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:

10 May2017

Anesthesia Business Group Executive Management Program

One of the ways in which Envision Physician Services invests in its physicians’ and physician leaders’ professional development is to send selected anesthesia providers and practice managers to the Anesthesia Business Group (ABG) Executive Management Program. This exclusive, four-day, on-campus, residential program is offered during the first quarter of each year by ABG in partnership with the Wharton School of Business. It has been Wharton Executive Education’s most highly rated program for five years in a row. The 2017 session took place February 12–16.

Program Overview

The tightly structured program uses multiple educational formats including lectures, workshops, role-play exercises and multiple break-out sessions each day. All the instructors are well-known, highly-respected subject matter experts including top healthcare management consultants and some of Wharton’s most highly-rated professors and department chairs.

Topics spanned a range of issues essential to effective management and leadership including strategy, negotiation and collaboration, all with a healthcare/anesthesiology focus. For example, the first educational session was on “The Changing Landscape of Health Care: Implementing Strategy.” On the third day, Thomas (Tom) Gakis, COO, Department of Medicine at The Clinical Practices of the University of Pennsylvania, shared his observations on leadership and operations challenges from the Penn Medicine perspective. In the final session, participants learned the STAR model of high-impact leadership, which is based on helping leaders and their teams focus on small, repeatable actions that produce a practical culture of success. Some sessions included case studies from other industries that offered valuable, relevant insights, such as the groundbreaking, flexible Results Only Work Environment (ROWE) platform whose autonomy-with-accountability framework has transformed workplace culture and management practices at companies worldwide.

Role-Play Exercises

We spoke about the value of this program with two of this year’s attendees, Envision Physician Services’ senior vice president Steven Topfer, D.O. and vice president of anesthesia operations for the Northeast region Laura Irwin, MBA, FACMPE. Both highlighted the sessions involving role-play exercises, in which groups of participants honed core skills they used routinely in their practices. In the negotiation workshop, participants were divided into groups. One person in each group played the role of a commodities salesperson who had one day to profitably liquidate the entire global supply of an extremely rare, highly perishable commodity for cash. The three other participants in each group played potential buyers, each of whom needed only a specific part of the product. Dr. Topfer was by far the most successful of the six sellers, negotiating a 32 percent profit on a $600,000+ investment while satisfying the needs of all three buyers. He shared his winning strategy with the other participants: discovering each buyer’s most pressing priority and then putting together a deal where everyone’s needs, including his, were met. Dr. Topfer called the exercise “an incredible learning experience.” Each participant came away understanding his or her personal bargaining style, what types of questions to ask and the best time to ask them, when to exert pressure and how to use a collaborative approach to arrive at win-win agreements.

The session on collaboration also featured a role-playing exercise. The scenario involved the radical clash of cultures following a large, foreign corporation’s acquisition of an independent, family-owned and -run U.S. company. Participants role-played difficult conversations, putting themselves in the shoes of several key players: the new president, who was one of the executives sent by the parent corporation to replace the family managers and impose rigid control via the corporation’s autocratic and bureaucratic operating model; the vice president of sales, who was being called in by the president to discuss the drop in sales since the acquisition and a suspected violation of company policy by the top-performing salesperson; and that salesperson, a key influencer within the now mistrustful, demotivated and demoralized sales team that would likely walk out en masse unless something could be done quickly to restore their trust. “I thought this role-play exercise was great,” Irwin said. “The physicians were all so smart and had so much clinical expertise, and it was interesting to see those in play as they practiced developing their EQ [emotional quotient] skills.”

Key Takeaways

Dr. Topfer said he came away with many useful insights into management and leadership, e.g., if you want to listen, don't discuss. “In other words, if you're in a room and you want to hear what everybody's thinking and feeling, don't let one individual engage you in a discussion, because it will shut everybody down,” he explained. “Instead, say ‘We can talk about that, but first, I want to hear what everyone else thinks.’ I also learned that, as a leader, my job is to be right at the end of the meeting, not at the beginning. The solution doesn’t need to be my idea.”

Both he and Irwin found the program’s anesthesiology-specific lens on management and leadership issues extremely valuable. “I and many of the physicians in the room had done MBA programs, but typically, participants come from different industries,” Irwin explained. “You might get a healthcare emphasis, but you still wouldn't have a single-specialty focus on anesthesiology.” Dr. Topfer said he also appreciated the “unparalleled” networking opportunities with both the instructors and the other program participants during the activities, breakout sessions and formal and informal meals.

Both were extremely impressed by the quality of the education and the professionalism of the program. “There was nobody on their cellphone, nobody lost in electronica, no one who snuck out to go to the bathroom and didn’t come back,” said Irwin. “Everyone was fully engaged and leaning into it. I think that was partially the audience—mostly anesthesiologists and nurse anesthetists—but also a recognition of how special the program is.”

28 March2017

A Thank You to Doctors Who Volunteer to Help Those in Need

On National Doctors’ Day, we honor all physicians and express our gratitude for their dedication to their patients and commitment to our profession. This year, we also want to bring special attention and thanks to the many doctors and other clinicians who, in addition to their day-to-day contributions in their practices, generously volunteer their skills and time and open their hearts and wallets to help those in need.

Humanitarian Medical Missions

In previous posts, we have spotlighted some of our physicians who have joined humanitarian missions overseas. For example, pediatric anesthetist Richard Berlin, MD is the associate chief medical officer for Operation Smile, which delivers free surgical care to patients in more than 60 countries. In 2015, Dr. Berlin led Operation Smile’s inaugural obstetric fistula repair mission to the Democratic Republic of the Congo, joined by Sheridan anesthesiologist Dr. Jean Miles, Sheridan obstetrician Dr. Julie Kang and other medical volunteers from around the world. In March 2016, Drs. Berlin and Miles led another mission to the Democratic Republic of Congo to perform more obstetrical fistula repair surgeries. And in June, 2016, Dr. Berlin traveled to Managua, Nicaragua, where he and other volunteer physicians and nurses performed 93 surgeries to repair cleft lips and cleft palates in less than five days. He has participated in more than 25 missions with Operation Smile so far. 

  

Drs. Richard Berlin and Jean Miles with two of the patients they helped during Operation Smile missions

We’ve also shared the twice-a-year, five-day surgical missions to the Dominican Republic for which Francisco Alvarez-Gil, M.D., Chairman of Anesthesiology at Sheridan partner Bayside Ambulatory Center in Miami, Florida, has been helping to recruit teams of volunteer anesthesiologists and surgeons for the past several years. These surgical teams perform badly needed surgeries for underserved populations in rural areas. During last June’s mission, the team performed 60 operations on 1200 adult and pediatric patients in three days. 

Community Outreach

The head of the Sheridan Anesthesia Group at Bayfront Health in St. Petersburg, Florida, Chief Anesthesiologist Albert Kabemba, MD, has a motto he often shares with his team: “It’s always important to remember that there’s more to life than medicine.” He and the rest of his leadership team-Vice Chief Anesthesiologist Jaime Mercado, MD, Chief CRNA Erik Rauch and Vice Chief CRNA Kelly Wier-plan frequent team-building activities outside the hospital for the group’s 25 CRNAs and 10 anesthesiologists. Some of these are just for fun, e.g., an excursion to a new indoor skydiving facility, while others focus on being of service to those in need in nearby communities. Twice in December 2015 and again in December 2016, members of Bayfront’s anesthesia department and some of their family members volunteered at the St. Vincent de Paul’s Food Kitchen in St. Petersburg to help feed hundreds of poor, hungry and homeless individuals during the holidays. This is now an annual activity for the department.

        

December 2015 — Bayfront Anesthesia Group members and family members serving those less fortunate at St. Vincent de Paul’s Food Kitchen

When one of their CRNAs, Brandon Davis, was diagnosed with Multiple Sclerosis (MS) last year, the group quickly rallied to support him, joining the MS Walk 2016 in Largo Central Park and raising more than $3,100 in donations to help find a cure for MS. 

         

Bayfront Health Anesthesia Group’s “Team Davis Attack” at the 2016 MS Walk

The department has also adopted Mrs. Seabaugh’s third grade class at Campbell Park Elementary School. Campbell Park Elementary, which is just two blocks from the hospital, is in a poor neighborhood and ranked 2,064 of Florida’s 2,072 elementary schools in 2016. On November 16, as part of Pinella County Schools’ Great American Teach-In event, a group of Bayfront’s anesthesiologists and CRNAs visited Mrs. Sebaugh’s class and gave a presentation about what they do. They brought surgical masks, hats and gloves for the kids to wear and made it fun as well as interesting for them to learn about the anesthesia profession. The students were thoroughly engaged during the entire visit and didn’t want it to end. This was an extremely positive and meaningful experience for the Bayfront volunteers as well, which led to the department’s “adoption” of Mrs. Seabaugh’s class. They bought a toy bank that is brought to the weekly department meetings so anesthesiologists and CRNAs can make regular contributions. Rauch explained, “We tell everybody that if they can put in just a dollar each per week, we’ll have more than enough to provide the school supplies that the kids in Mrs. Seabaugh’s class need.” The Bayfront anesthesia department now makes regular visits during the class’s lunch period to serve as reading mentors and bring a treat, such as pizza. They also played Secret Santa in December, asking the kids for a wish list and then purchasing and delivering a gift for each student. “Every time we walk into the classroom, they get so excited,” said Rauch.

           

Members of Bayfront Health’s Anesthesia Department during their first visit to Mrs. Sebaugh’s third grade class at Campbell Park Elementary School, which they “adopted” soon thereafter

There are many others like Drs. Berlin, Miles, Kang and Alvarez-Gil and Bayfront Health’s Anesthesia Group who go above and beyond to make a difference. We celebrate their generous contributions that make their communities, and the world, a better place. 

28 March2017

Northside Team Saves Mother, Baby in Complicated Delivery

Air Force major Jerry Gay and his pregnant wife, Mary, were looking forward to the expected February 9 arrival of their new daughter. Mary was at home in Georgia and Jerry was deployed in Qatar, in the Middle East. But the couple’s joy became tempered with fear when Mary’s ob-gyn, Dr. Alex Eaccarino, noticed a spot that didn’t look quite normal during Mary’s 30-week checkup, per a recent story on Fox 5 Atlanta

The spot turned out to be uterine scarring from Mary’s prior cesarean-section deliveries. The scarring increased her risk for a placenta accreta, a potentially life-threatening obstetric condition that occurs when part or all of the placenta invades the uterine wall and is inseparable from it, preventing the placenta from detaching as it should during birth. "The biggest risk factor to the mom would be the risk of post-partum hemorrhage or uncontrollable bleeding," Dr. Eaccarino told Fox 5 Atlanta. Mary was told that she would need a C-section and that it was likely she also would need a hysterectomy to remove all or part of her uterus. Jerry immediately rushed home from the Middle East on emergency leave and was with Mary at Northside Hospital’s Forsyth campus on January 4 for her surgery.

Mary’s three surgeons and the anesthesia team from Sheridan practice Northside Anesthesiology Consultants (NAC) were extremely experienced in dealing with this type of complicated, high-risk delivery. Northside has the busiest obstetric practice in the country, delivering more than 25,000 babies and performing roughly 7,000–8,000 C-sections each year, according to John Kimbell, CAA, MMSC, NAC’s administrative chief anesthetist. 

Anticipating the possibility of hemorrhage, the anesthesia team placed invasive monitoring lines pre-operatively, and a large supply of blood products had already been cross-matched and were available, if needed—preparations that helped saved Mary’s and her unborn daughter’s lives.

The C-section went better than expected, with minimal bleeding, and it appeared that the placenta accreta was not as extensive as the surgeons had originally thought, Dr. Eaccarino told Fox 5. At that point, he said, they agreed it would be best to preserve Mary’s uterus and decided against performing a hysterectomy. Jerry told the reporter that while he was in the NICU with newborn daughter Sinclair, he was ecstatic to receive a call from Mary's surgical nurse, who told him that she was doing well and was being moved to the recovery area.

Unfortunately, this best-case scenario didn’t last long. When Mary woke up from the anesthesia, she was in severe pain and her nurse quickly realized Mary was bleeding excessively. The nurse "got my doctor back in there really quickly and the anesthesiologist back into the OR,” she recalled to the reporter. By then, Mary was hemorrhaging and needed more than 30 units of blood to replace the blood she was losing.

The anesthesia team, which included Stephen Grice, MD, Jeff Mims, CAA, Jeff Thomas, CAA and Patty Flaherty, CAA, among others, activated its Massive Transfusion Protocol that allows quick coordination with the blood bank and enables predetermined packages of different blood products to be delivered quickly and constantly. Thanks to that team’s prior preparations and the Massive Transfusion Protocol, the surgeons were able to stop the bleeding and remove part of Mary's uterus. Jerry told Fox 5 that it "the longest hour and a half of my life." 

When Mary woke up in the ICU, on a ventilator, she immediately asked to see her baby, Sinclair. "I don't think you can go through things like that and have it not change you,” she told the reporter. “I appreciate things a lot more."

In their interview with Fox 5 Atlanta, Mary and Jerry expressed their gratitude for Dr. Eaccarino and the entire Northside team, whose skill and alertness helped save both Mary’s and Sinclair’s lives, and for the dozens of strangers whose blood donations helped make the life-saving surgery possible.

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 Patient Safety Award

Two years ago, CRNA Jason Cobb’s alertness, quick thinking and willingness to speak up prevented a potential wrong-site surgery. He recently became the first recipient of a new patient safety award that was inspired by his actions that day and his demonstrated commitment to patient advocacy.

In December 2014, a patient was being prepared for knee surgery at one of Sheridan’s partner facilities in Middleburg, Florida. All the records, including the consent form the patient had signed, showed that the surgery was to be performed on his right knee. The OR team confirmed that as the correct surgical site during the routine pre-op time-out. But when 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 the patient's left knee.

Cobb quickly checked his records again to verify that the right knee was the correct one, then immediately stopped the procedure and explained his concern about the site discrepancy. The surgeon checked the X-ray again, which showed that the right knee required surgery. He immediately closed the incision and called an emergency meeting with the patient's wife and Quality and Risk Management. The surgeon explained openly what had happened and, at the patient’s wife's direction, the surgery was performed on her husband’s right knee.

Subsequently, the patient and his wife spoke with the hospital and North Florida Anesthesia Consultants (NFAC), which provides anesthesia services in the Duval/Clay County area, about the stress the family experienced because of the potential wrong-site surgery that Cobb’s alertness and actions had prevented. All the parties were eager 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 the hospital and its not-for-profit philanthropic foundation to establish an award named in honor of the patient and his wife. The award would 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 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.”  

Cobb 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. 

Cobb estimates that the award ceremony was attended by 50-75 people, including the hospital’s CEO and other administrators and the philanthropic foundation committee. The ceremony began with an address by the hospital’s system vice president and chief medical & quality officer. He described the incident that led to the creation of the award and showed the patient safety video, which features this patient’s case, that is now part of the orientation for all new employees of the entire health system nationwide.

After the ceremony, Cobb, who has been in nursing for 18 years, met the couple’s son, who thanked the CRNA for what he had done for the son’s father. Cobb’s wife, an employee at the same hospital who has been in nursing for 25 years, finally had the opportunity to meet the patient and his wife, 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.”
 

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