”

Dr. Maccioli explained that physicians are highly educated problem solvers for whom development and engagement are connected, and offering them the chance to participate in strategic training increases their engagement. “If the physician is given the authority to co-lead, coupled with strategic planning training, that is a way to engage the physician and create buy-in at the same time. Physicians need to feel like they are making an impact,” he said. He believes that providing education around what processes doctors can impact and giving them a venue to do so are key to furthering their professional development. 

Communication is also important. The culture of a clinical practice is different from the culture of business, so physicians and administrators may not be on the same page. “Connecting the role of the clinical physician to organizational strategy and market trends is critical to trying to figure out where their training can be impactful,” Dr. Maccioli said.

Because of the siloed nature of clinical practices’ and administrators’ work, he argues that for physicians to be full partners, they need to understand the hospital’s business strategy. For that reason, he thinks hospitals should offer basic courses in fundamental business skills like finance and strategic planning. “Before I got my MBA and really became involved in strategic planning, there was a disconnect between clinical life and strategic direction,” he explained. “You can work at a facility 20 years and still not know what the organization's strategic goals are.”

When asked for specific examples of an organization's investment in professional development and physician engagement, Dr. Maccioli mentioned three of the development opportunities offered by Sheridan. One is an annual, three-day Sheridan Leadership Conference, the flagship event of the Sheridan Leadership Academy, which includes specialty-specific break-out tracks to keep physicians abreast of what is going on in their areas of specialization. Sheridan also sends selected anesthesiologists to a specialized one-week, intensive, Anesthesia Business Group Executive Management Program, offered in partnership with the Wharton School of Business. “We have seen this pay off, and people who take up this opportunity go on to assume departmental and leadership roles in the company.” He also mentioned the Sheridan Leadership Academy’s flagship Emerging Leaders Program, an 18-month program in which the participants, who must be nominated by their clinical leaders, are each paired with a Sheridan clinical or operational leader to coach them through a Capstone Experience in which they choose and tackle a current, real-life work challenge. The program culminates with the participants’ presentations of the results and lessons learned to their coaches and then to key stakeholders and other corporate executives. “I think the best leaders are grown and honed from within,” said Dr. Maccioli, “and that is the philosophy that exists here.” 

21 March2017

Three Breakthrough Technologies That Will Change Medicine

The Massachusetts Institute of Technology (MIT) publishes an annual list of 10 Breakthrough Technologies. Three innovations from this year’s list promise to have a dramatic impact on the future of medicine.

Brain Implants that Reverse the Effects of Paralysis

In recent years, brain implants have enabled lab animals and even a few people to use thoughts to control computer cursors or robotic arms. According to the 2017 MIT report,  researchers are “taking a significant next step toward reversing paralysis once and for all” using what French neuroscientist Grégoire Courtine calls a “neural bypass.” Wireless implants transmit electrical impulses from brain to spinal cord, bypassing damaged parts of the central nervous system and enabling movement of limbs once paralyzed due to spinal cord injuries. Courtine and a team of researchers at a Swiss university have used the implanted electronics to restore mobility of a partially paralyzed macaque monkey in hopes of future applications with humans.

A team at Cleveland’s Case Western Reserve University placed two of the same type of implants used in the Swiss experiment in the brain of a middle-aged quadriplegic volunteer who, on his own, could not move any part of his body other than his head and a shoulder. The implants are smaller than a postage stamp and “bristle with a hundred hair-size metal probes that can ‘listen’ as neurons fire off commands.” The Case team also inserted more than 16 fine electrodes into the muscles of the volunteer’s arm and hand. According to the MIT report, in videos of the experiment, “the volunteer can be seen slowly raising his arm with the help of a spring-loaded arm rest, and willing his hand to open and close. He even raises a cup with a straw to his lips.” This transformational technology is expected to be available in 10 to 15 years.

Next-generation Gene Therapy

For decades, researchers have been pursuing the idea of gene therapy—what the MIT report calls the use of “an engineered virus to deliver healthy copies of a gene into patients with defective versions”—with mostly disappointing results. Now, researchers have solved some of the puzzles that caused many earlier gene therapies to fail. Scientists are “using viruses that are more efficient at transporting new genetic material into cells” to develop the next generation of gene therapies—or “gene therapy 2.0”—to treat patients with rare hereditary diseases. 

European regulators have approved two of the treatments. One is Strimvelis, for treating children with severe combined immunodeficiency due to adenosine deaminase deficiency (ADA-SCID). The other is Glybera, for treating patients with lipoprotein lipase deficiency (LPLD), a rare disease that causes fat to accumulate in the blood and increases the risk of acute and recurrent pancreatitis. 

In the United States, one of Spark Therapeutics’ gene therapies for inherited retinal diseases (IRDs) is in phase III clinical trials. The company’s hemophilia B therapy, SPK-9001, is currently in an ongoing phase i/ii clinical trial and recently received breakthrough therapy and orphan product designations from the U.S. Food and Drug Administration. Another promising gene therapy in development could lead to a cure for hemophilia and enhance healing in patients suffering from epidermolysis bullosa, an excruciatingly painful and sometimes fatal hereditary skin disease. 

According to the MIT report, researchers are conducting clinical trials for gene therapies for some 40 to 50 diseases. “Fixing rare diseases, impressive in its own right, could be just the start.” 

The Human Cell Atlas

An international consortium of scientists is being assembled to develop the first comprehensive map of human cells. Biologists, clinicians, technologists, physicists, computational scientists, software engineers and mathematicians from the U.S., U.K., Sweden, Israel, the Netherlands, and Japan will be collaborating on the construction of what the MIT report calls “biology’s next mega-project”—a “cell atlas” that catalogs and maps the 37.2 trillion cells of the human body. 

The Human Cell Atlas website explains the significance of this massive, ambitious and unprecedented undertaking. “A complete Human Cell Atlas would give us a unique ID card for each cell type, a three-dimensional map of how cell types work together to form tissues, knowledge of how all body systems are connected, and insights into how changes in the map underlie health and disease. It would allow us to identify which genes associated with disease are active in our bodies and where, and analyze the regulatory mechanisms that govern the production of different cell types.”

The MIT report calls the future genomic reference map “a technological marvel that should comprehensively reveal, for the first time, what human bodies are actually made of and provide scientists a sophisticated new model of biology that could speed the search for drugs.”

According to the report, this new type of mapping is possible thanks to the confluence of three technologies: 

  • Drop-Seq—described in the abstract of a 2015 Cell article by Evan Z. Macosko and his colleagues as “a strategy for quickly profiling thousands of individual cells by separating them into nanoliter-sized aqueous droplets, associating a different barcode with each cell’s RNAs, and sequencing them all together.” 

  • Ultra-fast, extremely efficient sequencing machines that can decode and identify the genes active in single cells “at a cost of just a few cents per cell. One scientist can now process 10,000 cells in a single day.”

  • Innovative labeling and staining techniques that “can locate each type of cell—on the basis of its gene activity—at a specific zip code in a human organ or tissue.”

Among the key supporters of this project are the U.K.’s Wellcome Trust Sanger Institute, the Broad Institute of MIT and Harvard in Massachusetts, and the new Chan Zuckerberg Biohub in California funded by Facebook CEO Mark Zuckerberg and his wife, Priscilla Chan. Zuckerberg and Chan made the Human Cell Atlas project “the inaugural target of a $3 billion donation to medical research,” according to the MIT report. The human cell atlas should be available in five years.

28 February2017

The Stealthy Spread of Superbug CRE in U.S. Hospitals

An alarming new study from the Harvard T.H. Chan School of Public Health and the Broad Institute of MIT and Harvard suggests that carbapenem-resistant Enterobacteriaceae (CRE)—a new class of superbug referred to as “nightmare bacteria” by former CDC director Dr. Tom Frieden—may be spreading more widely and more stealthily than was previously thought. The researchers found that CREs are growing in numbers and strength, are far more diverse than expected, and have many more mechanisms for not only resisting antibiotics but also spreading that resistance to other bacteria than have been identified to date. The study’s findings were published in January in the Proceedings of the National Academy of Sciences (PNAS).

The CDC has called CRE a “triple threat”: These superbug bacteria are resistant to all or nearly all available antibiotics, including the carbapenem class, considered the “last line” drugs for such infections. They are associated with high mortality rates. And they have the alarming ability to transmit their antibiotic-resistant genes to other bacteria, threatening to make even common infections, such as E. coli, untreatable. In fact, last year a Pennsylvania woman was infected with a strain of colistin-resistant E. coli bacteria, the first time in the U.S. that scientists found bacteria carrying colistin-resistance gene mrc-1

While the researchers found little evidence of transmission of CRE bacteria from patient to patient in the hospital setting, they did see what William Hanage, associate professor of epidemiology at the Harvard T.H. Chan School of Public Health and the study’s senior author, termed “a riot of diversity” of CRE species as well as a wide variety of genetic traits that enable these bacteria to resist antibiotics. There are genes known to give bacteria resistance to carbapenems, but the researchers also found bacteria that did not carry those signature genes, yet were resistant to carbapenem antibiotics. The resistance mechanisms in those bacteria are not yet known. The researchers also found that these traits are transferring easily among different species of CRE. 

The study found indications of “continued innovation by these organisms to thwart the action of this important class of antibiotics.” According to a recent article in STAT, Dr. Alexander Kallen, an infection control expert at the CDC who refused to comment specifically on the study, agrees that CREs have myriad ways of overcoming drugs. 

Given that there wasn’t much evidence of transmission within hospitals, the question of how the bacteria are spreading remains unknown. Could it be transmitting from person to person asymptomatically?  The researchers recommend an increase in genomic surveillance of CREs. A Harvard press release quotes Hanage as saying, “The best way to stop CRE making people sick is to prevent transmission in the first place. If it is right that we are missing a lot of transmission, then only focusing on cases of disease is like playing Whack-a-Mole; we can be sure the bacteria will pop up again somewhere else.” 

27 January2017

Jason Cobb, CRNA Receives Inaugural Bob & Ethel Allison Patient Safety Award

The Bob & Ethel Allison Patient Safety Award was conceived in response to a potential wrong-site surgery two years ago that was prevented thanks to the alertness, quick thinking and willingness to speak up of CRNA Jason Cobb. On Tuesday, Cobb became the first recipient of the award his actions helped inspire.

In December 2014, Bob Allison was being prepared for knee surgery at St. Vincent’s Medical Center Clay County in Middleburg, Florida. All the records, including the consent form Bob had signed, showed that the surgery was to be performed on Allison’s right knee, and the OR team confirmed that as the correct surgical site during the routine pre-op time-out. But when Jason Cobb looked over the drape about two minutes into the procedure to check on how things were progressing, he noticed the surgeon was on the left side of the bed and the incision had been made on Allison’s left knee. Cobb quickly checked his records again to verify that the right knee was the correct one and then immediately stopped the procedure. He explained his concern about the site discrepancy and the surgeon checked the X-ray again, which showed the right knee required surgery. He immediately closed the incision and called an emergency meeting with Ethel Allison and the Quality and Risk Management, where he explained openly what had happened. At Mrs. Allison’s direction, the surgery was then performed on her husband’s right knee.

Subsequently, the Allisons spoke with the hospital and North Florida Anesthesia Consultants (NFAC), which provides anesthesia services for all three St. Vincent’s Medical Centers in the Duval/Clay County area, about the stress the family experienced as a result of the potential wrong-site surgery that Cobb’s alertness and actions prevented. All the parties were anxious to do something to help prevent this type of situation from happening in the future. The family and NFAC, which was acquired by Sheridan in 2016, partnered with hospital and The St. Vincent’s HealthCare Foundation to establish an award named in the Allisons’ honor to reward medical staff for making patient safety their highest priority and, as Cobb says, for “speaking up in an environment where you might feel that you are not the highest authority in the room and you might be afraid to say something when you see things that are wrong.” Cobb hopes the award, which will be presented quarterly, “will encourage others who may be afraid to speak up for fear of retaliation or of being fired – young people, new nurses, new graduates, people in other fields who are not in positions of authority at the hospital – to say something when they notice a potential issue and know that the hospital will support them and have their back.”  

He is extremely modest about being the award’s inaugural recipient, saying “I don’t think I did anything special, nothing that anyone else wouldn’t have done.” But the Summary Data of Sentinel Events Reviewed by The Joint Commission suggests he’s not giving himself enough credit: Wrong-patient, wrong-site and wrong-procedures were the second most common type of sentinel event reviewed by the Joint Commission that year. 

Practice manager Sarah Turpie, MBA, MSN, RN, praises Cobb’s outstanding clinical, leadership and personal qualities and says he quickly became a valued member of the group after joining NFAC in February 2014. When he applied for the group’s inaugural Chief AHP position last year when Sheridan acquired NFAC, Turpie says that during the interviews he stood out as a leader who would put his coworkers first, represent their collective voice well, and maintain the group's “unique cohesiveness.” Since Cobb became Chief AHP, she says he has taken on every challenge given to him “with utmost attention and dedication” and has gone the extra mile to solicit and implement ideas from the staff to improve their work environment. 
 
The employees from all three St. Vincent Duval/Clay County campuses, which are part of the Ascension Health system, were invited to the award ceremony. Cobb estimates 50-75 people attended, including the hospital’s CEO and other administrators and the St. Vincent’s HealthCare Foundation committee. The ceremony began with an address by the hospital’s system vice president and chief medical & quality officer, Ken Rothfield, MD, who described the incident that led to the creation of the award. He showed the patient safety video featuring the Allison case that is now part of the orientation for all new Ascension Health employees nationwide. Mrs. Allison also spoke about how the risk of the wrong-site surgery had affected her family.
 
After the ceremony, Cobb, who has been in nursing for 18 years, met the Allisons’ son, who thanked him for what he had done for Bob. And Cobb’s wife, a St. Vincent’s employee who has been in nursing for 25 years, finally had the opportunity to meet Mr. and Mrs. Allison, who told her, “We love Jason as much as you do.” After the ceremony, the Cobbs returned to be with another of Jason’s biggest admirers, his 12-year-old daughter, who couldn’t wait to hear all about the event and see her father’s well deserved award. 

17 January2017

Study Identifies Risk Factors for Congenital Heart Disease in Infants

A study in the Canadian Medical Association Journal identified the chronic conditions that may predispose women to give birth to infants with congenital heart disease, also known as congenital heart defects or CHD.

The study reviewed the Taiwan Maternal and Child Health Database’s records of 1,387,650 live births from 2004 to 2010. The researchers investigated three data sets including:

  • Birth Registrations data on the sociodemographic characteristics of live births
  • Birth Notifications data on prenatal care and the lifestyles of pregnant women
  • Medical claims data from Taiwan’s National Health Insurance program

The researchers found that several maternal chronic diseases were associated with higher rates of CHD in babies. These conditions include type 1 and type 2 diabetes, hypertension, CHD, anemia, connective tissue disorders, epilepsy and mood disorders. Pregnant women who are identified as at risk can receive preconception counselling and developing fetuses can be more closely screened for CHD via fetal echocardiography. Early recognition of CHD can additionally help clinicians optimize the care of both women and infants.

That said, there are some limitations to the study. The detection period for the study was restricted to the first year of life. Potential cases of CHD may have developed in later years; however, under-identification should be minimal, given the high frequency of prenatal care and health checkups for infants under National Health Insurance coverage. Additionally, researchers noted that maternal lifestyle factors, including smoking and alcohol consumption, were likely to be underreported in the Birth Notifications data set.

About CHD

CHD affects nearly 1 percent of births per year in the United States and is a leading cause of birth defect-associated infant illness and death, according to the CDC. About 25 percent of babies with CHD have a critical CHD and generally require surgery or other procedures in their first year of life.

Although a few states track CHD among newborns and young children, no tracking system exists for older children and adults with heart defects. A study published last July estimates that approximately 2.4 million people – including 1.4 million adults and one million children – were living with CHD in the U.S. in 2010. Nearly 300,000 of those individuals had severe CHD.

Research projects like the review published in the CMAJ continue to improve care for people affected by CHD. Improved counseling and screening procedures for CHD have the potential to both reduce the prevalence of CHD and its resulting fatalities.

5 January2017

Our 10 Most Popular Blog Posts of 2016

The most-read posts on the Sheridan blog in 2016 focused on key topics – ranging from the challenges involved in the transition to value-based care and this country’s physician burnout epidemic to exciting technology innovations and trends in clinical practice.

The 10 most popular posts from the past year are:

  1. How to Manage the Burdens of Change on Physicians and Health Care Practitioners, a summary of Chief Quality Officer Dr. Gerald Maccioli’s presentation at the 2016 Health:Further Summit about the overwhelming burdens on providers created by current and planned changes to the U.S. health care landscape and strategies for managing them.

  2. Sheridan’s 2016 Leadership Conference Recognizes Eight Outstanding Clinical Leaders: Dr. Mike Adkins, Anesthesia Services Chief of the Year; Dr. Joseph Toscano, Emergency Medicine Chief of the Year; Dr. Frank Seidelmann, Radiology Chief of the Year; Dr. Mitchell Stern, Women’s and Children’s Chief of the Year; Dr. Adam Blomberg, Diamond Award Winner; Cindy Houck, CRNA, Platinum Award Winner; Dr. Gary Gomez, Innovation Award Winner; and Dr. Jonathan Katz, Innovation Award Winner.

  3. Six Physician Communication Strategies to Increase Patient Engagement and Improve Outcomes, including encouraging patients to talk about psychosocial factors that might be related to their conditions, tailoring communications to each patient based on his/her culture, values and beliefs to avoid inadvertent offense or mistrust, educating patients on care best practices and about responsible antibiotic stewardship, providing compassionate, personalized care and reassurance, and providing online information resources to educate patients and set appropriate expectations.

  4. Technology Innovations That Will Transform the Future of Radiology, including the groundbreaking work of the IBM Watson Health medical imaging collaborative, in which Sheridan and its chief of teleradiology, Dr. Glenn Kaplan, are playing a key role.

  5. Five Medical Practices That Soon May Be Outdated, including hospitals advising doctors not to apologize, prescription labels that don’t include what condition the drug is treating, monitoring handwashing by hospital staff, doctors spending more time on paperwork than on patient care, and making it difficult for patients to get their medical records quickly.

  6. The AMA’s New Tools to Ease MACRA Transition for Physicians, including the MACRA Assessment (aka Payment Model Evaluator), new MACRA-focused modules in the AMA STEPS Forward interactive, online practice transformation series, and the Inside Medicare’s New Payment System ReachMD podcast series.

  7. The Physician Burnout Epidemic, Part 1: Root Causes of This Alarming Trend, which looked at the factors fueling the increase in U.S. physician burnout. Part 2 offered strategies physician leaders can use to help combat burnout.

  8. Career Advice from Sheridan’s Chief Medical Officer for Radiology Services, Dr. Frank Seidelmann, including being proactive in managing your career, embracing technology and investing in your professional development and of the physicians you lead. 

  9. How Video Laryngoscopy Is Shaping the Future of Anesthesiology, which highlighted a discussion by Regional Medical Director Dr. Joseph Loskove, Chief Quality Officer Dr. Gerald Maccioli and National Education Director, Anesthesiology Division, Dr. Adam Blomberg in their Anesthesia News article, The Shift Toward Video Laryngoscopy: The Good, the Bad, and the Future.

  10. Pain Management Boosts Patient Satisfaction, which addressed the significant impact of addressing patients’ and caregivers’ concerns and setting their expectations appropriately – as well as treating patients’ physical pain – on their satisfaction with their pain management and overall care. 

22 December2016

Putting Patients at the Center of the Perioperative Period

Dr. Adam Blomberg, Sheridan’s National Education Director, Anesthesiology Division, is a strong proponent of putting patients at the center of the entire perioperative period rather than just during preoperative testing. That’s the focus of a new program, TEMPO, that Sheridan has just begun to roll out formally at two partner facilities. 

TEMPO evolved from Sheridan’s proprietary ClearPATh preadmission testing (PAT) framework, which significantly streamlined the PAT process by increasing efficiency and freeing up other operating room (OR) resources. This framework has helped Sheridan anesthesiologists reduce or eliminate unnecessary testing, consultations and preoperative visits and given them the tools to coordinate all the aspects of patient care they touch. ClearPATh has made PAT patient-centric rather than a cookie cutter testing approach. It has also shortened wait times and reduced same-day cancellations – a win-win-win for hospitals, physicians and patients. 

The new TEMPO framework, which builds on the success of ClearPATh, gives anesthesiologists the tools to take ownership of the entire perioperative period, rather than just preoperative testing. Dr. Blomberg explained that TEMPO is named for the “coordinated rhythmic movement” that the new framework is designed to orchestrate to further increase efficiency, reduce delays and improve patient satisfaction throughout the perioperative period. Speaking with Megan Wood of Becker’s Spine Review, Dr. Blomberg said, "It's a coordinated effort when a patient goes to surgery and there should be a rhythm to it; it should not be sporadic."

For example, postoperative nausea is a common patient complaint. The TEMPO framework gives Sheridan anesthesiologists streamlined, readily accessible guidelines for postop nausea management as well as other aspects of postoperative pain management, including ERAS (enhanced recovery after surgery) programs. Sheridan is also preparing to pilot preoperative pharmacogenetic testing next year that will help anesthesiologists tailor medications based on patients’ genetic data. This will not only minimize negative drug reactions but also help identify patients with a predisposition to narcotic addiction. For these patients, Sheridan anesthesiologists can find pathways for treatment using no or limited opioids during the perioperative period.

"If you have standardized care with evidence-based medicine practices, you're going to improve outcomes," Dr. Blomberg explained.
 
To learn more about how Sheridan is using TEMPO to put patients at the center of perioperative care, read excerpts of Dr. Blomberg’s interview in Becker’s Spine Review article, “Centering the perioperative period around the patient.”
 

21 December2016

Sublingual Sufentanil Safe and Effective for Controlling Postoperative Pain

A recent postoperative pain study sponsored by AcelRx Pharmaceuticals has demonstrated the safety and efficacy of sublingual sufentanil for controlling moderate to severe acute postoperative pain. AcelRx has an Investigational New Drug (IND) application with the U.S. Food and Drug Administration (FDA) to prove that sublingual sufentanil mini tablets are safe and efficacious in the treatment of moderate to severe acute postoperative pain. The sponsor approached Sheridan Clinical Research in April, 2016 about participating in this multicenter, randomized study of its 30-mcg sublingual sufentanil tablet, which must be administered by a healthcare professional. Sheridan anesthesiologist Juan Restrepo, MD, who had participated previously in a study of patient-controlled, 15-mcg sublingual sufentanil, was the Principal Investigator for the location research conducted at Boca Raton Regional Hospital. For this study, Dr. Restrepo followed a randomized group of patients who had a procedure with general or spinal anesthesia and who needed to remain at the hospital for at least 12 hours afterward.

Sublingual sufentanil adheres to the sublingual mucosa within seconds of administration. Due to its very small size, it causes minimal taste and saliva response, minimizing the amount of swallowed drug. The 30-mcg sublingual sufentanil tablet is in Phase III development. Per an Anesthesiology News article, the tablet is being developed in collaboration with the Department of Defense, which hopes to use it to treat moderate to severe acute pain in settings such as battlefield trauma, emergency medicine and ambulatory surgery.

Pamela Palmer, MD, PhD, chief medical officer and co-founder of AcelRx Pharmaceuticals, said in the article that results from the multicenter study suggest that 30-mg tablets are “efficacious and well tolerated across a variety of ambulatory surgery procedures for the management of moderate to severe acute postoperative pain.” She continued, “Patient comfort and satisfaction postoperatively and time to discharge are critical end points, and sublingual sufentanil appears to address both of these. Sufentanil’s prompt absorption into the central nervous system and lack of active metabolites scientifically support such desirable outcomes.”

 

 

Juan Restrepo, MD

15 December2016

U.S. Surgeon General Calls for Action on the Opioid Crisis

Opioid abuse remains a devastating public health concern, and the health care community has grappled with its role in the crisis and medical professionals’ responsibility to patients struggling with substance use. U.S. Surgeon General Vivek Murthy has responded with a report released last month analyzing the current opioid crisis and providing several recommendations for treating and preventing substance use disorders. These recommendations include:

1. Eliminate stigma

Misconceptions and negative judgments about people with substance use disorder abound, and the report stresses that even medical professionals are not immune to seeing addiction as a “moral failing or character flaw.” Murthy’s report states that substance use disorder is a medical problem, and that as such doctors should lead a cultural shift in thought through advocating for medicine and counseling treatment for affected patients.  

2. Provide effective screening

Along with its goal of changing societal perceptions of addiction, the report calls for changing the health care system’s process for identifying substance use disorder. Effective screening must occur in general health settings, including primary, psychiatric, and emergency care centers. With this change, physicians can identify affected patients earlier and create individual treatment plans for them.

3. Make use of medication

One of the many misconceptions about the opioid crisis is the assumed futility of medical treatment – it is essentially seen as “substituting one substance for another,” so abstinence is believed to be the best treatment plan. Murthy’s report extensively disputes this belief, asserting that using approved medicines within a broader behavioral therapy plan can help treat substance use disorder.

4. Involve an integrated medical team

Ultimately, Murphy’s report declares that effective substance use treatment plans must involve an integrated team of social workers, recovery specialists, nutritionists, and other caregivers. As with programs designed for diabetes or cancer treatment, all aspects of the affected patient’s life must be considered to address and treat the disorder.

Programs to Aid in the Fight Against the Opioid Crisis

Many patients first encounter opioids during the surgical period. As the nation’s largest anesthesia provider, Sheridan is piloting several initiatives aimed at combating the opioid crisis by reducing the opportunity for exposure. 

  • Sheridan anesthesiologists and their surgical colleagues are piloting ERAS (enhanced recovery after surgery) programs, using a combination of non-steroidal anti-inflammatory agents and specialized regional nerve blocks with local anesthetics to optimize recovery and minimize narcotics use. 
  • We are also preparing to pilot pre-operative pharmacogenetic testing next year. Not only will this testing help anesthesiologists tailor medication based on a patient’s genetic data, thereby minimizing negative drug reactions, but it will also help identify patients predisposed to narcotic addiction. For these patients, Sheridan physicians can find pathways for treatment using limited to no opioids during the perioperative period. 

Our goal is to gather and share data on the effectiveness of these programs to help enrich the health care community’s efforts to stop the opioid crisis. 

14 December2016

Using Icon-based Transport Labels to Cut Blood Product Waste and Save Money

Even simple, inexpensive changes can have a big impact on solving challenging problems. A great example is the University of Florida (UF) College of Medicine successful initiative that dramatically reduced blood product waste and saved the hospital nearly $20,000 in five months, just by replacing text-heavy instruction labels for blood transport coolers with intuitive, icon-based labels.

A multidisciplinary committee comprising blood bank staff, anesthesiology staff and operating room managers determined that a significant cause of operating room blood product waste was units that were stored and/or returned outside the required temperature range established by the American Association of Blood Banks (AABB), according to the abstract of a presentation at the 2016 annual meeting of the International Anesthesia Research Society (IARS). The committee was inspired by a Mayo Clinic study of a blood transport and storage initiative that significantly reduced median monthly red blood cell and fresh-frozen plasma waste and saved approximately $9,000 per month after replacing existing storage coolers and improving the educational cooler label. The UF College of Medicine committee decided to start small by testing the impact simply changing the label. 

According to a recent Anesthesiology News article. Ashley Screws, M.D., an anesthesiologist at the UF College of Medicine and UF Health Shands Hospital in Gainesville, Florida, worked with her team on the visual, icon-driven label design to replace the previous text-heavy label that was often ignored. The new labels were implemented hospital-wide in September 2015.

A $20K Savings In Just Five Months

Dr. Screws and co-investigators, Jeffrey White, M.D., and J. Peter R. Pelletier, M.D., compared data for blood product waste collected during October/November 2014 with data for blood product waste collected during October/November 2015. During October/November 2014, 235 product units were marked for waste, 25.5 percent of which were returned to the blood bank outside of regulation temperature range, and the total calculated cost of this waste was $9,167, per the abstract ($8,717, according to the Anesthesiology News article). During October/November 2015, after the new transport cooler labels were implemented, only 149 blood product units were wasted and only 10.7 percent of those were returned outside of temperature range, a $3,178 total calculated waste cost – a $6000 ($5,500) year-over-year (YOY) savings for those two months. The number of lost platelet units, the most expensive of the blood products, decreased from six units during October/November 2014 to only two platelet units during October/November 2015.

During the presentation, Dr. Screws reported the researchers also compared blood product waste collected December 2014–February 2015 with waste collected December 2015–February 2016, according to the article. During December 2014–February 2015, 99 product units were marked for waste, of which 34 percent were returned to the blood bank outside of regulation temperature range – a total calculated waste cost of $21,987 for the quarter. During December 2015–February 2016, only 32 blood product units were wasted, of which only 11 (34 percent) were returned outside of regulation temperature range at a total calculated waste cost of $8,155 versus the same period the prior year – a savings of nearly $14,000. Including the $6,000 savings during October-November 2015, that’s a $20,000 YOY savings over five months, even though large transport coolers in which massive transfusion protocol blood products are dispensed did not have the new labels until December 2015. 

The hospital plans to build on this success by creating new labeled bags for platelet transport to prevent them from being placed inside coolers improperly and an electronic medical record reminder to encourage proper and timely blood product return.

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