Table of Contents
Message from the Chair.............................................................2
RESEARCH
Department Overview................................................................3
Research Overview..................................................................37
Department Leadership..............................................................4
Labs Focus on Translational Science.......................................38
Administrative Staff...................................................................5
Key Clinical Research Studies.................................................41
Endowed Lectureships & Awards..............................................6
Vanderbilt Lands Patient-centered Research Grant ................43
EDUCATION
Putting the Power of Technology into Practice........................44
Office of Educational Affairs.....................................................8
Perioperative Clinical Research Institute (PCRI)....................46
Educational Courses and Conferences.....................................10
Vanderbilt Anesthesiology & Perioperative Informatics
Research (VAPIR) Division.....................................................48
Simulation Provides Invaluable Lessons................................. 11
BH Robbins Scholars Excel.....................................................12
Department Plays Lead Role in $1 Million AMA Grant.........15
Center for Research & Innovation in Systems Safety (CRISS)...50
Selected Publications, 2012-2013............................................51
Achieving Balance...................................................................56
Vanderbilt International Anesthesia Continues to Expand.......16
New Faculty Reinforce International Outreach.......................19
CLINICAL CARE
Clinical Overview....................................................................20
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Division of Pain Medicine.......................................................31
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Division of Obstetric Anesthesiology......................................30
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Division of Neurosurgical Anesthesiology..............................29
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Division of Multispecialty Adult Anesthesiology....................28
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Anesthesia Technicians Provide Critical Support....................27
P e ri o p e r a ti v
Certified Registered Nurse Anesthetists...................................26
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Division of Cardiothoracic Anesthesiology.............................25
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Division of Anesthesiology Critical Care Medicine................24
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Division of Ambulatory Anesthesiology..................................22
Established 1946
Division of Pediatric Anesthesiology.......................................33
Division of Pediatric Cardiac Anesthesiology.........................34
Vanderbilt Preoperative Evaluation Center (VPEC)................35
Veteran’s Affairs Anesthesiology Service................................36
1
Message from the Chair
We are in a time of growth and transformation at the Vanderbilt
University School of Medicine’s Department of Anesthesiology. The
department is vibrant and strong, and we are well prepared to face the
challenges that the changing healthcare economy will surely place
before us.
The department is excelling in all areas of our three-fold mission:
•
•
•
Practicing excellent perioperative medicine
Providing top-notch education for our medical students,
residents, and fellows
Conducting cutting-edge basic, translational, and clinical research
We have one of the largest clinical programs in the country, providing
on-demand coverage for more than 90,000 adult and pediatric
anesthetic encounters annually at more than 100 anesthetizing
locations. We cover critical care, pain management, and all
perioperative anesthesia needs. Vanderbilt University Hospital is
the region’s only Level I Trauma Center. Additionally, we have an
active high-risk obstetrics program, a busy Transplant Center, and the
region’s largest pediatric referral hospital.
Responding to demand for ambulatory procedures, we added off-site
service locations by taking over anesthesia services at Vanderbilt
Bone & Joint in 2011. Moreover, we expanded our regional
anesthesia services, pulling increasingly complex procedures
out of the inpatient OR and into the outpatient setting. We have
consolidated our Pain Medicine services in order to provide
consistent, comprehensive care for both acute and chronic pain. In
2013, the department also formed the new Division of Neurosurgical
Anesthesiology, under the leadership of Lorri Lee, MD, a nationally
renowned neuroanesthesiologist.
Our commitment to patient safety was strengthened with the 2011
formation of the Center for Research and Innovation in Systems
Safety (CRISS), which conducts basic and applied research in
healthcare informatics, patient safety, and clinical quality and designs
and evaluates informatics user interfaces, care processes, and medical
technology across VUMC. This center has been awarded a twoyear, $750,000 grant from the Patient Centered Outcomes Research
Institute (PCORI), one of the first grants awarded by the nonprofit
institute established by the Patient Protection and Affordable Care
Act of 2010. In 2011, we also formed the Vanderbilt Anesthesiology
& Perioperative Informatics Research (VAPIR) Division to leverage
our wealth of historical data, with the goal of generating valuable
research and new evidence-based protocols to bring consistency and
excellence to our patient care.
To support clinicians in their pursuit of excellent patient care, we
have redoubled our development of cutting-edge perioperative
information systems. We continue to refine and deploy our
internally-developed OR VigilanceTM and VigiVUTM applications.
These applications provide increased transparency and situational
awareness for clinicians by making data visible and pushing it –
literally – to the clinician’s hand. We have used these applications
to implement quality improvement projects that have brought
rebates to the department from the Vanderbilt Self Insurance Trust.
More importantly, the automated process monitoring and process
control systems developed at Vanderbilt have contributed materially
to improving patient outcomes by, for example, reducing wound
2
infection rates and
14-day readmission
rates. We are
international leaders
in perioperative
informatics, and as
healthcare reforms
promise increased
accountability
and efficiency,
our sophisticated
systems provide a
unique competitive
advantage.
Our educational
programs continue
to excel. In the
Warren S. Sandberg, MD, PhD
2013 National
Chair, Department of Anesthesiology
Residency Match, our Vanderbilt University School of Medicine
department received
852 applications for 15 positions. After interviewing 111 outstanding
medical students, the program successfully filled all 15 positions
within the top 25 students on our Match list. Ten out of the 15
are AOA members, and the Mean USMLE Step 1 Score for the
entire group is 245. We provide one-on-one faculty instruction
and mentorship, and deep offerings in didactic education with
grand rounds, case discussions, lectures, journal clubs, and visiting
professorships from our top colleagues across the country.
We nurture enterprising young researchers through the innovative
BH Robbins Scholars Program, and we support seasoned research
veterans who mentor developing researchers and generate significant
extramural research funding. In 2012, the department’s investigators
brought in more than $4.5 million in new extramural research funding
from NIH and other sources. The department now boasts more than
$8.5 million in active grants, and Vanderbilt Anesthesiology now
places 12th among U.S. academic anesthesiology departments in NIH
funding. The department also makes a major investment in protected
academic time for its faculty, and the department’s Perioperative
Clinical Research Institute provides complete support for clinical and
informatics research activities.
During the 2012-2013 academic year, our faculty produced more than
220 publications, including five books and 35 book chapters. At the
2013 Annual Meeting of the American Society of Anesthesiologists,
department members contributed more than100 entries, including
oral presentations, medically challenging cases, poster presentations,
problem-based learning discussions, workshops, panel discussions,
and refresher courses. The department’s researchers organized, led,
or presented at more than a dozen national or international meetings
in 2013.
The Vanderbilt Department of Anesthesiology is excelling in patient
care, providing superb education across the whole anesthesia
curriculum, and advancing research and academic enquiry across
all fronts. We proactively seek innovative ways to provide the best
possible care for patients with the smartest use of our resources
and technology. Through its successes, our department is positively
influencing the future of our specialty as a whole.
Department Overview
The Vanderbilt Department of Anesthesiology was one of the first independent
departments of anesthesiology in the United States, established on December
12, 1945. After observing that the battlefield-wounded of World War II were
more likely to survive if they received immediate, skilled anesthesia care,
Vanderbilt physicians advocated that anesthesiology be established as an
autonomous department. At that time, few medical schools possessed an academic
anesthesiology service of any type.
This tradition of pioneering in our specialty continues today. Our exemplary
faculty provide top-quality clinical services for a full spectrum of medical
specialties. Vanderbilt Anesthesiology is recognized as an innovator in perioperative
management, healthcare information technology, and scientific discovery. We also
have high-caliber basic science and clinical research teams pursuing fundamental
and translational knowledge to directly improve patient safety and care.
Department Chairmen
Dr. Warren S. Sandberg
(2010-present)
Dr. Michael S. Higgins
(2004-2010)
Vanderbilt Anesthesiology is also:
•
A national leader in developing and applying new technologies – often
developed in-house by our own physicians and research personnel – to
improve the effectiveness and safety of perioperative patient care. These
include electronic medical record keeping, automated real-time decision
support, and smart phone-based OR transparency software.
•
Well-represented on the editorial boards of major anesthesia journals.
•
Highly represented as educators at the Annual Meeting of the American
Society of Anesthesiologists and at national anesthesiology, critical care,
and pain medicine subspecialty conferences.
•
Home to a number of NIH-funded principal investigators and seven Board
Examiners for the oral exams of the American Board of Anesthesiology.
Dr. Jeffrey R. Balser
(2001-2004)
Dr. Charles Beattie
(1994-2001)
In addition to our department’s achievements, recent accolades for Vanderbilt’s
medical program are many:
•
In 2012, Vanderbilt University Medical Center (VUMC) was recognized
for the 13th consecutive year as one of the top 100 hospitals in the country
in a study by Thomson Reuters Healthcare.
•
Becker’s Hospital Review named VUMC one of America’s 100 Best
Hospitals in rankings released in March 2013.
•
Monroe Carell Jr. Children’s Hospital at Vanderbilt is included among
the nation’s leaders in pediatric health care in U.S. News & World Report
magazine’s Best Children’s Hospitals rankings. The hospital achieved
rankings in 9 out of 10 pediatric specialty programs.
•
VUMC is one of the top medical schools for National Institutes of Health
funding, receiving more than $286 million for research initiatives for
fiscal year 2012.
•
For the ninth consecutive year, Vanderbilt University Medical Center was
named one of the nation’s 100 “Most Wired” hospitals and health systems
for its innovative efforts in medical technology, according to the 2013
Most Wired Survey and Benchmarking Study conducted by Hospitals and
Health Networks magazine.
•
VUMC has been named the top hospital in Tennessee and the top health
care provider in the Metro Nashville region according to U.S. News &
World Report’s 2013-2014 Best Hospitals edition.
•
Vanderbilt University Hospital earned an “A” Hospital Safety Score
in July 2013 from the Leapfrog Group, placing VUH among the safest
hospitals in the nation.
Dr. Bradley Edgerton Smith
(1969-1993)
Dr. Charles Bernard Pittinger
(1962-1969)
Dr. Benjamin Howard
Robbins (1946-1961)
3
Department Leadership
Vice-Chairs and Administrative Leadership
Suanne Daves, MD
Vice-Chair for Pediatric
Anesthesiology
Anesthesiologist in Chief, Monroe
Carell Jr. Children’s Hospital at
Vanderbilt
Stephen Doherty
Associate Director for Finance
Edward Sherwood, MD, PhD
Vice Chair for Research
Matt Weinger, MD
Vice-Chair for Faculty Affairs
Curtis Baysinger, MD
Division of Obstetric
Anesthesiology
James Berry, MD
Division of Multispecialty Adult
Anesthesiology
Suanne Daves, MD
Division of Pediatric Cardiac
Anesthesiology
Robert Deegan, MD
Division of Cardiothoracic
Anesthesiology
Eric Delpire, PhD
Basic Science Research
Katherine Dobie, MD
Division of Ambulatory
Anesthesiology
Marc Huntoon, MD
Division of Pain Medicine
4
William Furman, MD
Vice-Chair for Clinical Affairs
Matthew McEvoy, MD
Vice-Chair for Educational Affairs
Division Chiefs
Lorri Lee, MD
Division of Neurosurgical
Anesthesiology
Lee Parmley, MD, JD
Division of Anesthesiology
Critical Care Medicine
Ann Walia, MD
Division of Veteran’s
Affairs Anesthesiology
CRNA Leadership
Steve Blanks
Chief CRNA
Buffy Lupear
Assistant Chief CRNA
Administrative Staff
The Vanderbilt Department of Anesthesiology’s administrative and research staff members provide critical support for every division of the
department. From personnel who manage clinical scheduling and payroll, to staff members who provide research support and perform general
administrative duties, each division of the department has assigned administrative staff members. There are approximately 54 administrative
staff members and 20 research staff members. These individuals are vital to successfully achieving the department’s three-fold mission of
practicing excellent perioperative medicine; provide exemplary education for our medical students, residents and fellows; and conducting
cutting-edge basic, translational and clinical research.
5
Endowments Support Special Lectureships & Awards
The Vanderbilt Department of Anesthesiology hosts several
special lectureships throughout the year, as well as presenting
distinct recognitions to department members who have provided
exemplary service to both their patients and colleagues. Many of
these are a direct result of philanthropic support from our alumni,
as well as from current department members and other program
supporters. Fortunately, such “seed” funding is within the reach
of many private donors, whose gifts materially improve the
academic life of the Vanderbilt Department of Anesthesiology.
“We are very appreciative of our many donors who support our
department,” said Chairman Warren Sandberg, MD, PhD. “Through
these gifts we are able to establish and strengthen programs;
support innovative research endeavors; and advance the education
and continued betterment of our faculty, staff, and students.”
Members of Dr. James Phythyon’s family attend the annual lecture
named in his honor. Shown here is the family with guest lecturer
Randall Wetzel, MD, Vice-Chair for Pediatric Anesthesiology Suanne
Daves, MD, and Department Chairman Warren Sandberg, MD, PhD.
Dr. James Phythyon Endowed Lectureship in
Pediatric Anesthesiology
For the past eight years, the Dr. James Phythyon Endowed
Lectureship in Pediatric Anesthesiology has brought renowned
experts in the field to Vanderbilt’s campus as visiting professors.
At a special Grand Rounds lecture, these experts share their
research findings and expertise with the department. During
their visit, the speakers also meet with residents and fellows for
small group teaching sessions and informal discussions. The
lectureship was established by the family of Dr. James Phythyon,
a founding member of VUMC’s Pediatric Anesthesia Division.
Dr. Phythyon’s widow, Mrs. Marlin Sanders, and the couple’s
daughters, Mary Neal Meador, Elizabeth Donner, and Sarah
Miller, are strong supporters of the department. Each year, they
attend the lecture and other events in honor of Dr. Phythyon.
In 2013, Randall Wetzel, MD, Chairman of the Department of
Anesthesiology Critical Care Medicine at Children’s Hospital in
Los Angeles presented a well-received Grand Rounds lecture on
“Meaningful Use of Complex Medical Data.”
6
Past Phythyon Lectureship speakers include: Peter Marhofer,
MD, Director of Paediatric Anaesthesia and Professor,
Anaesthesia and Intensive Care Medicine, at the Medical
University of Vienna, Vienna, Austria; Dean Andropoulos, MD,
MHCM, Chief of Anesthesiology at Texas Children’s Hospital;
Shobha Malvia, MD, of The University of Michigan Health
System; Philip Morgan, MD, of the University of Washington and
Seattle Children’s Hospital; Francis X. McGowan Jr., MD, of the
Children’s Hospital Boston; Peter Davis, MD, of the Children’s
Hospital of Pittsburgh; and Myron Yaster, MD, of Johns Hopkins
University School of Medicine.
Left to right: Vice-Chair for Pediatric Anesthesiology Suanne Daves,
MD, Sandidge Pediatric Pain Management Award winner Drew
Franklin, MD, and Paula C. Sandidge, MD.
Sandidge Pediatric Pain Management
Endowed Fund
Retired Vanderbilt anesthesiologist Paula C. Sandidge, MD,
created The Sandidge Pediatric Pain Management Endowed
Fund at Monroe Carell Jr. Children’s Hospital at Vanderbilt in
2010 to recognize and encourage progress in pain management
for children. An anesthesiologist for 30 years, Dr. Sandidge
recognized how lacking her early training had been in controlling
pain for the youngest of patients when her grandson was born
with a painful form of osteogenesis imperfecta. He lived just one
day, but Sandidge realized then that pain control provided infants
something irreplaceable: the opportunity to be held comfortably
by the people who love them for the few precious moments they
have.
In 2013, Pediatric Anesthesiologist Drew Franklin, MD, received
the Sandidge Pediatric Pain Management Award in recognition of
his work with patients at the Pediatric Pain Management Clinic
at Children’s Hospital. Dr. Franklin presented a Grand Rounds
lecture entitled “A multidisciplinary approach to the management
of refractory pediatric complex regional pain syndrome.”
Past recipients of the Sandidge Pediatric Pain Management
Award include Stephen Hays, MD, FAAP, associate professor
of Anesthesiology & Pediatrics and director of Pediatric Pain
Services; and Twila Luckett, BSN, RN-BC.
Family members of David H. Chestnut, MD, along with Bradley E. Smith,
MD (second from left) and Department Chair Warren Sandberg, MD, PhD
(far right).
Perinatology (SOAP), as well as the Society for Technology in
Anesthesia (STA). He also represented the state of Tennessee on the
ASA Board of Directors for many years.
Winner of the 2013 Vuksanaj Award is Jenna Helmer Sobey, MD. Shown
with her, left to right, are Vice-Chair for Educational Affairs Matt McEvoy, MD, past Vice-Chair for Educational Affairs John Algren, MD, and
Vice-Chair for Pediatric Anesthesiology Suanne Daves, MD.
Dila Vuksanaj Memorial Fund for
Resident Education
Pediatric anesthesiologist Dila Vuksanaj, MD, practiced at the
Children’s Hospital for 13 years, dedicating herself to her patients
and to the hundreds of trainees who looked to her as a role model,
mentor, and friend. Following her death in 2009, her family,
including her husband Jacques Heibig, MD, founded the Dila
Vuksanaj Memorial Fund for Resident Education. The fund is
used to present an annual award to the anesthesiology resident
who demonstrates the best overall performance in pediatric
anesthesiology. In 2013, Jenna Helmer Sobey, MD, was recognized
for her outstanding work at Children’s Hospital. Past recipients
include: Korie Vakay, MD; Justin Sandall, DO; and Elizabeth Lee,
MD.
Dr. Bradley E. Smith Endowed Lectureship on
Medical Professionalism
Throughout his more than four decades of practice and leadership,
former Anesthesiology Department Chairman Bradley E. Smith,
MD, defined what it means to be a true professional, and in 2009 a
lectureship on medical professionalism was established in his name
by then department chairman Michael Higgins, MD. The goal of
the lectureship is to reflect on the characteristics, responsibilities,
and rewards of professionalism as applied to the practice of
anesthesiology.
As chairman of the department for nearly 25 years, Dr. Smith was
a national leader in the development of anesthesia subspecialties.
He was a cofounder of the Society for Obstetric Anesthesia and
David H. Chestnut, MD, was the guest speaker for the Smith
Lectureship in 2013. Dr. Chestnut is the editor of Obstetric
Anesthesia: Principles and Practice, which is regarded as the leading
textbook in obstetric anesthesia. Dr. Chestnut is director of Medical
Education at Gundersen Lutheran Health System in LaCrosse,
Wisconsin.
Past speakers for this special lectureship include: William D.
Owens, MD, recipient of the American Society of Anesthesiologists
Distinguished Service Award; Peter McDermott, MD, PhD, past
president of the ASA; and Joseph Gerald “Jerry” Reves, MD, Dean
of the College of Medicine at the Medical University of South
Carolina (MUSC).
Dr. Charles Beattie Endowed Lectureship
Established in 2011 by the current
chairman, this lectureship honors Charles
Beattie, MD, the fourth chair of the
department. “Dr. Beattie was many things
to the many people who knew him,” said
Dr. Sandberg. “He was at once a great
humanist, a colorful character, and an
early and forceful driver in the creation
of what we now call ‘systems-based
practice,’ the core competency which we
exercise to create robust systems to assure
that all patients receive consistent, safe,
outstanding care in an environment that
Charles Beattie, MD
naturally performs well.”
Dr. Beattie came to anesthesiology after first becoming a nuclear
power engineer. This background surely informed and motivated
his passions in anesthesiology. The lectureship is intended to
bring innovators in anesthesiology from unique backgrounds and
compelling world views to Vanderbilt as visiting professors.
7
Office of Educational Affairs
The Office of Educational Affairs for the Vanderbilt Department
of Anesthesiology supports and oversees the full continuum of
education related to anesthesiology and perioperative medicine,
which includes undergraduate medical education, graduate medical
education for residents and fellows, and continuing education for
faculty and advanced practice nurses. The extensive education and
training programs offered by the Department of Anesthesiology
integrate scientific and clinical advances with current clinical practice
to prepare medical students, residents, fellows, nurses, and faculty for
productive careers as clinicians, academicians, and scientists.
A major factor in attracting residents, fellows, and faculty is the
strength of the department’s subspecialties, as residents and fellows
benefit from in-depth training in all subspecialty disciplines of
clinical anesthesiology, critical care, and pain management. An
additional draw is the Vanderbilt International Anesthesia (VIA)
rotation, which provides a month-long global health experience to
an average of eight residents and fellows each year. Trainees are
also attracted by the department’s extensive research opportunities,
in particular the BH Robbins Scholars program, which offers oneon-one mentorship and collaboration for young physician-scientists
preparing for careers as academic anesthesiologists.
“Vanderbilt offers a comprehensive clinical experience that spans
the breadth of clinical anesthesia and perioperative medicine, and it
does this in the context of one institution,” said Matt McEvoy, MD,
Vice-Chair for Educational Affairs and Program Director. “We offer
the full scope of training experiences, as well as opportunities for
academic development in the fields of research, education, medical
informatics, and leadership. Furthermore, we are leveraging our
departmental and institutional resources to be a national leader in the
new ACGME Milestones system and in the concept of the
surgical home.”
The Office of Educational Affairs including oversight of the Residency
Program, is led by Dr. McEvoy and is supported by Associate Program
Director Jane Easdown, MD; Associate Program Director Michael
Pilla, MD; Director of Medical Student Education Amy Robertson,
MD; and four administrative staff members. The department’s specific
offerings to each learner group are outlined below.
Medical Students
Dr. Amy Robertson serves as the Director of Medical Student
Education for the department and oversees a wide range of programs
for medical students. The department’s faculty members contribute
to Vanderbilt medical students’ education throughout the fouryear curriculum, beginning with Vanderbilt University School of
Medicine’s (SOM) College Advisory system. Associate Program
Director Michael Pilla, MD, serves in a leadership role as a SOM
College Mentor in this system. Dr. Robertson was recently selected
as one of 10 Portfolio Advisors for the SOM. Additionally, Dr. Jesse
Ehrenfeld is a co-director of the Continuity Clinical Experience
(CCX) for all medical students in Curriculum 2.0, a longitudinal
clinical experience spanning all four years of medical school. Formal
clinical courses provide numerous opportunities for clinical education
in anesthesiology and perioperative medicine, including Introduction
to Anesthesiology elective, Critical Care Skills Course, Perioperative
Medicine “Immersion Course,” Critical Care elective, and Advanced
Anesthesiology Clerkship for senior students. Many medical students
also participate in research mentored by Anesthesiology faculty.
8
Additionally, informal, as well as formal, mentorship of medical
students by faculty and residents has advanced the understanding and
appreciation of the specialty. These efforts have led to an increase in
Vanderbilt medical students planning careers in anesthesiology, from
six graduates in the class of 2011 to 12 students in the class of 2012.
Residents
The department’s fully accredited residency program is highly
sought after by the nation’s top medical students. Proof of this is in
the numbers: in the 2013 National Residency Match, the department
received 852 applications for 15 positions. After interviewing 111
outstanding medical students, the program successfully filled all
15 positions from the top 25 students on its rank list, including five
of the top 10. The National Residency Matching Program Report
continues to rank Vanderbilt’s program in the top quartile of all U.S.
anesthesia residency programs for key quality indicators: number
of positions offered, recruiting efficiency, AOA membership (67%),
mean USMLE Step 1 score (245), and mean USMLE Step 2 score
(256). It is the department’s goal to produce perioperative physicians
who are prepared with all of the requisite cognitive, technical, and
academic skills to be leaders in the future of our specialty in medicine
as a whole. The department seeks applicants who desire this level of
training and development during their residency
and beyond.
Vanderbilt Anesthesiology’s four year residency program currently
enrolls 15 resident physicians per year. Our physician educators are
nationally and internationally recognized as leaders in their fields,
and the department successfully supports residents interested in
academic anesthesiology so they can develop careers focused on
advancing knowledge in the specialty. The department typically
has 25-30 residents who present original research and overviews of
challenging cases at national meetings every year, a clear indication
that the department’s educational programs are creating physicianscholars who are prepared for both medical practice and scientific
investigation.
The department’s educational program for residents, as well as
fellows, consists of a combination of comprehensive didactic
conferences, mentored clinical training by subspecialists in every
domain of anesthesiology, simulation training, and self-study.
Simulation training features prominently in the cognitive, procedural,
and teamwork aspects of anesthesia education, and Vanderbilt
University School of Medicine’s Center for Experiential Learning
and Assessment is a nationally renowned, on-campus resource for
this training. The ACGME core competencies form a framework for
the training program, and a major curricular revision is underway that
is targeting the new ACGME Milestones system, as well as the recent
changes to the ABA Certification process. On average, Vanderbilt
Anesthesiology residents have scored at the 70th percentile on
standardized examinations when compared with the national cohort.
The goal of the curriculum revision will be to continue to achieve or
exceed that level of academic achievement.
Fellows
Building from the department’s strength in subspecialties, six
clinical fellowships, as well as a research fellowship, are offered
to individuals seeking advanced, focused training. The following
clinical fellowships are offered at Vanderbilt:
The Office of Educational Affairs includes, front row, Associate Program Director Jane Easdown, MD; Associate Program Director Michael Pilla, MD; and
Administrative Director Joyce Speer. Back row, Program Coordinator Marsha Moore; Vice Chair for Educational Affairs Matthew McEvoy, MD; and Program
& Events Coordinator Deborah Nelson-Rouse. Not pictured: Director of Medical Student Education Amy Robertson, MD.
•
•
•
•
•
•
Adult Cardiothoracic Anesthesiology* – 3 fellows
Anesthesiology-Critical Care Medicine* – 8 fellows
Obstetric Anesthesiology* – 1 fellow
Pain Medicine* – 3 fellows
Pediatric Anesthesiology* – 4 fellows
Regional Anesthesiology** – 2 fellows
*ACGME Accredited **ACGME Accreditation not offered
Advanced Practice Nurses
The Department of Anesthesiology has a unique partnership with
the Vanderbilt University School of Nursing to offer an Acute Care
Nurse Practitioner (ACNP) Intensivist track as part of the ACNP
master’s degree program. The program combines the didactic training
of the School of Nursing’s ACNP program with supplemental
specialty lectures in critical care medicine. Students perform their
clinical rotations in seven of the Vanderbilt and VA ICUs. Students
also receive additional exposure to ICU medicine through twice
monthly simulation sessions and weekly clinical case conferences
taught jointly by members of both faculties. Additional partnership
programs between the Anesthesiology Department and the School
of Nursing are being planned. Vanderbilt University Medical Center,
one of the largest employers of nurse practitioners in the country,
and the Division of Anesthesiology Critical Care Medicine now have
more than 35 Acute Care Nurse Practitioners on staff who provide
highly skilled treatment in intensive care settings.
Nurse Anesthetists
More than 100 Certified Registered Nurse Anesthetists form a
critical part of our department. Their continuing education is led by
Steve Blanks and is supported with recurring education programs,
including Grand Rounds and Morbidity, Mortality & Improvement
Conferences. In addition, Vanderbilt is a primary clinical affiliate of
the Middle Tennessee School of Anesthesia (MTSA) in Madison,
Tennessee, and of the Union University Nurse Anesthesia program
in Jackson, Tennessee. Student nurse anesthetists participate in
approximately 7,000 anesthetics per year while on Vanderbilt
rotations, and their on-campus training is coordinated by the
Department of Anesthesiology.
Continuing Medical Education
The Office of Educational Affairs oversees a full calendar of
continuing medical education opportunities for faculty, residents,
fellows, nurse anesthetists, and nurse practitioners. Some examples are
weekly Grand Rounds, which feature leading experts from throughout
the world; Mortality, Morbidity & Improvement Conferences (MM& I),
which focus on recent cases with the goal of improving patient care;
Faculty Development Seminars, which provide targeted training for
professional development; and Combined Integrative Health and
Pain Medicine Quarterly Rounds, which focus on issues related to the
management and treatment of pain.
Awarding and Recognizing Excellence
The department recognizes excellence in both its trainees and faculty
members. Outstanding performance by residents is recognized through
annual Clinical Excellence Awards, and exceptional performance in
teaching is recognized through the annual presentation of Golden
Apple Awards and the Volker I. Striepe Award for Outstanding
Teaching. In addition to these local awards, our faculty members
garner national and international recognition of their excellence in
educational programs and research. Dr. Ehrenfeld is part of a team
in the SOM that was recently awarded a $1 million grant from the
AMA as a part of the Accelerating Change in Medical Education
program. Dr. Mark Newton was celebrated in 2012 by the American
Medical Association with the Dr. Nathan Davis International Award in
Medicine, recognition of his 15 years of service at Kijabe Hospital as
a leader of international anesthesia education in Kenya. Additionally,
our faculty routinely are awarded research grants from the Foundation
for Anesthesia Education and Research.
9
Educational Courses and Conferences
The Vanderbilt Department of Anesthesiology provides a full
calendar of educational opportunities for anesthesiologists and other
medical professionals. Our medical education offerings include:
For Medical Students
Critical Care Skills Week: Weeklong, quarterly workshop for thirdyear medical students to prepare them to recognize and manage
critical problems encountered in clinical practice. This training
includes hands-on education using simulation at Vanderbilt’s Center
for Experiential Learning and Assessment (CELA), as well as
lectures by departmental faculty.
Surgery Clerkship Selective: This rotation provides a hands-on,
continually monitored and mentored experience. Students become
an integral part of an anesthesia care team and participate in
perioperative management of adult patients presenting for surgical,
diagnostic, or therapeutic interventions. Students participate in
preoperative assessment, risk stratification, anesthetic planning
and conduct of anesthesia, airway management, and postoperative
planning and care of patients.
Introduction to Anesthesia: This rotation provides a hands-on,
continually monitored and mentored experience. Students become
an integral part of an anesthesia care team and participate in
perioperative management of adult patients presenting for surgical,
diagnostic, or therapeutic interventions. Students participate in
preoperative assessment, risk stratification, anesthetic planning
and conduct of anesthesia, airway management, and postoperative
planning and care of patients.
Perioperative Medicine Immersion Courses: This four-week
course emphasizes perioperative medicine as a continuum of care
with application of both basic science and clinical knowledge
from a variety of rotation experiences. Basic science topics are
applied to specific disease processes, clinical decision making, and
perioperative outcomes. Emphasis is placed upon the importance of
the collaboration of care with medical specialists and healthcare team
members to achieve optimal patient outcomes.
Senior Anesthesia Elective: This four-week elective for fourthyear medical students provides a multidisciplinary experience in
Anesthesiology so that all students rotate through the following
venues: Adult Anesthesia at VUH and/or VA; Cardiothoracic
Anesthesia; Pediatric Anesthesia; OB Anesthesia; Neuro ICU/SICU/
BICU; and Acute Pain Service. In addition, students participate
in departmental lectures for residents, Grand Rounds, and MM&I
Conferences.
For Interns
Boot Camp: Workshops held during orientation, as well as
periodically throughout the year, focusing on developing specialized
skill sets essential to anesthesia and perioperative care.
Intern Conferences: Introduction to Anesthesia Seminars; Matrix
Seminars (QI training program); and practice-improvement
discussions, organized using the Healthcare Matrix and Basics of
Anesthesia lectures.
For Residents
ABA BASIC Exam Prep Series: Weekly conferences for CA-1
residents. The content of this didactic series maps directly to the ABA
Content Outline for the new ABA BASIC Exam that starts in August
2014.
Subspecialty Conferences: Conferences coordinated by individual
divisions of the department, including Pediatric, Obstetric,
Cardiothoracic, Neurosurgical Anesthesiology, Regional, Pain
Medicine, Critical Care Medicine, and Multispecialty Adult
Anesthesiology.
Senior Seminars: Seminar series for senior residents focused on
problem-based learning and preparation for Oral Exams.
Professional Development Conferences: Resident conferences
focused on elements of subspecialty selection, career paths, and
business practices related to perioperative anesthesia.
For All
Journal Clubs: Informal meetings in which medical articles
pertaining to the specialty are summarized and reviewed. Journal
Clubs are held by department divisions, including Multispecialty,
Pediatric, Cardiothoracic, Critical Care, and Pain Medicine.
Academic Development Conferences: For fellows, residents, and
faculty on topics related to educational theory and practical aspects of
classroom and clinical teaching, mentorship, etc.
Transesophageal Echocardiogram training offered by the Department of
Anesthesiology includes real-time cardiac simulation.
10
Grand Rounds: Formal, weekly lectures featuring recognized
experts in the fields of anesthesiology, perioperative medicine, or pain
medicine.
Mortality, Morbidity & Improvement Conferences: Monthly
conferences focused on case studies with the goal of improving
patient care. Each quarter, Perioperative M&M Conferences also
include surgical specialties and nursing services to better facilitate the
exploration of cases and the exchange of ideas.
Special Courses
Fundamentals of Critical Care Support (FCCS): Multidisciplinary,
two-day comprehensive course addressing fundamental management
principles for the first 24 hours of critical care. This course is
sponsored by the Society of Critical Care Medicine, and is directed
by members of the Anesthesiology Department’s Division of
Anesthesiology Critical Care Medicine. Instructors for the FCCS
course represent multiple specialties at Vanderbilt University
Medical School.
Maintenance of Certification in Anesthesiology (MOCA®)
Simulation Courses: The department, in partnership with the Center
for Experiential Learning and Assessment (CELA) at Vanderbilt, offers
immersive patient simulation education for ABA Diplomates seeking to
fulfill their Practice Performance Assessment and Improvement (PPAI)
requirement for the American Board of Anesthesiologists’ (ABA)
Maintenance of Certification in Anesthesiology (MOCA®) Program.
This course fulfills the simulation education requirement of Part 4 of
MOCA®. The VUMC simulation program has been endorsed by the
ASA Committee on Simulation Education.
Combined Integrative Health and Pain Medicine Quarterly
Rounds: Quarterly day-long course for anesthesiology faculty, as
well as integrative health services providers, including rehabilitation
physicians, physical therapists, psychiatrists, and others involved in
treatment and management of pain.
Simulation Education Provides Invaluable Lessons
Simulation education is a virtual approach to training physicians
and other medical providers in the management of complex
clinical cases and challenging situations, especially those
they might not encounter on a regular basis in the clinical
setting. The Vanderbilt University School of Medicine has a
remarkable on-campus resource for medical simulation training,
the Center for Experiential Learning and Assessment (CELA),
and our Anesthesiology Department faculty are national
leaders in providing simulation training in anesthesiology
airway management, critical care, perioperative management,
and transesophageal echocardiogram
procedures. Arna Banerjee, MD, an
assistant professor of anesthesiology in
the Division of Anesthesiology Critical
Care Medicine was named director of
CELA in July 2013.
endorsed by the American Society of Anesthesiologists (ASA)
as one of about 30 centers in the nation officially approved
to deliver certified educational programs. Anesthesiologists
can receive Continuing Medical Education (CME) simulation
training at CELA that qualifies for American Board of
Anesthesiology Maintenance of Certification in Anesthesiology
(MOCA®) credit. To achieve the ASA endorsement, the CELA
program met strict criteria, including having strong leadership,
and the necessary equipment, facilities, and personnel to
provide consistent, effective training.
CELA, which opened in 2007, is an
11,000-square-foot facility that is
home to both the Program in Human
Simulation and the Simulation
Technologies Program. The center offers
advanced simulation technologies,
including computerized mannequins
that can reproduce both routine and
critical clinical situations. One floor
of the facility includes flexible space
that can serve as a six-bed emergency
department, a four-bed intensive care
unit, or a couple of operating rooms —
all monitored by computer-controlled
audio/video equipment.
At Vanderbilt’s Center for Experiential Learning and Assessment (CELA), computerized
In May 2009, the Vanderbilt Simulation
mannequins, including obstetric and infant mannequins, are used to reproduce routine and critical
Technologies Program, under the direction care clinical situations.
of Matthew B. Weinger, MD, was
11
BH Robbins Scholars Excel with Publications, Lectures
For young scholars, building critical academic research skills
under the mentorship of established scientists makes them
strong future investigators. With this goal, the Benjamin
Howard Robbins Scholars Program began in 2007. The
program is named in honor of the Vanderbilt Anesthesiology
Department’s first chairman, a renowned physician-scientist.
The BH Robbins Scholars program is multidisciplinary,
encouraging and supporting mentorships and collaborations
that extend far beyond the traditional boundaries of anesthesia.
Benjamin Howard Robbins, MD,
the Department of Anesthesiology’s
first Chair and a noted physicianscientist.
“This program provides a unique mentored research
experience for young scholars that culminates in a two-year
multidisciplinary fellowship, with at least one year devoted to
research,” said Department Chair Warren Sandberg, MD, PhD.
“Our Robbins Scholars benefit from one-on-one mentorship,
a wealth of research and educational resources, protected
research time, and a stipend during their residency and
fellowship.”
The BH Robbins Scholars program is co-directed by Jerod
Patrick Henson, DO
Denton, PhD, and Pratik Pandharipande, MD. Following is an
update on current Scholars’ progress and achievements in the
Patrick Henson, DO, is working
past academic year.
under the mentorship of Dr. Ed
Sherwood, MD, PhD, and is actively
enrolling patients in his study aimed
at evaluating and measuring cellular
expression of PD-1 and markers of
immune tolerance in patients following
severe burn injury. He has been active
in many local teaching opportunities.
Thomas Austin, MD, is in the
second year of his two-year, $175,000
Foundation for Anesthesia Education
and Research (FAER) Mentored
Research Training Grant-Basic
Science for his project, “Effect of
Neuronal K-Cl Cotransporter KCC2
Activation on Pain Perception.” Dr.
Austin is mentored by Eric Delpire,
PhD. In the past year, Dr. Austin has
presented at the Society for Pediatric
Anesthesia, the American Society of
Anesthesiologists, and the Association
of University Anesthesiologists
meetings, has authored three
manuscripts, and is currently pursuing
a master’s degree in statistics.
Thomas Austin, MD, who is mentored by Eric Delpire, PhD, won the 2011 Association of University Anesthesiologists’ resident travel award as a result of his research.
12
Adam Kingeter, MD, is
the most recent BH Robbins
Scholar. He is interested in
health resource utilization
and is presently involved in a
project evaluating cost of care
in the ICU
Christopher Hughes, MD, has published several original research manuscripts during his B.H. Robbins Fellowship, and he has presented his
work at national meetings.
Christopher Hughes, MD, is serving as the Vanderbilt site
PI of an NIH-sponsored multicenter MENDS 2 study that evaluates
the role of sedation paradigms on delirium and mortality in
critically ill septic patients. He has successfully obtained
Vanderbilt Institute for Clinical and Translational Research
(VICTR) funding for two projects pertaining to the role of
endothelial dysfunction in delirium. In the past academic year,
Chris has presented the findings of his research at both national
and international meetings and has published over 10 peer
reviewed articles/book chapters, including manuscripts in The
New England Journal of Medicine, Critical Care Medicine,
and Anesthesiology. Dr. Hughes is mentored by Pratik
Pandharipande, MD, MSCI, as well as Wes Ely, MD, MPH
(Department of Medicine’s Division of Allergy, Pulmonary and
Critical Care).
Amanda Lorinc, MD, is
a recent recipient of the
Foundation for Anesthesia
Education and Research
(FAER) Research in Education
Grant (REG) for her project,
“Handover Tool Participatory
Design and Educational
Training Intervention to
Improve Perioperative
Neonatal Safety.” She is
mentored by Matthew Weinger,
MD. She is also working with
Dan France, PhD, on projects
related to improving neonatal
outcomes via monitoring of
non-routine events. Amanda
has presented at the Society for
Pediatric Anesthesia and has
authored two manuscripts in
this past year.
Carrie Menser, MD, is
researching the utilization of
a pediatric pain service in the
perioperative management of
pediatric palliative care patients
and evaluating perioperative
complications in pediatric
palliative care patients. She is
also involved in projects related
to delirium and withdrawal
in pediatric patients, as well
another project evaluating cry
acoustics in neonates. She
recently presented her research
at the Society for Pediatric
Anesthesia.
Adam Kingeter, MD
Amanda Lorinc, MD
Carrie Menser, MD
13
Joseph Schlesinger, MD, at right, discusses his research with Vice-Chair
for Clinical Affairs William Furman, MD.
Joseph Schlesinger, MD, is examining multisensory perceptual
training, and specifically improving unisensory pulse oximetry
pitch perception and attention load processing. Dr. Schlesinger
has received a VICTR grant for his research and is mentored by
Mark Wallace, PhD, Director of the Vanderbilt Brain Institute.
Dr. Schlesinger has presented his work at the American Society
of Anesthesiologists, the Society for Neuroscience, the American
Society of Critical Care Anesthesiologists, and the American Medical
Association. His original research articles have been published in
Anesthesiology and Anesthesia and Analgesia.
Heidi Smith, MD, MSCI, won the award
for best oral presentation at the 2013
Anesthesiology Department Research
Symposium. Department Chair Warren
Sandberg, MD, PhD, presented the award.
14
Heidi Smith MD, MSCI,
has ongoing studies, in
collaboration with pediatric
psychiatry and critical care,
that include validation of a
delirium monitoring instrument
for children under the age
of five, an observational
study evaluating executive
dysfunction in critically ill
children, an implementation
study of delirium monitoring
in critically ill children, and
an epidemiological study
evaluating the prevalence,
risk factors, and outcomes
associated with delirium in
critically ill patients. Heidi is
a recent recipient of a VICTR
Heidi Smith, MD, MSCI
grant. She has presented her
work at regional and national
meetings, including the American Society of Anesthesiologists,
the Association of University Anesthesiologists, and the Society of
Critical Care Medicine. She has numerous publications including
research in Critical Care Medicine, Seminars in Respiratory and
Critical Care Medicine, and Pediatric Clinics of North America.
BH Robbins Scholars gathered at the 2013 Anesthesiology Department Research Symposium to present
their research. Here, left to right, are Department Chair Warren Sandberg, MD, PhD; guest lecturer
Cor Kalkman, MD; Joe Schlesinger, MD; BH Robbins Program Co-Director Pratik Pandharipande,
MD, MSCI; Amanda Lorinc, MD; Carrie Menser, MD; Heidi Smith, MD, MSCI; Patrick Henson, DO;
and Adam Kingeter, MD. Not pictured: Thomas Austin, MD; and Chris Hughes, MD.
Department Plays Lead Role in $1 Million AMA Grant
In June 2013, American Medical Association (AMA) selected
Vanderbilt University School of Medicine (VUSM) to receive
a $1 million grant as one of the nation’s 11 top medical
schools transforming medical education. The grant, part of the
AMA initiative Accelerating Change in Medical Education,
makes Vanderbilt the recipient of $1 million over the next
five years to take part in a consortium created to rapidly
disseminate best practices in medical education across the
country.
Bonnie Miller, M.D., senior associate dean for Health Sciences
Education, said the announcement is evidence the innovations
brought about by VUSM’s new educational curriculum,
Curriculum 2.0, are among the nation’s most advanced. For
VUSM, Curriculum 2.0 represents the departure from a
highly regarded, but traditional medical school curriculum
to a complex, integrated, collaborative, and flexible course
schedule that includes less traditional lecture-based learning
and more clinical and case-based experience.
“This is a validation that Curriculum 2.0 represents some of
the most exciting and innovative ideas for medical education,”
Miller said. “It is just what the AMA is looking for. Through
this grant, the AMA hopes to disseminate best practices to
medical educators throughout the nation. We believe this
funding and collaboration will allow us to accelerate the
changes we hope to bring about with Curriculum 2.0, and to
rigorously evaluate the curriculum’s effectiveness.”
Dr. Ehrenfeld will lead efforts related to the first goal,
learning in which students are embedded in the health care
workplace. This will be largely accomplished through the
Clinical Continuity Experience (CCX) program in which
students become team members at a single clinical site for the
duration of their undergraduate medical education. Intentional
learning activities are spread across a four-year curriculum,
including seminar activities and clinical experiences. The
mission of CCX is to create self-directed learners, integrate
the patient care experience with medical knowledge, integrate
systems knowledge with clinical care, and cultivate respectful
professionals.
Submissions for the AMA grant were quite competitive,
with more than 80 percent of the nation’s medical schools
providing proposals. Dr. Ehrenfeld and the grant coinvestigators will serve in the national consortium of medical
schools established by the AMA grant, giving Vanderbilt an
exciting opportunity to exchange best practice information
with our colleagues. This initiative will likely change the face
of medical education in our country.
Jesse Ehrenfeld, MD, MPH, associate professor of
Anesthesiology, Surgery, and Biomedical Informatics, is one
of four Vanderbilt co-investigators for the grant. Dr. Miller
authored Vanderbilt’s submission along with co-investigators
Robert Dittus, MD, MPH, associate vice chancellor for Public
Health and Health Care; Kim Lomis, MD, associate dean for
Undergraduate Medical Education; and Anderson Spickard III,
MD, MS, FACP, associate professor of Medicine and assistant
professor of Biomedical Informatics.
In brief, the grant has three primary goals:
1. To embed learning in the workplace throughout
undergraduate medical education.
2. To create a competency-based assessment system that
guides student learning with explicit, standardized
expectations and provides accurate information for high
stakes decisions independent of time in the educational
program.
3. To develop a process for personalized learning plans
guided by individual student strengths, needs, and
interests, and facilitated by a comprehensive electronic
portfolio that collects and displays assessment data and
links to the curriculum management system and the
electronic health record.
Jesse Ehrenfeld, MD, MPH, associate professor of Anesthesiology,
Surgery, and Biomedical Informatics, is one of four Vanderbilt co-investigators for the AMA grant. Bonnie Miller, MD, senior associate dean for
Health Sciences Education, is author of the grant.
15
Vanderbilt International Anesthesia Continues to Expand
When Mark Newton, MD, speaks of the urgent need to reach
medically underserved populations throughout the world,
his words of compassion are backed up by 15 years worth of
action. Dr. Newton’s humanitarian efforts in healthcare were
recognized in 2012 by the American Medical Association with
the presentation of the Dr. Nathan Davis International Award
in Medicine. Named for AMA’s founder, the award honors
physicians whose influence reaches the international patient
population and changes the future of their medical care.
Dr. Newton, an associate clinical professor in the Department
of Anesthesiology and a pediatric anesthesiologist at Monroe
Carell Jr. Children’s Hospital at Vanderbilt, was instrumental
in founding, and now directs, the Vanderbilt International
Anesthesia (VIA) program. Established in 2007, VIA is the
Vanderbilt Department of Anesthesiology’s global service,
education, and research division which focuses on anesthesia and
ICU issues in low resource countries. Dr. Newton also developed
an anesthesia education and training program for indigenous
anesthesia providers in Kenya. Dr. Newton divides his time
between being a pediatric anesthesiologist at Vanderbilt and
serving as chief anesthesiologist for Kijabe Hospital in Kenya.
“Over the span of his career, Mark has contributed substantially,
and at great personal sacrifice, to international anesthesia
education and training in low income countries,” said
Warren Sandberg, MD, PhD, Chairman of the Department of
Anesthesiology. “Anesthetic morbidity and mortality are a
leading cause of death among surgical patients in developing
countries, largely due to lack of trained personnel. Mark
embodies, in spirit and action, the true meaning of a physician
servant, and his personal contribution to healthcare on an
international level will have a perpetual, positive impact.”
Working in partnership with the Vanderbilt Institute of Global
Health (VIGH), VIA has sent residents, fellows, and faculty
to areas including Haiti, Guatemala, Vietnam, Jamaica, and
East Africa (Kenya) for the past five years in order to improve
anesthesia provision in these areas. The faculty has provided
education to anesthesia care providers in Jamaica and Vietnam
through locally organized seminars. Pediatric anesthesiologists,
fellows, and CRNAs also share their skills at a children’s hospital
in Guatemala City through a partnership between the Monroe
Carell Jr. Children’s Hospital at Vanderbilt and the Shalom
Foundation. Each year some of the pediatric anesthesia fellows
Mark Newton, MD, at far left, and Kelly McQueen, MD, at center, join a recent class of Kenyan Registered Nurse Anesthetists (KRNAs) in Kijabe, Kenya.
16
are able to practice pediatric anesthesia in Guatemala, alongside
one of their Vanderbilt mentors who is a specialist in global
anesthesia.
Vanderbilt residents in their CA-3 year can participate in an
ACGME-approved, one-month, international anesthesia rotation
at Kijabe Hospital in Kenya. The program allows four to six
residents annually an international opportunity, providing a
unique educational experience unlike any other found in U.S.
academic anesthesiology training programs. Each resident is
exposed to a medical experience in a resource-poor setting
where clinical skills must be sharpened to compensate for lack
of technology and supplies. The residents also provide clinical
training and give classroom lectures to local medical providers.
The nurse anesthetist training program in Kenya continues
to expand under Dr. Newton’s leadership, with now up to 20
students per class. After graduation, these students provide
anesthetic care in remote areas of Africa. In addition, multiple
critical care fellows from Vanderbilt have had critical care
rotations in Kenya while managing complicated, critically ill
patients in an environment with fewer resources. Each of these
Vanderbilt Anesthesiology’s Jenna Helmer Sobey, MD, assists KRNA
students as they provide anesthesia to a pediatric patient at Kijabe
Hospital.
Mark Newton, MD, has developed a close bond with the healthcare providers he helps train in Kenya.
17
rotations has been instrumental in preparing anesthesia care
providers for a career that will include a global health focus.
“We have successfully positioned our department to lead
in global anesthesia development from our home base at
Vanderbilt,” said Dr. Sandberg. “It is rewarding to know that our
efforts have a definitive impact on the provision of safe, effective
anesthesia in parts of the world where people often die due to
the lack of basic medical care. Going overseas to both train and
be trained is invaluable to our residents and fellows, and they
typically come back from VIA missions changed doctors. They
gain experiences there that cannot be learned from a textbook or
from our clinical environments in the United States.”
The capacity building projects that have been developed at
Kijabe Hospital over the past 15 years revolve around training
physicians and non-physicians for rural anesthesia care in
Kenya, South Sudan and areas of the Horn of Africa. These
programs have all been developed in coordination with the
respective Ministries of Health and national(African) academic
institutions. Partnerships between academic institutions in
Africa (University of Nairobi, Department of Anesthesiology),
AIC Kijabe Hospital, and Vanderbilt University have provided
the foundation for strengthening of physician anesthesia
training in East Africa. Kijabe Hospital is now hosting a
resident per month for clinical and didactic education as part of
its program from the University of Nairobi. In addition, the East
Africa Pediatric Anesthesia Fellowship began in September
Kenyan Registered Nurse Anesthetists perform an ultrasound-guided leg block. The students receive training in regional anesthesia techniques
through the VIA Regional Anesthesia and Acute Pain Initiative.
18
2013 with the involvement of the World Federation of Societies
of Anaesthesiologists (WFSA), many international pediatric
anesthesia societies, and the University of Nairobi/Kijabe
Hospital partnership.
In his long-term position in East Africa, Dr. Newton has had
the opportunity to assist in the development of these exciting
physician anesthesia capacity building programs which are
deeply embedded in the local academic fabric of each involved
country.
“These are exciting times for our department, and our
leadership in global health continues to attract some of the
brightest residents and fellows who want to have an impact on
the world with their specialty training,” said Dr. Sandberg.
Vanderbilt physicians Jenna Helmer Sobey, MD, at left, and Chris Sobey,
MD, at right, assist KRNAs during a procedure.
New Faculty Reinforce International Outreach
To further strengthen VIA’s efforts in global outreach/research, grant
writing, and in fundraising to support the initiative, Kelly McQueen,
MD, MPH, was recruited by the Department of Anesthesiology
in 2012 to serve in the role of Director of Vanderbilt Anesthesia
Global Health and Development. Dr. McQueen has a career-long
commitment to disaster response and humanitarian aid, and her
continued work on advocating for surgery and anesthesia as a global
health agenda has grown in the past year at Vanderbilt.
Matt McEvoy, MD, vice-chair for Educational Affairs and
program director, joined the Department of Anesthesiology
faculty in April 2013 and is a strong supporter and advocate
of the VIA experience for residents and fellows. Through Dr.
McEvoy’s leadership, the VIA opportunity is actively promoted
during recruitment of new medical students, residents, and
fellows with special interest in global medical service.
She is a founding member of the
Alliance for Surgery and Anesthesia
Presence (ASAP), an advocacy and
action group that builds awareness
regarding the urgent need for safe
global surgery and anesthesia
facilities. In August 2013, ASAP
became the 6th Integrated Society of
the International Society of Surgeons,
and Dr. McQueen was elected as
president of this new international
society. She also continues to serve
as chair of the American Society
of Anesthesiologists’ Global
Humanitarian Outreach Committee,
as well as directs the Global
Surgical Consortium, a non-profit
organization dedicated to improving
surgical infrastructure in low income
countries through data collection and
advocacy.
“The Vanderbilt community is
a collaborative and nurturing
environment for Global Health across
the disciplines, and I am thrilled to be
part of the anesthesia faculty and VIA
Team” said Dr. McQueen.
Kelly McQueen, MD, lectures to healthcare providers at Kijabe Hospital in Kenya. Dr. McQueen, who
joined Vanderbilt Anesthesiology in 2012, has more than two decades of experience in international medical outreach.
19
Clinical Overview
Serving in one of the largest clinical programs in the nation,
the Vanderbilt Department of Anesthesiology’s clinicians
provide procedural, critical care, pain management, and
all perioperative anesthesia services for more than 90,000
adult and pediatric patient encounters annually at more than
100 anesthetizing locations. Of these, more than 10,000
patients are seen annually in the Vanderbilt Interventional
Pain Clinic, and approximately 20,000 Vanderbilt adult and
pediatric patients receive an anesthetic during a radiologic,
gastrointestinal, or other diagnostic or therapeutic procedure.
The department’s faculty, residents, fellows, certified
registered nurse anesthetists (CRNAs), and nurse practitioners
provide care in our operating rooms, five adult intensive care
units, and the pediatric and neonatal intensive care units, and
perform approximately 4,000 anesthetics per year in the labor
and delivery suite.
The faculty, residents, fellows, nurse anesthetists, and nurse
practitioners provide services in three hospitals (Vanderbilt
University Hospital, Monroe Carell Jr. Children’s Hospital
at Vanderbilt, and the Nashville Veterans Administration
Hospital) and five outpatient facilities. Specialized clinicians
provide the full range of anesthetic techniques and procedures
in the operating rooms, procedural suites, intensive care
units, and pain management clinics. All surgical specialties
are represented, including adult and pediatric cardiac surgery,
all types of solid-organ transplantation, robotic surgery,
neurosurgery, and high-risk obstetrics. Vanderbilt’s trauma
service, which includes the orthopedic trauma program, is
among the busiest in the nation.
Tracy Jackson, MD, a member of the Pain Medicine Division, examines needle
placement during a fluoroscopically guided radio frequency stimulation procedure.
The operating room staff practices anesthesia care according
to the Anesthesia Care Team model. Anesthetics are provided
by one of the department’s highly skilled trainees or CRNAs
under the direction of one of the medical faculty. By means of
this model, the highest quality care is delivered in a safe and
effective manner using the unique skills of all team members.
ClinicalClinical
Staff Staff
of the
Department
Anesthesiology
of the
Department ofofAnesthesiology
300
Residents
CRNAs
Faculty
250
200
150
100
50
0
20
FY06
FY07
FY08
FY09
FY10
FY11
FY12
FY13
Vanderbilt Department of
Anesthesiology is also known
for innovation in the use
and development of new
technologies to deliver and
improve patient care and
to improve our educational
offerings. The faculty use
advanced human patient
simulators to teach basic
anesthesia skills, critical
event response techniques,
and team management
in the operating rooms
and intensive care units.
Vanderbilt is one of the few
medical training centers
with a 3-D TEE simulator
to teach the essential skill
of cardiac ultrasound. The
medical information systems
at Vanderbilt are second to
none and support the delivery
of safe and efficient patient
care. Perioperative record
keeping is highly automated
and managed through an
anesthesia information management system developed by the
Department of Anesthesiology. This system both enhances
effective patient care and supports the clinical research program.
Highlighted on the following pages are the services provided
by the Vanderbilt Department of Anesthesiology’s clinical
divisions.
Department of Anesthesiology Clinical Volumes
Department of Anesthesiology Clinical Volumes
120,000
Pain Procedures
Out of OR
100,000
OR
80,000
60,000
40,000
20,000
-
FY06
FY07
FY08
FY09
FY10
FY11
FY12
FY13
21
Division of Ambulatory Anesthesiology
Katherine Dobie, MD, performs an ultrasoundguided block at the Vanderbilt Bone & Joint
Surgery Center.
“At Vanderbilt, we remind ourselves every
day that ambulatory anesthesiology is rapidly
evolving as a subspecialty, and we are going
to be a big part of that,” said Ambulatory
Anesthesiology Division Chief Katherine
Dobie, MD. With a diverse patient and case
mix, we are continually looking for new
practices to improve our safety and quality.
Currently, we have one of the highest patient
satisfaction ratings within the institution, with
minimal complications and minimal hospital
transfers. At 13,000 patients and nearly 4,000
regional anesthetics yearly, we are proud
of this. Growth coupled with enthusiasm is
something we feel fortunate to have in our
Division.”
National statistics indicate that more than 70 percent of
all surgeries are now performed in an outpatient setting.
Vanderbilt’s Division of Ambulatory Anesthesiology meets the
local manifestation of this increased demand with growth, both
in locations and in additional services.
In March 2011, the Division of Ambulatory Anesthesiology
began providing anesthesia services at Vanderbilt’s newest
ambulatory surgery center, Vanderbilt Bone & Joint in
Franklin. The three-room center specializes in orthopedic
procedures, and the expansion extended VUMC’s regional
anesthesia services, including an at-home peripheral nerve
catheter program, to Williamson
and neighboring counties. The new
site also added more than 3,000
ambulatory cases per year, to total
nearly 13,000 cases annually in all
of our outpatient centers.
As NSC is primarily an orthopedic/sports
medicine center, the majority of training in peripheral regional
anesthesia occurs there. Under the leadership of Randall
Malchow, MD, NSC Medical Director, Vanderbilt residents
receive training in the techniques of ultrasound-guided regional
blockade and the placement of regional catheters for homebased post-operative pain management.
“We are unique among resident training programs in that we
take the residents out of the OR for an eight-hour didactic
training session at the beginning of their regional rotation,”
said Dobie. “Attending anesthesiologists do the blocks that
The Division of Ambulatory
Anesthesiology was formed in 2008
and provides services for Vanderbilt
University Medical Center satellite
locations that include Nashville
Surgery Center (NSC), Vanderbilt
Outpatient Surgery (VOS), Cool
Springs Surgery Center (CSSC),
and Vanderbilt Bone & Joint
Surgery Center. Two of the four
centers are joint ventures where
both Vanderbilt and community
surgeons work, allowing for a
broad base of cases rarely seen in
an academic practice, including
those requiring GI, ophthalmologic,
ENT, plastic surgery, pediatric,
urologic, neurosurgical, spine,
orthopedic, and dental procedures. Vanderbilt Bone & Joint Surgery Center in Franklin, Tennessee, is the newest ambulatory surgery center
in Vanderbilt University Medical Center’s network of satellite locations.
22
day, and residents do not start performing clinical regional
anesthesia until we know they have a strong knowledge base.
With the large volume of regional cases, residents and fellows
leave our rotations equipped not only with technical skill, but
also with an understanding of application in a high-volume,
fast-paced environment. We have been able to do this without
compromising efficiency.”
Successful implementation of an outpatient catheter program,
pioneered by Dr. Malchow in 2008, has allowed the migration
of complex shoulder and foot and ankle cases out of the
inpatient setting into the more patient-friendly ambulatory
setting. All regional blocks are documented in Dr. Malchow’s
comprehensive database for future academic research, which
now contains 9,500 cases.
The volume of pain management procedures offered at Cool
Springs has also increased with the addition of a satellite
location of the Vanderbilt Interventional Pain Center. Dan
Lonergan, MD, who completed a Pain Medicine Fellowship
at Vanderbilt, performs interventional pain procedures at
the Cool Springs location to serve Williamson County and
adjacent counties.
Outpatient GI endoscopies have been increasing in volume
at CSSC, and pediatric volume has been exponentially
increasing at every center, with the largest percentage being
pediatric ENT cases from community surgeons. Under the
leadership of Jane Brock, MD, Cool Springs Surgery Center
was named Symbion’s “Surgery Center of the Year” for 2011
and 2012.
Cool Springs Surgery Center is located on Mallory Lane in Franklin,
Tennessee.
“This is a national recognition
that we have enjoyed two
years in a row; Dr. Brock’s
leadership amidst tremendous
growth and change has been
outstanding,” said Dobie.
The Vanderbilt outpatient
surgery center (VOS) is
primarily an ENT center
where complex ear,
sinus, and voice cases are
performed, along with
routine tonsillectomies and
adenoidectomies.
The Division of Ambulatory
Anesthesiology is led by Dr.
Dobie and includes five fulltime faculty, 21 CRNAs, and
two to three residents who
rotate through the program
monthly.
Nashville Surgery Center is located on Patterson Street in Nashville, Tennessee.
23
Division of Anesthesiology Critical Care Medicine
The Division of Anesthesiology Critical Care Medicine provides
critical care services in the cardiovascular ICU, neurological ICU,
surgical ICU, and burn ICU at Vanderbilt University Medical Center
and at the surgical ICU at the Tennessee Valley Health Care System
Nashville Veterans Administration Medical Center. To address
growing demands of critical care services with the recent opening of
the 11-story Critical Care Tower, the division has expanded to include
21 anesthesiology intensivists along with more than 35 acute care
nurse practitioners (ACNPs) and physician assistants (PAs), making
it one of the largest critical care divisions in the country. The division
operates using a multidisciplinary, intensivist-led critical care team
model that includes ACNPs and PAs; this paradigm is being replicated
with increasing frequency across the nation.
for five years. Fellows have a diverse clinical experience through
our subspecialty ICUs and an innovative didactic program of
lectures delivered by multispecialty faculty, problem-based learning
discussions, simulations, workshops, journal clubs, and an interactive
web-based learning portal. Faculty and fellows participate in teaching
the Fundamentals in Critical Care Support (FCCS) and the Advanced
Trauma Life Support (ATLS) courses. In addition, faculty from the
division have taken leadership roles in medical student education
through the development of Immersion Courses and Critical Care
Skill programs as part of the redesigned curriculum of the Vanderbilt
University School of Medicine. An ongoing alliance between the
Critical Care Division and the School of Nursing also supports an
ACNP Intensivist training program.
The Division of Anesthesiology Critical Care Medicine strives to
provide excellent patient care, promote education, and engage in
scholarly activity. Faculty and fellows routinely participate in CME
activities and workshops to maintain and acquire new skills to
keep abreast of modern technology and the changing spectrum of
caring for the critically ill. This includes proficiency in ultrasound,
echocardiography, and management of patients with ventricular-assist
devices or who are on ECMO.
By encouraging research to identify better ways to care for
perioperative and critically ill patients, the division takes a proactive
approach to the ever-changing demands and regulations in healthcare
and the changing milieu of critical care. Active research programs in
the Division of Anesthesiology Critical Care Medicine encompass
both clinical and translational research and focus on perioperative
risk factors and mechanisms of cognitive impairment, kidney injury
in cardiac and non-cardiac patients, sepsis and its monitoring,
education and implementation science, health resource utilization,
multisensory training, and quality improvement projects. Active
grants in the division include an RO1, a K23 training grant, and a
FAER Education grant, in addition to numerous smaller industry and
Vanderbilt Institute for Clinical and Translational Research (VICTR)
grants. Faculty have been involved in more than 20 peer reviewed
manuscripts and textbook chapters in the past academic year alone.
Division faculty, who are involved in the training and mentoring
of critical care fellows and residents from many disciplines, also
participate in educational activities at the local, regional, national,
and international level. The Critical Care Anesthesia Fellowship itself
has recently been expanded to eight ACGME-accredited fellowship
positions per year, accepting fellows with both anesthesiology and
surgical training, and the fellowship has received accreditation
Division of Anesthesiology Critical Care Medicine: Front row, left to right: Jonathan Shoopman, MD; William Costello, MD; Justin
Sandall, DO (Fellow); James Mykytenko, MD; Josh Squiers, ACNP; Ryan Henderson, ACNP; Stuart McGrane, MD; David Hall, MD; Chris
Hughes, MD; Lisa Weavind, MD; Pratik Pandharipande, MD; Lindsay Trantum, ACNP; Patrick Henson, DO; Frederick “Josh” Billings, MD; Steve
Widmar, ACNP. Second row, left to right: Sheena Weaver, MD; Tracy McGrane, MD; Anna Fong, ACNP; Nathan Ashby, MD; Meg Shiffrin, ACNP;
Jayme Gibson, ACNP; Roy Neely, ACNP; Ryan Truesdale, ACNP; Lee Parmley, MD, JD; Laura Wilkinson, ACNP; Arna Banerjee, MD. Not pictured: Holly Brooks, ACNP; Justin Calabrace, ACNP; John Barwise, MD; Jodi Cressler, ACNP; Olga Dayts, ACNP; Edmund Donahue, PA; Jamie
Gibson, ACNP; Elizabeth Heitman, PhD; Amanda Hill, ACNP; April Kapu, ACNP; Jason Kennedy, MD; Hannah Maloney, ACNP; Lauren Nevels,
ACNP; Nahel Saied, MD; Chad Wagner, MD; Nora Azzazy, MD; Jeff Barton, PA, Debra Cirone, ACNP; Donald Crabtree, MD; Gregory Evans,
MD; Ailish Garrett, ACNP; Irina Gault, MD; Molly Goidel, ACNP; Meredith Golden, PA; Emily Holcombe, ACNP; Katherine Jackowski, ACNP;
Ariel Kappa, ACNP; Michelle Kearney, ACNP; Avinash Kumar, MD; Jean Anne Leininger, MD; Aimee Marlar, PA; Roy Neeley, MD; Monica Nevels,
ACNP; Kellie O’Connell, ACNP; Andrea Primm, ACNP; Christina Riley, ACNP; Briana Rogers, ACNP; Emily Spring, PA; Melissa Wiley, ACNP;
Laura Wilkinson, ACNP; Joey Williams, ACNP; Briana Witherspoon, ACNP.
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Division of Cardiothoracic Anesthesiology
The Division of Cardiothoracic Anesthesiology is led by
Robert Deegan, MD, PhD, and includes ten faculty members
and ten nurse anesthetists. Each month, three residents rotate
through the service. The fellowship program, under the
leadership of Annemarie Thompson, MD, expanded in 2013 to
three fellows trained annually. The Division is a microcosm of
the larger department within which it resides, supporting the
tripartite missions of clinical excellence, academic pursuits in
anesthesiology, and education.
practice, and is performed on nearly all adult cardiac
patients. The cardiothoracic anesthesiologists are also
increasingly in demand to provide intra-procedure TEE
in the electrophysiology suite to, for example, rule out
thrombosis of the atrial appendage, to guide trans-septal
puncture, and to look for evidence of cardiac tamponade. All
studies are performed and interpreted by the cardiothoracic
anesthesiologist, and cases are digitally archived for future
study.
Innovation, research, and education are all key components
of the division, as is evidenced by its support of novel clinical
environments in the hybrid cath lab/OR, the introduction of
transesophageal echocardiography as an invaluable monitoring
tool in intensive care units, many research initiatives, and a
strong commitment to being a national leader in cardiothoracic
anesthesia education.
The Division Cardiothoracic Anesthesiology faculty conduct
research in vascular system function, cardiopulmonary
conditioning, renal failure, and perioperative inflammatory
response. Extramural grant support comes from the American
Heart Association and the National Institutes of Health.
The division works alongside the surgeons and cardiologists
of the Vanderbilt Heart and Vascular Institute to perform
approximately 1,200 adult cardiac procedures a year. These
include coronary artery bypass grafting (the majority of
which are performed off-pump), valvular surgery, cardiac
transplantation, adult congenital procedures, hybrid bypass
procedures, aortic aneurysm and dissection repair, and
ventricular assist device (VAD) insertions. The VAD program
dramatically expanded in 2013 to a rate of about 80 per
annum. The TAVR program (percutaneous aortic valve
replacement for severe aortic stenosis in patients who are
too high risk for open-heart surgery) began in 2011, and
approximately 100 TAVRs are completed annually (Corevalve
and Sapiens).
The division also has significant external and internal
education presence. Division faculty have hosted successful
workshops in perioperative transesophageal echocardiography
(TEE) and hemodynamic echo, drawing anesthesiology
residents, fellows, faculty, and private practitioners from
throughout the region. Cardiothoracic anesthesiologist Julian
Bick, MD, received a $100,000 Research in Education
Grant from the Foundation for Anesthesia Education and
Research which is used to train CA-1 residents in TEE. A TEE
simulator, which provides 3-D, computer-generated views
of the heart as a probe is guided through a mannequin, is
housed at Vanderbilt’s Center for Experiential Learning and
Assessment (CELA). The division’s TEE training is conducted
with the simulator as the centerpiece.
In addition to cardiac surgery,
the division works with thoracic
surgeons to perform about 600
thoracic cases annually, including
thoracotomy, mediastinoscopy,
lung transplantation, and
esophageal procedures. Anesthesia
services are also provided for
bronchoscopies, placement of
internal cardiac defibrillators,
valvuloplasty, electrophysiology
procedures, and septal ablations,
which together account for
approximately 2,500 cases
annually. A subset of the division’s
faculty is also board-certified in
intensive care medicine. These
individuals rotate through the
cardiovascular intensive care
unit, under the direction of
division faculty member Chad
Wagner, MD.
Intraoperative transesophageal
echocardiography (TEE) is
an integral part of the clinical
Division of Cardiothoracic Anesthesiology: Front row, left to right: Julian Bick, MD; Annemarie
Thompson, MD; Susan Eagle, MD; and Robert Deegan, MD, PhD. Back row, left to right: Chad Wagner,
MD; Mias Pretorius, MD; Jason Kennedy, MD; and Frederick “Josh Billings,” MD. Not pictured: Jeremy
Bennett, MD; Antonio Hernandez, MD; and Brigitte Messenger, MD.
25
Certified Registered Nurse Anesthetists
More than 100 Certified Registered Nurse Anesthetists are a critical component of the anesthesia care team model used at Vanderbilt University
Medical Center.
The Vanderbilt Department of Anesthesiology embraces
the anesthesia care team approach to patient care, involving
anesthesiologists and residents, certified registered nurse
anesthetists (CRNAs), student registered nurse anesthetists
(SRNAs), and anesthesia technicians. The more than 115
CRNAs at Vanderbilt provide anesthesia for all types of surgical
procedures, including cardiac, pediatrics, vascular, trauma,
neurosurgery, plastics, radiologic, and special procedures.
CRNAs administer general, regional, and monitored anesthesia
care for scheduled and emergency surgical, obstetric, and
diagnostic procedures.
Key job responsibilities of the CRNA include preoperative
patient evaluation, management of the patient through
completion of the operative procedure, safe transport of the
patient to the recovery area, and assurance of the appropriate
postoperative care. Additionally, CRNAs provide instruction
and education for student nurse anesthetists (SRNAs). They also
support the residency educational mission by providing service
coverage to allow residents to attend educational activities
and participate in elective rotations. Thus, the CRNAs are
essential to many core endeavors. In terms of personnel, the
CRNA Division is the largest division within the Department of
Anesthesiology.
Vanderbilt is the primary clinical affiliate of the Middle
Tennessee School of Anesthesia (MTSA) in Madison,
Tennessee, which is the second largest nurse anesthesia program
26
in the country. Vanderbilt is also the primary clinical affiliate
for the Union University Nurse Anesthesia program in Jackson,
Tennessee. Student nurse anesthetists assist in approximately
7,000 anesthetics per year while on Vanderbilt rotations. SRNA
coordinators are CRNAs Brad Koss and Andrew Philips.
The CRNA Division mirrors the VUMC operating room
pod organization, and the service specialist position within
the CRNA structure improves communication with all pod
members. The six service specialists are Neurosurgery Service
Specialist Tammy Freehling; AOS/Ortho Service Specialist
Kathy Mitchell; General Oncology/Urology Service Specialist
Ken Donnell; Opthalmology/Otolaryngology/Oral Surgery/
Plastics Service Specialist Mark Haffey; Out-of-OR Service
Specialist Ki Szmyd-Hogan; and Pediatric Cardiothoracic
Service Specialist Lewis McCarver.
In addition to SRNA training, the CRNA division has developed
a strong program of Continuing Education Unit-eligible
educational programs designed specifically for CRNAs. These
programs are overseen by CRNA Educator Mike Leersnyder.
Chief CRNA Steve Blanks and Assistant Chief CRNA Buffy
Krauser-Lupear direct the CRNA Division. Five designated lead
CRNAs are Brian Reid in Ambulatory; Paul Wilson in Obstetric/
Gynecology; Edith Newberry in Adult Cardiac; Amanda
Dickert in Pediatrics; and John Butorac in Multispecialty Adult
Anesthesia.
Anesthesia Technicians Provide Critical Support
Vanderbilt University Medical Center is staffed with 38 anesthesia
technicians who contribute to safe, efficient anesthesia care by
providing highly skilled assistance to anesthesiologists and nurse
anesthetists at both on- and off-campus clinical locations. Anesthesia
technician duties include equipment maintenance and servicing,
running laboratory tests on blood samples, maintaining quality
assurance records, and operating a variety of equipment used to
monitor, evaluate, and manage the patient undergoing anesthesia.
As the level of the anesthesia technician’s training, experience,
and knowledge increases, the anesthesia technician provides closer
intraoperative support to the anesthesia provider. The department
offers structured classroom lectures to train technicians in a nondistracting clinical setting. The anesthesia technician, the certified
anesthesia technician, and the certified anesthesia technologist
cover areas related to the following adult and pediatric services:
neurosurgery, plastics, urology, ophthalmology, vascular, trauma,
cardiothoracic, general surgery, orthopedics, obstetrics/gynecology,
and ENT. They also provide support for special procedures in
the radiology department that include MRI, PET scan, radiation
oncology, GI Lab, CT Scan, nuclear medicine, and the cardiac
catheterization lab.
Buffy Krauser-Lupear, Assistant Chief CRNA, oversees the
Anesthesia Technician Program. Sue Christian, a certified anesthesia
technologist and long-time member of the Vanderbilt team fills the
Anesthesia Technician Manager/Educator position. The technical
staff continues to evolve with greater emphasis being placed on
teamwork and advancing clinical skills.
Anesthesia
technicians
with specialized
training operate
autotransfusion
equipment at
Vanderbilt.
Members of the anesthesia technician team at VUMC include, left to right, Ray Brazill and Mao Shinoda.
27
Division of Multispecialty Adult Anesthesiology
The Division of Multispecialty Adult Anesthesiology is the
department’s largest division, providing perioperative anesthetic
care for more than 12,000 patients annually in 45 operating rooms
and procedure suites for a wide variety of surgical services,
including general surgery, orthopedics, urology, plastic surgery,
ophthalmology, vascular surgery, otolaryngology, hepatobiliary
surgery, liver and renal transplantation, and oral/maxillofacial
surgery. MSA faculty and staff also provide 24-hour coverage
for emergency and trauma surgery for the region. The division
has 48 full- and part-time faculty members, most of whom have
significant subspecialty training and expertise. An additional MSA
activity is providing preoperative consultations.
MSA Division faculty provide anesthesiology residents a wide
variety of introductory and advanced clinical experiences and
make many contributions to the educational programs for medical
students, residents, and fellows. Additionally, MSA faculty
teach and supervise residents from other specialties, as well
as student registered nurse anesthetists who rotate in the MSA
Division. Division faculty pursue a wide range of academic
interests including regional anesthesia, airway management,
information technology, perioperative cognitive dysfunction,
echocardiography, and ultrasound imaging.
The division’s members are also highly active in research, with
numerous investigator-initiated clinical research projects currently
in progress. MSA Division Chief James Berry, MD, believes the
division’s multi-year research efforts to demonstrate the value of
wireless monitoring of post-operative patients will ultimately lead
to institution-wide adoption of the technology. By using wireless
monitors that collect patients’ vital signs in post-op areas not
typically monitored, nursing staff can be notified and medical staff
would be able to respond immediately if abnormal readings are
detected.
Division of Multispecialty Adult Anesthesiology: Front row, left to right, Letha Mathews, MD; Amy Robertson, MD; Tekuila Carter, MD; Steve Hyman, MD; James Berry, MD; Clifford Bowens, MD; Michael Pilla, MD; Kofi Kla, MD; and Brian Rothman, MD. Second row, Michael Higgins, MD;
Raj Gupta, MD; Jesse Ehrenfeld, MD, MPH; Chairman Warren Sandberg, MD; Marc Hayes, MD; Jason Lane, MD; James Blair, DO; and Edward
Sherwood, MD, PhD. Not pictured: Brian Allen, MD; Eswara Botta, MD; Eric Briggs, MD; Jane Brock, MD; Susan Calderwood, MD; Chris Canlas,
MD; Meera Chandrashekar; Katherine Dobie, MD; Jane Easdown, MD; Jean Fischer, MD; William Furman, MD; Stephen Harvey, MD; Loren
Hemachandra, MD; Patrick Henson, MD; Shannon Hersey, MD; Doug Hester, MD; Scott Hoffman, MD; Kenneth Holroyd, MD; Lisa Jaeger, MD;
Shannon Kilkelly, MD; Randall Malchow, MD; Jeffrey Martin, MD; Kelly McQueen, MD; Stephanie Rasmussen, MD; Staci Ridner, MD; Thomas
Shultz, MD; Paul St. Jacques, MD; Jonathan Wanderer, MD; Matthew Weinger, MD; and Robert Wells, MD.
28
Division of Neurosurgical Anesthesiology
For the third year in a row, Vanderbilt’s departments of Neurology
and Neurological Surgery have ranked among the top of U.S.
News & World Report’s “America’s Best Hospitals.” Neurosurgery
and other neurologic services continue to expand at Vanderbilt
University Medical Center, and faculty specializing in neurosurgical
anesthesiology are providing increasingly complex anesthesia and
sedation services.
The Clinical Neurosciences Institute, a collaborative group
established at Vanderbilt in 2011 by the departments of Neurology,
Neurological Surgery, and Psychiatry to provide comprehensive
patient care, continues to attract increasing numbers of referrals
for service. The Vanderbilt Department of Neurological Surgery
currently has the highest volume of deep brain stimulator
implantation in North America. The Vanderbilt Brain Tumor Center
provides comprehensive care for patients with brain tumors, and
more than 400 major brain tumor operations are performed annually.
More than 2,839 neurologic cases required anesthesia in fiscal year
2012.
Because of these exciting changes in the Department of Neurological
Surgery requiring increased demand for neurosurgical anesthesiology
expertise, a separate division devoted to this subspecialty was
created in September 2013. Anesthesiology Chair Warren Sandberg,
MD, PhD, recruited Lorri Lee, MD, formerly a professor in the
Department of Anesthesiology and Pain Medicine at the University of
Washington, to head the division. Dr. Lee is nationally recognized for
her work on outcomes and complications related to the perioperative
management of neurosurgical procedures, primarily through the
American Society of Anesthesiologists Closed Claims Project. She
is also widely known for her efforts as a member of the Anesthesia
Patient Safety Foundation Executive Committee and Newsletter coeditor.
One of Dr. Lee’s primary goals is to make the division a national
leader in neuroscience research through collaborative efforts with
the departments of Neurological Surgery and Neurology, while
maintaining the excellent clinical reputation that the division has
earned. Current research in the department by Drs. Jesse Ehrenfeld,
Letha Mathews, James Blair, and Koffi Kla and neurosurgeons in
the Department of Neurological Surgery involve a series of clinical
research projects aimed at improving patient outcomes and costeffectiveness.
Paramount to the success of this newly created division is the
collegial working relationship among team members. Dr. Letha
Matthews, the newly appointed associate chief of the division,
commented, “What excites me most is the successful collaboration
that we have among the neurosurgical, anesthesia, and nursing teams.
Our experienced and dedicated neuroanesthesia and neurointensivist
faculty ensure that our quality of care is outstanding, resulting in one
of the shortest average lengths-of-stay in the country following brain
tumor surgery.”
It is the patient that benefits most from the camaraderie of the
clinical providers, as top quality care is consistent throughout the
perioperative period. Four experienced certified registered nurse
anesthetists led by Tammy Freehling, CRNA, are dedicated to
neuroanesthesia services and are an integral part of the patient care
Lorri Lee, MD
Division Chief, Division of Neurosurgical Anesthesiology
team. Avinash Kumar, MD, FCCP, and his neurointensivist team
provide comprehensive intensive care management of critically ill
neurosurgical patients in VUMC’s state of the art ICU.
VUMC has six designated neurosurgical operating rooms where
anesthesia services are provided for operations, including brain
tumor, blood vessel malformation, aneurysms, stroke intervention,
trauma, complex spinal procedures, functional neurosurgery,
and chronic pain management. The Division of Neurosurgical
Anesthesiology also provides specialized anesthesia services for
“awake craniotomies” where patients are intermittently awake to
facilitate speech and motor mapping during surgery to preserve
the most vital areas of the brain. Anesthesia is also provided by the
division in neurointerventional radiology suites, and at Monroe Carell
Jr. Children’s Hospital at Vanderbilt. Like their surgical colleagues,
neuroanesthesiologists face many unique challenges, including the
length of procedures, which may last more than 16 hours in the OR,
unusual patient positioning, and unexpected intraoperative events
such as seizures or intracranial hemorrhage.
“We are manipulating neurophysiology with drugs and other
interventions during the procedure to facilitate surgery while we
share the target organ with the neurosurgeons,” said Dr. Mathews.
Residents on the neurosurgical anesthesia rotation find the ability to
have an immediate impact on the operation exciting and gratifying,
as do the faculty leading the training. Drs. Jane Easdown and Sheena
Weaver have developed educational modules to illustrate these
clinical concepts. Dr. Lee noted: “We all went to medical school to
make a difference in patients’ lives, and neuroanesthesiology is one
of the best fields to accomplish that goal every day.”
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Division of Obstetric Anesthesiology
Division of Obstetric Anesthesiology: Left to right, Sarah Starr, MD; Jill Boyle, MD; Ray Paschall, MD; Michael Richardson, MD; John Downing,
MD; Curtis Baysinger, MD; Matthew Buck, MD; and Adrienne Rey, MD.
The Division of Obstetric Anesthesiology provides dedicated, 24hour in-house obstetric care for approximately 4,000 deliveries
at Vanderbilt University Medical Center annually, nearly half of
which are considered high risk. The team also provides anesthesia
services for approximately 2,500 gynecologic and other surgical
procedures for primarily women in a suite of three operating rooms.
In addition to offering the full complement of techniques for labor
analgesia, the division provides consultation and critical care
management services for high-risk obstetric patients, as well as
specialized anesthesia care for fetal surgery.
The resumption of in utero repair of myelomeningocele, a
procedure pioneered at Vanderbilt University Medical Center
in 1997, has brought an added dimension of specialized clinical
service to the Division of Obstetric Anesthesiology. The results of a
seven-year National Institutes of Health-funded trial, Management
of Myelomeningocele Study (MOMS) demonstrated clear benefit
for babies who undergo fetal surgery to treat spina bifida. These
surgeries began again at VUMC in April 2011.
The MOMS trial found fetal surgery significantly improved the
child’s chances of being able to walk. There was no increased risk
of death for the baby or the mother when the fetal surgery group
was compared with a group that received surgery after birth. With
patients being referred from across the nation, it is estimated that
about 15 of these procedures will be performed at VUMC annually,
with Obstetric Anesthesiologist Ray Paschall, MD, taking the lead
in providing anesthetic care for these complex cases.
Trainees in the Division of Obstetric Anesthesiology, including
both residents (three each month) and fellows, receive extensive
experience in the care of clinically challenging patients. In 2012,
the Division of Obstetric Anesthesiology received ACGME
30
accreditation for their fellowship program. The Division is among
the first 11 programs in the country that received approval from
the ACGME/Resident Review Committee. The program received
the full, three-year accreditation, and the first ACGME fellow
completed his training in July 2013.
The Division also has a number of on-going clinical research
projects, including studies on various anesthetic techniques on
patient outcomes. Research projects concerning transversus
abdominis block for the relief of pain following Cesarean delivery,
factors affecting the choice of pain relief during labor, and the
effects of low-molecular-weight heparin on thromboelastographic
measurements are ongoing. The Division has also recently resumed
work examining the effects of obstetric and anesthetic drugs on
both the maternal and fetal vasculature within the placenta using
a dual-perfusion technique of isolated placenta tissue subunits.
Research examining the transfer of drugs across the placenta
from the maternal to fetal side is also planned, as well as work to
understand the ion channel expression within in the vasculature of
the placenta.
The Division of Obstetric Anesthesiology is directed by Curtis
Baysinger, MD, who will be stepping down from the position in
early 2014. To then fill the role of division chief, the department has
recruited one of the specialty’s top leaders, who has a longstanding
reputation in innovative research, an impressive list of academic
accomplishments, and a strong record in national leadership.
The Division of Obstetric Anesthesiology includes six other
faculty members, two CRNAs, and one administrative assistant.
The division’s faculty members have all completed Obstetrical
Anesthesia fellowship training and have extensive experience in
obstetric care, regional anesthesia, and acute pain management.
Division of Pain Medicine
Chronic pain affects an estimated 100 million people in the
United States – more than diabetes, heart disease, and cancer
combined – according to the Institute of Medicine of the
National Academies. In particular, the roles of select surgeries
and cancer survival resulting in persistent chronic pain states
are growing and are of interest to Anesthesiology. Because pain
is complex and often involves physiological, psychological,
emotional, and environmental factors, clinicians at Vanderbilt
University Medical Center’s Pain Management Center utilize
a multidisciplinary approach to pain care, offering thorough
evaluations, consultations, and referrals to optimize available
treatment modalities.
“The Center is for all patients who have pain, regardless of
cause and what has or hasn’t been done previously,” said Marc
Huntoon, MD, Chief of the Division of Pain Medicine and
Director of the Vanderbilt Pain Management Center. “It is the first
stop for pain patients at Vanderbilt.”
The Pain Management Center sees patients with all types of pain,
including back, neck, abdominal, pelvic, nerve and joint pain,
and chronic headache. During the first clinic visit, a patient’s
medical history is thoroughly reviewed, and his or her condition
is evaluated by Vanderbilt pain specialists to develop a teambased treatment plan. This team could include specialists from
anesthesiology, psychology, psychiatry, neurology, neurosurgery,
orthopedics, and rehabilitation. In partnership with the Vanderbilt
Center for Integrative Health, the new EMPOWER program
(Empowerment and Mindfulness Program for Outpatient
Wellness, Education, and Rehabilitation) is being developed to
offer those patients with recalcitrant pain syndromes new hope.
The program focuses on education, functional improvement, and
improvements in pain, anxiety, and other related issues. Pain
Management Center physicians also work closely with a patient’s
primary care providers to close the loop effectively and foster
shared responsibility of patient health.
“Providers at the primary care level often haven’t had the
right resources for pain care,” Dr. Huntoon said. “At the Pain
Management Center, we build relationships with primary
care providers, get patients the care they need, and work
on an ongoing basis with the providers. We see it as a very
collaborative and supportive relationship.”
The Vanderbilt Medical Group Pain Advisory Council, which
first met in April 2010, began to envision a pain center, striving
Division of Pain Medicine: Front row, left to right, Irina Phillips, MD; Meenal Patil, MD; Heather Jackson, NP; Tracy Jackson, MD; and Becca
Ognibene, PT. Second row, left to right, Dan Lonergan, MD; Kurt Dittrich, MD; Marc Huntoon, MD; Chris Sobey, MD; and Amy Turner, RN. Not
pictured: Natalie Strickland, MD; Brent Dilts, MD; John Corey, MD; and Janie Smith, MD.
31
to create an easy referral
resource for both Vanderbilt
physicians and outside
providers that offered
cutting-edge care based
on the latest evidence.
When Huntoon arrived at
Vanderbilt in June 2011, he
had much the same plan.
“Many institutions try to
achieve this to some extent
but are unable to coordinate
the multi-disciplinary
vision,” Huntoon said. “The
idea is that pain crosses
many boundaries. No one
specialty has the knowledge
and capabilities to best serve
all patients, but if we put
our heads together, we can
ensure optimal care.”
The Pain Management
Center and Interventional
Pain Clinic are housed
at Vanderbilt Health
One Hundred Oaks,
just off Interstate 65 in
Tracy Jackson, MD, performs a fluoroscopically-guided block for a patient at the Vanderbilt Interventional Pain
Nashville, Tennessee. The
Interventional Pain Clinic’s Center.
surgical service for patients with pain syndromes requiring the
7,000-square-foot space
expertise of the Division of Pain Medicine faculty. The belief is
includes state-of-the-art procedure rooms, exam rooms, recovery
that patients admitted to Vanderbilt University hospitals should
bays, and multidisciplinary rooms. In July 2011, a branch of
have access to expert pain care, regardless of the reason for
the Interventional Pain Center opened in the Cool Springs area
admission. The Department of Anesthesiology’s interventional
of Williamson County, under the direction of Vanderbilt Pain
pain implantable device practice is also growing, and the CPS
Medicine faculty member Dan Lonergan, MD. Services are
also manages our own patients who are admitted for either device
provided at the Cool Springs Surgery Center on Mallory Lane in
trials or permanent implants. Providing targeted pain control for
Franklin.
both chronic and acute pain at the area of injury has produced
better pain control, improved patient satisfaction, and the ability
Monroe Carell Jr. Children’s Hospital at Vanderbilt is the site
to reduce patients’ time in the hospital.
of a unique Pediatric Pain Clinic, where Vanderbilt providers
work with patients, their families, and their physicians to provide
Expanding pain medicine education at Vanderbilt, from the
the best pain management for the pediatric patient’s specific
medical student level up, is a goal of Dr. Huntoon and the
needs. The clinic sees two to three new patients every week,
division. The Regional Anesthesia and Acute Pain Fellowship has
and additional patients who live at a distance are monitored by
already proven successful under the leadership of Lisa Jaeger,
telephone. The Neonatal Intensive Care Unit at the Children’s
MD, with two fellows in 2013-2014 learning advanced regional
Hospital has its own specialized pain management program, and
anesthesia and acute pain, developing into educators for residents,
there is a regional anesthesia program to treat young patients as
and growing to be scholars by developing research studies for
well.
publication. In addition, the division’s chronic pain fellowship
The Comprehensive Pain Service (CPS) at VUMC also continues grew to include three fellows in 2012-2013. Both the acute and
chronic pain fellowships are integral parts of the educational
to grow as patients are benefitting in increasing numbers from
continuum. Dr. Huntoon hopes to continue to incorporate pain
epidural catheters, peripheral nerve blocks, and peripheral nerve
medicine topics into the medical student curriculum and to
catheters for pain management for complex shoulder and arm
improve both resident and fellow initiatives in the specialty,
surgery, knee arthroplasties, extensive ankle restorations, and
making use of Vanderbilt’s advanced simulation technology, as
repeated burn debridements. The CPS began in August 2012 as
well as the anatomy lab setting.
a new vision for in-hospital pain care that builds on the overall
vision of the Pain Program. The new service continues to build
capacity and capability to see consults from any medical and
32
Division of Pediatric Anesthesiology
A much anticipated $30 million, 33-bed expansion at the Monroe
Carell Jr. Children’s Hospital at Vanderbilt in 2012 has kept the
Division of Pediatric Anesthesiology on their toes, finding ways to
provide top-quality clinical services more efficiently, while keeping
both young patients and their families happy.
the nurse practitioners who work with the Division of Pediatric
Anesthesiology in preoperatively preparing patients for anesthesia or
sedation. Jill and her team work with Dr. Kilkelly in the scheduling
and coordination of various care teams, as well as helping families
navigate the process.
In September 2013, Suanne Daves, MD, was named vice-chair
for Pediatric Anesthesiology, a key leadership role for both
the Department of Anesthesiology and the Monroe Carell Jr.
Children’s Hospital at Vanderbilt. In 2012, Dr. Daves was named
Anesthesiologist-in-Chief of the Children’s Hospital. Dr. Daves
joined the Anesthesiology Department in December 2008 as
an associate professor in the Division of Pediatric Cardiac
Anesthesiology. She was then appointed chief of the Pediatric
Cardiac Division in January 2009.
Education and training of medical students, anesthesia residents,
nurses, and associated healthcare personnel is a major faculty
commitment. Several anesthesiology residents rotate on pediatric
anesthesiology services each month and gain experience in the
management of patients undergoing both routine and complex
surgical procedures, as well as diagnostic and interventional
procedures performed outside the operating room. The Pediatric
Anesthesiology Fellowship Program offers a year of subspecialty
training in pediatric anesthesia and perioperative care, including
critical care and pain management.
Knowing they were facing increasing demands on their resources
with the hospital’s expansion, members of the Division of Pediatric
Anesthesiology began examining their processes under a microscope,
identifying areas for improvement. One example is their participation
in an initiative to improve perioperative care processes. The initiative
is led by a task force consisting of a surgeon, the nurse managers
of the OR and the Holding/PACU areas, two business analysts, and
Daniel Roke, MD, from Anesthesiology. The group initially focused
on First Case Starts, examining the preoperative process thoroughly.
Based on their recommendations, first case start times improved
dramatically. The on-time first case start rate was 38% in April 2010
and is now above 70%, assuring that more patients and families have
a timely start to their procedure.
Modifications were also made in the areas of pediatric pain services
and in pediatric radiation services to increase efficiency and serve
more patients. With Stephen Hays, MD, and Drew Franklin, MD,
both having dedicated clinical time to see patients, the number of
patients seen in the pediatric pain clinic has tripled, and both internal
and external referrals continue to increase. Peter Chin, MD, oversees
anesthesiology services for pediatric radiology, and through finding
better ways to manage patient flow, volume has increased and
Saturday service for MRI procedures has been added.
Areas of academic interest to the division’s faculty include quality
improvement, airway management, pediatric pain management,
regional anesthesia, ECMO, and perioperative care of cardiovascular
patients. The Division of Pediatric Anesthesiology is an active
member of Wake Up Safe, a quality improvement initiative of the
Society for Pediatric Anesthesia. It is a Patient Safety Organization
(PSO) composed of the leading children’s hospitals throughout the
country. Through voluntary reporting from its member institutions,
Wake Up Safe has developed the first-ever national registry of
adverse perioperative events in pediatric patients. Its goal is to help
define quality in pediatric anesthesia and develop strong quality
improvement systems in an effort to help improve anesthetic care in
children of all ages.
The division provides perioperative care for more than 13,000
patients per year at Children’s Hospital, the region’s major pediatric
referral center. The division’s 21 attendings, 22 CRNAs, and four
fellows provide services for a variety of pediatric surgical procedures,
including general surgery, ENT, neurosurgery, urology, and
orthopedics. The division provides anesthesia services for procedures
outside the operating room, including oncology, gastroenterology,
and diagnostic and therapeutic radiologic procedures. Faculty also
provide both acute and chronic pain management services.
Jill Kilkelly, MD, an assistant professor in the division, spearheads
a unique service at Children’s Hospital known as the CCoC
(Complex Coordination of Care). Many children require frequent
sedation or anesthesia for procedures or diagnostic testing. Frequent
anesthetics create a tremendous burden for these patients and their
families in terms of time away from school and work, as well as
restrictions on eating and drinking before procedures. The goal of
the CCoC is to provide a single, continuous anesthetic for multiple
procedures or scans. While this sounds simple, the scheduling of
multiple surgical and interventional services, often in different
locations, is challenging. Jill Kinch, MSN, is the manager for
Division of Pediatric Anesthesiology: Front row, left to right, Liz Hughes,
MD; Kevin Saunders, MD; John Algren, MD; Stephen Hays, MD; and
Kimberly Nesbitt, MD. Second row: Laura Zeigler, MD; Peter Chin,
MBBS; Amanda Lorinc, MD; Jill Kilkelly, MD; and Thomas Romanelli,
MD. Back row: Dan Roke, MD; Humphrey Lam, MD; Andrew Franklin,
MD; Thomas Austin, MD; and Mark Newton, MD. Not pictured:
Christopher Karsanac, MD; and Vikram Patel, MD.
33
Division of Pediatric Cardiac Anesthesiology
As demand for pediatric cardiac anesthesia services at Monroe
Carell Jr. Children’s Hospital at Vanderbilt continues to grow,
the anesthesiologists providing those services are committed to
ensuring that the quality and safety of patient care is continually
improved as more patients are served.
members, Gina Whitney, MD, and Suanne Daves, MD, are also
board certified in Critical Care and are members of the Pediatric
Cardiac Critical Care Division. They split their time between
caring for pediatric cardiac patients in the operating room and in
the cardiac critical care unit.
In fact, one of the biggest accomplishments of the Division of
Pediatric Cardiac Anesthesiology was to tackle the problem
of unnecessary blood transfusions and wasted blood products
during the treatment of critically ill children. The division’s
effort reduced the number of transfusions by anesthesiologists
in pediatric cardiac operating rooms by an average of 40%.
And their success did not go unnoticed. The Pediatric Cardiac
Anesthesiology Division was selected to be in the inaugural
Vanderbilt Quality and Patient Safety Pioneer Program. Selection
was based on proposed improvement goals, evidence of past
improvement efforts, and leader participation. Through the
Quality and Patient Safety Pioneer Program, the division’s
members received training, as well as support, to design,
implement, and test additional performance improvements. The
group is tapping into valuable, archived patient data to guide their
quality improvement plans.
“The ability to continue care through the entire perioperative
period has positively impacted the intraoperative management of
our cardiac patients,” added Daves. “For example, the operative
and critical care teams developed a ‘Hand-Over’ protocol that
facilitates communication of intraoperative information to the
ICU team. The second part of this process improvement project,
‘Hand-Over Part II,’ aims to standardize the physical presentation
of the critically ill neonate between the ORs and ICUs.”
“This is one of our initiatives, to use that data to improve patient
care,” said Vice-Chair for Pediatric Anesthesiology Suanne
Daves, MD. “We will be looking for outliers in areas like length
of intubation and central line complications in order to make
intelligent decisions to improve patient care.”
Children with heart defects represent a complex group of
patients who often require intensive surgical repairs to thrive or
even survive into adulthood. The Division of Pediatric Cardiac
Anesthesiology was formed in 2007 to support the growth of the
program that cares for these patients at the Children’s Hospital.
The division’s faculty members also provide intraoperative
and catheterization laboratory anesthesia care. Two faculty
Members of the Pediatric Cardiac Anesthesiology Division also
team with surgeons for highly specialized procedures such as
placement of Berlin Heart devices. The device is similar to other
left ventricular devices (LVADs) used in adults, but is much
smaller.
The pediatric cardiac anesthesiologists work closely with
nurse anesthetists trained in cardiac anesthesia care who have
many years’ experience working with these unique patients.
The division also trains pediatric and cardiothoracic clinical
anesthesia fellows, as well as provides expert assistance and
consultative services for children with congenital heart disease
who are undergoing non-cardiac surgery/procedures.
In the 2012-2013 academic year, several faculty members
participated in the annual meetings of the Society of
Cardiovascular Anesthesiologists, the Society for Pediatric
Anesthesia, and the Congenital Cardiac Anesthesia Society, and
the division’s members are actively involved in education and
quality improvement at the national level.
Division of Pediatric
Cardiac Anesthesiology: Suanne Daves, MD;
Scott Watkins, MD; Gina
Whitney, MD; Brian
Donahue, MD, PhD; and
Alex Hughes, MD.
34
Vanderbilt Preoperative Evaluation Center (VPEC)
Manager of Patient Care Services Russell Kunic, FNP-BC, front row right, and staff members at the Vanderbilt Perioperative Evaluation Center’s
TVC location show off their 5-Star Award for Overall Quality of Care.
The Vanderbilt Preoperative Evaluation Center (VPEC) continues
to earn praise from the patients that come through its doors for
evaluation before undergoing surgery at Vanderbilt University
Medical Center. In 2013 – for the fifth year in a row – the service
received a Professional Research Consultants, Inc. patient
satisfaction award, the coveted 5-Star Award for Overall Quality
of Care. This means the center scored at the 90th – 99th percentile
based on 2012 calendar year results and as compared with similar
centers nationwide. For the second time, both VPEC sites, the
main Vanderbilt University Hospital location and the location at
Vanderbilt Health at One Hundred Oaks, received the awards.
“VPEC faculty and staff perform comprehensive patient
assessments and consult with our patients’ primary care
physicians, specialists, and surgeons,” said VPEC Clinic Manager
Russell Kunic, FNP-BC. “We are able to make decisions
regarding the need for preoperative testing to assess the patients’
overall risk for surgery. Once the patient report is completed at
VPEC, it becomes part of the patient’s electronic medical record
and is accessible by any Vanderbilt medical provider with Internet
and security access.”
To ensure that patients undergoing scheduled procedures are
properly evaluated and that all necessary labs and other patient
information are in hand, VPEC offers a free evaluation and
consultation service. This better ensures patient safety and helps
prevent surgical delays and cancellations. The inpatient arm of
VPEC completed more than 1,500 preoperative assessments in
2012. Also in 2012, VPEC clinicians evaluated 20,027 patients
in clinic, or approximately 60% of all on-campus adult surgical
patients.
VPEC’s main location at Vanderbilt University Hospital has 11
exam rooms and is conveniently located adjacent to outpatient lab
and radiology on the first floor of The Vanderbilt Clinic. VPEC’s
second location at the Vanderbilt Health at One Hundred Oaks
campus has seven exam rooms and is also adjacent to outpatient
lab and radiology services. Additionally, VPEC is expanding
to reach patients at a distance through phone interviews and is
building an infrastructure that will make it possible to evaluate
patients with telemedicine and through other virtual processes.
VPEC includes 25 total staff, including 13 nurse practitioners, one
of the largest single groups of nurse practitioners at Vanderbilt.
Serving as VPEC’s Medical Director and Associate Medical
Director are Vanderbilt Anesthesiologists Jonathan P. Wanderer,
MD, MPhil, and Michael Pilla, MD.
35
Veteran’s Affairs Anesthesiology Service
The Veteran’s Affairs Anesthesiology Service provides
perioperative patient care services for more than 9,000
anesthesia procedures annually at the Veterans Administration
Medical Center in Nashville and the Alvin C. York campus
in Murfreesboro, Tennessee. The service provides anesthesia
care for the full range of surgical procedures, including cardiac
and thoracic surgery; orthopedic procedures including joint
replacements; as well as major vascular, neurosurgical, ENT,
ophthalmic, urologic, plastic, bone marrow, and transplant
surgeries. In addition, sedation services are provided in several
out-of-OR sites, including electro-convulsive therapy, diagnostic
and therapeutic radiology procedures, pulmonary procedures,
cardiac catheterization, electrophysiologic studies, cardioversion,
and transesophageal echocardiography and gastroenterology
services. The service also provides primary coverage for the VA
surgical intensive care unit, acute and chronic pain management,
and emergency airway management.
In addition to patient care, education is a prime mission for
the VA Anesthesiology Service. In addition to training senior
anesthesiology residents and fellows, the service also educates
critical care and emergency room physicians and other allied
personnel in airway management skills outside the operating
room. This excellence in teaching is demonstrated by the fact
that, each year since 2009, a VA faculty member has received
either a Golden Apple Award (given by Anesthesiology
Department residents for superior teaching) or the Volker Striepe
award (given by residents for superior teaching and mentorship).
“Even though 80% of our surgical patients are ASA3 and 4, our
morbidity and mortality rate is lower than the national average,”
said Veteran’s Affairs Anesthesiology Service Chief Ann Walia,
MBBS. “We have 85% on-time first-case starts, and a DOS
case cancellation rate of less than 1%. For the past five years we
have achieved 100% compliance with all National Performance
Measures. We have a great team here, and they work hard to
provide excellent care to our veterans.”
The Division, led by Ann Walia, MBBS, is staffed by 21
anesthesiologists, 15 certified registered nurse anesthetists, eight
nurse practitioners, three residents, a critical care anesthesiology
fellow, four health technicians, and four administrative staff
members.
Areas of academic interest in the division include airway
management, ultrasound-guided regional anesthesia, ischemiareperfusion injury and coronary artery disease in liver transplant
recipients, and anesthesia practice pattern variations in liver
transplantation. These have resulted in several national and
international presentations and publications.
The Veteran’s Affairs Anesthesiology Service provides a full range of perioperative care to veterans at VA medical campuses in Nashville and
Murfreesboro.
36
Research Overview
Major translational research initiatives at Vanderbilt University
are moving discoveries from the bench to the bedside, and our
scientists are working to transform both health care and health
care delivery. In federal fiscal year 2012, the Vanderbilt University
School of Medicine ranked 13th among U.S. medical schools for
National Institutes of Health (NIH) funding, and VUSM funding
from all sources has more than doubled since 2001. In academic
year 2011, faculty across all disciplines received more than $521
million in external funding for research. The Vanderbilt Department
of Anesthesiology is a key contributor to the institution’s standing
as it is consistently ranked one of the top extramurally funded
anesthesia research programs in the nation. In 2012, the department’s
investigators brought in more than $8.5 million in total extramural
research funding. This includes more than $3.39 million in awarded
NIH grants in federal fiscal year 2012, which placed Vanderbilt
Anesthesiology 12th among U.S. academic anesthesiology
departments in NIH funding.
Edward Sherwood, MD, PhD, joined Vanderbilt’s Department of
Anesthesiology faculty in July 2012 as Vice Chair for Research,
and he oversees all of the department’s investigational endeavors.
A distinguished translational physician-scientist, Dr. Sherwood
previously served as Vice Chair for Research and Professor/James
F. Arens Endowed Chair of the Department of Anesthesiology as
well as Director of the MD-PhD Combined Degree Program at the
University of Texas Medical Branch in Galveston, Texas.
The vision of the Research Division is to improve upon the
department’s currently successful program by fostering excellence,
collaboration, and the development of young investigators.
The Vanderbilt Department of Anesthesiology has a strong,
multifaceted approach to research, including:
•
A strong Basic Science Research Division, under the leadership
of Eric Delpire, Ph.D., focusing on ion channel physiology and
pain mechanisms.
•
The Perioperative Clinical Research Institute (PCRI), which
provides all support services needed for successful clinical
research. Numerous investigator-initiated and industrysponsored clinical studies are being conducted with the support
of PCRI.
•
Best-in-class anesthesia and perioperative information systems,
with complete control of application development and a
dedicated team of analysts devoted to making electronic data
widely available to investigators and quality improvement teams.
These systems are managed by Perioperative Informatics, an
institutional entity directed by Brian Rothman, MD.
•
The Vanderbilt Anesthesiology & Perioperative Informatics
Research (VAPIR) Division, which is actively leveraging
historical and current clinical data, with the goal of generating
research and new control algorithms to positively impact patient
safety under the leadership of Jesse Ehrenfeld, MD.
•
Strong statistical support from statisticians within our faculty
with expertise in experimental design and complex analyses of
large datasets.
•
The Center for Research and Innovation in Systems Safety
(CRISS), which serves as an institution-wide resource for basic
and applied research in healthcare informatics, patient safety
and clinical quality, and designs and evaluates informatics
user interfaces, care processes, and medical technology across
Vanderbilt University Medical Center.
In addition to providing a solid research infrastructure, the
Department of Anesthesiology places a strong emphasis on faculty
and fellow career development in academic anesthesiology. Active
mentoring programs pair young investigators with experienced
scientists in both basic and clinical research. The department’s B.H.
Robbins Scholars Program provides a mentored research experience
that is initiated during residency and
culminates in a two-year clinical &
research fellowship. Scholars may request
to participate in clinical or basic science
fellowship training or pursue additional
formal education (e.g., Masters of Science
in Clinical Investigation, Master of Public
Health, Master of Science in Statistics)
offered at Vanderbilt during the latter part
of the program.
Read more about the Vanderbilt
Department of Anesthesiology’s specific
research strengths on the department’s web
site under the Research heading: www.
vandydreamteam.com.
The Vanderbilt Department of Anesthesiology’s multi-faceted approach to scientific
investigation includes well-established
basic science research laboratories as well
as many successful endeavors in clinical
research.
37
Labs Focus on Translational Science
Basic Science Research Division: First row, left to right, Research Vice Chairman Edward Sherwood, MD; Albena Kozekova; Kelen Taylor;
Sreedatta Banerjee; Kristie Lee; Basic Science Research Chief Eric Delpire, PhD; and Svetlana Stepanovic, PhD. Second row, Melissa Chont; Kerri
Rios; Kevin Currie, PhD; Yin Guo, Julia Bohannan, PhD, and Afeef Husni, PhD. Back row, Stephen Bruehl, PhD; Mark Jewell, MS; Franck Potet,
PhD; Jose Ponce-Coria, PhD; Jerod Denton, PhD; and Rene Raphemot. Not pictured: Daniel Swale, PhD; Jingbin Wang; and Liming Luan.
The major focus of the Basic Science Research Division is the
study of the physiology, pharmacology, and cell biology of ion
channels, transporters, and receptors. These membrane proteins
are involved in functions as diverse as shaping the cardiac action
potential, salt and water homeostasis in the kidney, hormone and
neurotransmitter release, modulation of synaptic transmission,
and the gating/processing of pain signals. Because the disruption
of each of these physiological processes has a significant impact
on human health, research in the Basic Science Research Division
addresses the translational missions of the National Institutes of
Health and of private biomedical research-oriented foundations.
Currently, there are two major themes that cut across multiple
laboratories: drug discovery and the study of pain mechanisms.
Three laboratories within the Research Division are actively
pursuing drug discovery for clinically relevant ion channel
and transporter targets. This work is sponsored by the National
Institutes of Health Molecular Libraries Probe Center Network.
Work in the laboratory of Jerod Denton, PhD, is aimed at
understanding the integrative physiology and therapeutic
potential of inward rectifier potassium (Kir) channels. Dr.
Denton’s group employs high-throughput screening, medicinal
chemistry, ion channel electrophysiology, and molecular
modeling to develop small-molecule Kir channel probes used to
interrogate Kir channel structure, function, and physiology. The
Denton lab recently developed the first small-molecule probes
of the renal outer medullary potassium channel, ROMK (Kir1.1)
(Lewis et al., Mol. Pharmacol., 76: 1094-1103, 2009; Bhave et
al., Mol. Pharmacol., 79: 42-50, 2011), an emerging diuretic
target for hypertension (Denton et al., 2013). They are also
developing pharmacological probes of the astroglial Kir channel,
Kir4.1, which may represent a novel target for hypertension
and epilepsy. Dr. Denton’s team was recently awarded a Grand
Challenges in Global Health grant from the Foundation for the
National Institutes of Health to develop chemicals to induce
“kidney” failure in the mosquito Anopheles gambiae to help
38
fight malaria. Other work in Dr. Denton’s lab is funded by the
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) and the National Institute of Neurological Disorders
and Stroke (NINDS).
The lab of Eric Delpire, PhD, studies the regulation of
intracellular Cl- in central and sensory neurons, and the
regulation of renal salt transport mechanisms. The lab devised a
screen to identify potent and specific inhibitors of a transporter,
KCC2, involved in modulating inhibitory neurotransmission.
By pumping Cl- ions out of neurons, this K-Cl cotransporter
maintains a low intracellular Cl- concentration, strengthening
inhibitory GABA- and glycine-mediated inhibition. This
cotransporter is therefore involved in preventing hyperexcitability and the development of epileptiform activity. After
developing a fluorescence-based methodology to visualize
the activity of KCC2, Dr. Delpire’s group screened a 250,000
compound library and identified multiple inhibitors and some
putative activators of KCC2 (Delpire et al. Proc Natl. Acad.
Sci. 106: 5383-5388, 2009). Synthesis and analysis of a number
of chemical variants of the most promising chemical scaffold
yielded more potent inhibitors whose properties are being further
analyzed (Delpire et al. Bioorganic & Med. Chem. Lett. 22:
4532-4535, 2012). The Delpire group also uses computational
modeling to study protein-protein interaction and to design drugs
that interact with the regulatory domains of protein kinases which
regulate the ion transporters.
Another interest in the Basic Science Research Division is
the study of pain and pain mechanisms. Leading the effort in
translational work bridging the basic and clinical sciences is
Stephen Bruehl, PhD, who studies endogenous pain modulatory
systems, links between these systems and psychological factors,
and mechanisms contributing to chronic pain and pain-associated
cardiovascular co-morbidities. Work in his lab has identified painrelated alterations in interacting cardiovascular-pain modulatory
systems that contribute to enhanced pain responsiveness (Bruehl
et al., Pain 2010; 149: 57-63) and may elevate future risk for
both chronic pain (Walker et al., Pain 2010; 150: 568-572) and
hypertension (Chung et al., Pain 2008; 138: 87-97). Work in Dr.
Bruehl’s lab also explores how endogenous opioid pain inhibitory
systems are intertwined with brain mechanisms underlying
regulation of negative affect (Bruehl et al., Psychosom Med,
2011 Sep;73(7):612-9) and how these opioid systems are altered
by persistent pain (Bruehl et al., Pain 148:167-171, 2010).
His current National Institute on Drug Abuse-funded project
examines predictors of responsiveness to opioid analgesic
medications and the role of individual differences in endogenous
opioid function in those predictive effects (Bruehl et al., Pain
154:1856-1864, 2013). Dr. Bruehl is also collaborating with Dr.
Denton to identify variants in genes encoding G protein-coupled
Kir (GIRK) channels that may influence opioid modulation of
pain pathways, including responsiveness to opioid analgesic
medications (Bruehl et al., Pain 2013 Aug 27. doi:pii: S03043959(13)00475-2; epub ahead of print). Dr. Bruehl mentors B. H.
Robbins scholar Carrie Menser, MD.
The lab of Kevin Currie, PhD, investigates the regulation of
voltage-gated calcium channels and neurotransmitter/hormone
release. Members of the CaV2 calcium channel family are
expressed on presynaptic nerve terminals of primary afferent
nociceptors and play key roles in pain transmission. The Currie
lab investigates how neuromodulators, inflammatory mediators,
and drugs alter channel function and transmitter release (Jewell
Rebecca Brindley, PhD, is a member of the Kevin Currie laboratory,
where the team studies the regulation of voltage gated calcium channels
and neurotransmitter/hormone release.
Jerod Denton, PhD, at left, and Rene Raphemot work together in the
Denton lab to study novel methods of mosquito control.
et al, Mol Pharmacol 79, 987-996; 2011; Zamponi & Currie,
Biochim Biophys Acta 1828, 1629-43; 2013). This includes
dissecting the cellular mechanisms by which gabapentin acts
(Todd et al, Anesthesiology 116: 1013-24; 2012). Gabapentin
is commonly used to treat chronic neuropathic pain, but can
also exert acute perioperative analgesic effects and blunt intraoperative hemodynamic perturbations. The sympatho-adrenal
stress response, in particular release of adrenal catecholamines
and neuropeptides, is another area of focus in the Currie lab.
Current projects investigate how G protein coupled receptors
(including opioid receptors) and the serotonin transporter, an
important target for antidepressants, orchestrate precise control
of catecholamine secretion. The Currie lab, in collaboration
with the Baudenbacher lab in the Department of Biomedical
Engineering, is also developing novel microfluidic devices for
“lab-on-a-chip” analyses of neurosecretion (Ges et al, Biosensors
& Bioelectronics 34, 30-36; 2012).
The laboratory of Eric Delpire, PhD, is also involved in pain
research including the examination of the role of ion cotransport mechanisms in the modulation of GABA and glycine
neurotransmission in the terminals of primary afferent fibers and
in spinal cord neurons. The presynaptic terminals of primary
afferent fibers are loaded with Cl- anions through a secondary
active transport mechanism (NKCC1) that pumps Cl- into the cell
against its electrochemical gradient equilibrium potential. High
Cl- allows depolarization of the terminals upon GABA release
and presynaptic inhibition. On the postsynaptic side, a different
transporter, KCC2, pumps Cl- out of the cell, strengthening
GABA and glycine inhibition. Tom Austin, MD, a B.H. Robbins
scholar in the Delpire laboratory, devised a method of implanting
intrathecal catheters in mice for the delivery of novel compounds
targeting the postsynaptic transporter. The study showed that
inhibition of KCC2 shortened the response to heat-evoked
nociceptive signals (Austin and Delpire, Anesth. Analg. 113(6):
1509-1515, 2011). Dr. Austin is supported by a Foundation for
Anesthesia Education and Research (FAER) Mentored Research
Training Grant.
39
In October 2012, Brad Grueter, PhD, and Carrie Grueter, PhD,
joined the Department of Anesthesiology. The husband-wife
team are doctoral graduates of the Department of Molecular
Physiology and Biophysics at Vanderbilt University. The
goal of the Grueter lab research program is to advance the
current understanding of the nucleus accumbens (NAc), a
brain region responsible for integrating information from
diverse inputs and modifying complex motivated behaviors,
including its involvement in adaptive responses to rewarding
and aversive stimuli. Specifically, the lab strives to elucidate
the molecular constituents in the NAc that are necessary and
sufficient to drive complex motivated behaviors. As part of the
mesolimbic dopamine system, the NAc integrates a complex
mix of excitatory, inhibitory and modulatory inputs to optimize
adaptive motivated behaviors. Dynamic alterations in synaptic
transmission within this circuitry are strongly implicated in the
development and expression of many neuropsychiatric disorders.
Thus, two broad questions addressed are: 1.) How does in vivo
experience such as cocaine exposure, pain, or high fat diet
alter the neurocircuitry of the NAc? 2.) What are the synaptic
mechanisms underlying the behavioral adaptations to in vivo
experience? The approaches the Grueter lab incorporates allow
the researchers to thoroughly characterize the synaptic circuitry
of the NAc in basal and pathophysiological conditions using a
combination of cutting edge techniques in electrophysiology,
molecular biology, metabolic phenotyping, optogenetics and
behavior. These studies will provide information on how the NAc
circuits integrate environmental stimuli and allow for specific
behavioral responses. This enhanced understanding of NAc
function may provide a basis for a more individualized approach
to the treatment of many psychiatric disorders.
The lab of Edward Sherwood, MD, PhD, is studying several
aspects of sepsis and the systemic inflammatory response
syndrome. A major interest is to define mechanisms of sepsisinduced systemic inflammation and organ injury with emphasis
on the roles of natural killer (NK) and T lymphocytes. Current
studies are being performed to evaluate the mechanisms of
NK and T cell activation and chemotaxis during sepsis with
emphasis on the chemokine receptor CXCR3 and its ligands,
CXCL9 and CXCL10. The Sherwood group showed that CXCR3
activation is crucial for NK cell trafficking during sepsis and
that CXCR3 blockade will decrease inflammation and organ
injury in experimental models of sepsis. The underlying goal
is to further understand the contribution of CXCR3 activation
in the pathogenesis of sepsis and develop clinically relevant
interventions to block CXCR3 and improve outcome.
In further studies, Dr. Sherwood’s lab group is evaluating the
immunomodulatory properties of TLR4 agonists and their
ability to modify the host response to systemic infection. The
group showed that the TLR4 agonists lipopolysaccharide and
monophosphoryl lipid A are potent immunomodulators that alter
systemic cytokine production and enhance innate resistance
to bacterial infections. The improved resistance to infection
is caused by neutrophil expansion and enhanced neutrophil
functions. The group is working to define the mechanisms by
which TLR4 agonists promote the antimicrobial functions of
neutrophils and develop TLR4 agonists as agents that can be used
40
Kerri Rios works in the laboratory of Eric Delpire, PhD, where the
group identifies inhibitors of a transporter, KCC2.
clinically to improve the resistance of critically ill patients to
infection.
Together, the members of Basic Science Division of the
Department of Anesthesiology pursue a mutually complementary
and collaborative program of research to create new knowledge
leading to improved practice in anesthesiology. Moreover,
the division provides critical mentorship to a new generation
of anesthesia clinician scientists who will help bind the basic
science and clinical missions of the department together even
more effectively.
Key Clinical Research Studies
Key Clinical Research Studies
Homeless Surgical Patients: Optimizing Care and Follow-Up
Bret Alvis, MD: RIFL (Rigid and Flexing Laryngoscope) vs. Fiberoptic Bronchoscope: A Comparison of the Ease of Use During Intubation on Difficult Airways
Impact of Attending Surgical Case Coverage on Perioperative Outcomes
Curtis Baysinger, MD: Effects of Tadalafil (Cialis), a Long-acting
PDE5 Inhibitor, on the Human Fetoplacental Microcirculation: A
study Using the in Vitro, Dual-perfused, Single-isolated Cotyledon,
Human Placental Model
Impact of On-time OR Starts on Workflow Perceptions
Multi-Center, Double-Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Analgesic Efficacy and Safety of Intravenous CR845 Dosed Preoperatively and Postoperatively in Patients
Undergoing a Laparoscopic Hysterectomy
Tyler Berutti, MD: Delirium in Critically Ill Children: Prevalence,
Risk Factors and Outcomes.
Impact of Diabetes Quality Improvement Protocol
Impact of Sexual Orientation and Gender Identity on Health Outcomes
Incidence and Impact of Hypoxemia During Surgery and Anesthesia
Information Management Systems for Continuous Evaluation and
Feedback
Multicenter Performance Site (MPS)
Normothermia and the Risk of Surgical Site Infection
Frederic T. Billings, MD: The Effect of Short-term Atorvastatin Use
on Acute Kidney Injury Following Cardiac Surgery
Objective and Novel Approach to Resident Competency Measurement: Utilizing Data from Anesthesia
James L. Blair, DO: Does Continuous Perioperative Dexmedetomidine Infusion Reduce Time to Discharge in Patients Undergoing Major Lumbar Fusion? A Double-Blind, Placebo-controlled Study
Predictors of Post-Operative Deterioration
Peri-anesthetic Imaging of Cognitive Decline (PAICOD) – A Prospective Pilot Study
Clifford Bowens, MD: Comparison of Perineural Catheter Depth for
the Continuous Popliteal Nerve Block using Ultrasound Guidance
and Dermabond
Stephen P Bruehl, PhD: Hypogonadism and Pain
Christopher Canlas, MD: Perioperative Pulse Oximetry in Obstructive Sleep Apnea Patients in the Ambulatory Setting
Elizabeth Card, RN: Prevalence of Delirium in the Post Anesthesia
Care Unit
Brent Dilts, MD: Ultrasound-guided Cervical Medial Branch Blocks
for Diagnosing Cervical Facet Joint Pain
Katherine Dobie, MD: Takeover of a Private ASC Practice by Academic Anesthesiologists: A Retrospective Before and After Study
Over Two Years.
Ultrasound-guided Isolation and Blockade of the Upper Trunk for
Shoulder Surgery: Time to Replace the Traditional Interscalene Approach?
Jesse M. Ehrenfeld, MD, MPH: Automatic Identification of Postoperative Events Using Advanced Informatics Tools
Automatic Prediction of Perioperative Events
Awareness and Prevention of Acute Lung Injury
Central Line Placement Under Ultrasound: Are Routine Chest X-rays
Warranted?
Does Use of Non-depolarizing Neuromuscular Blocking Agents Predict Postoperative Respiratory Complications?
Effects of Protease Inhibitors on Post-operative Pain Control
Effect of a Novel Electronic Blood Ordering System on Patient Outcomes
Perioperative Risk Stratification of Surgical Patients
Prevalence of Red-Green Colorblind Healthcare Providers: Pilot
Study
Real-Time Evaluation of Perioperative Risk Scores
Technology Diffusion and Uptake Into and Across Anesthesia Departments
Understanding the Impact of Health Literacy and Perioperative Outcomes
United States Critical Illness and Injury Trials Group (USCIITG) Informatics Working Group (IWG) Utility of the Surgical Apgar Score
on Postoperative Outcomes in Pediatrics
Using Natural Language Processing to Identify Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Patients
Daniel France, MD: Efficiency Evaluation of Mobile Clinical Information System
Andrew Franklin, MD: Open-label, Multicenter Study of the Safety
of Twice Daily Oxycodone Hydrochloride Controlled-release Tablets
in Opioid Experienced Children from Ages 6 to 16 Years Old, Inclusive, with Moderate to Severe Malignant and/or Nonmalignant Pain
Requiring Opioid Analgesics
Open-label, Extension Study to Assess the Long- Term Safety of
Twice Daily Oxycodone Hydrochloride Controlled-release Tablets in
Opioid Experienced Children Who Completed the OTR3001 Study
Stephen R. Hays, MD: Multisite RCT Comparing Regional and
General Anesthesia for Effects on Neurodevelopmental Outcome and
Apnea in Infants
Pediatric Anesthesia NeuroDevelopment Assessment Study (PANDAS)
Randomized, Placebo Controlled, Multicenter Study of the Efficacy,
Pharmacokinetics (PK) and Pharmacodynamics (PD) of Intravenous
(IV) Acetaminophen for the Treatment of Acute Pain in Pediatric
Patients
Evaluation of Disparities in Care of Perioperative Patients
Genomic Impact on Patient Response to Anesthesia
41
Multicenter Study of the Safety, Tolerability, Effectiveness, and
Pharmacokinetics of Oxymorphone HCl Extended-Release Tablets
in Pediatric Subjects Requiring an Around-the-Clock Opioid for an
Extended Period of Time
Open-Label, Non-Randomized, Multicenter, Ascending Dose by Age,
Single-and Multiple-Dose Evaluation of the Effectiveness, Safety,
and Tolerability of Oral Liquid Oxymorphone HCl Immediate-Release Oral Liquid for Acute Postoperative Pain in Pediatric Subjects
Patrick Henson, DO: Study Evaluating the Expression of Effectors
of Immune Tolerance and Associated Infectious Outcomes in Burn
Patients
Douglas Hester, MD: King Vision Video Laryngoscope vs. Glidescope Video Laryngoscope: A Comparative Study in Ambulatory
Surgery Center Patients
Marc Huntoon, MD: Controlled, Two-arm, Parallel Group, Randomized Withdrawal Study to Assess the Safety and Efficacy of Hydromorphone Hydrochloride Delivered by Intrathecal Administration
Using a Programmable Implantable Pump
Heidi Smith, MD: Pediatric Delirium: Validation of the Preschool
Confusion Assessment Method for the Intensive Care Unit (psCAMICU)
Assessing the Compliance and Reliability of a Unit-wide Rollout of a
Nursing Delirium Screening Tool in a Pediatric Critical Care Unit.
Paul St. Jacques, MD: King Vision Video Laryngoscope vs. the McGrath Video Laryngoscope: A Comparative Study
Sarah Starr, MD: Initiation of a Nitrous Oxide Service: Implications
for Patient Access to Obstetric Anesthesia Services
Chad Edward Wagner, MD: Multicenter Retrospective hTEE Review
Jeffrey Waldman, MD: Ischemic Kidney Injury During Liver Transplantation Surgery
Steve A. Hyman, MD: Survey to Determine the Level of Honesty in
Survey Participants When Asked About Personal Drug Usage
Ann Walia, MD: Incidence of Coronary Artery Disease and Morbidity and Mortality in Patients with Coronary Artery Disease that Underwent Orthotopic Liver Transplantation
Christopher Karsanac, MD: Tonsil and Adenoidectomy PACU
Questionnaire QI Project
Jonathan P. Wanderer, MD, MPhil: An External Validation of the
Z-Score System for Normalizing Residency Evaluations
Michael Leersnyder, CRNA: Congruence of Perceived Effective
Clinical Teaching Characteristics Between Students and Preceptors of
Nurse Anesthesia programs (Part I & II)
Determinants of Variation in Anesthetic Drug Costs
Lesley Lirette, MD: Comparing Efficiency in Delivering Regional
Anesthesia in a Teaching Model Style Outpatient Surgery Center vs.
A Non-trainee Outpatient Surgery Center
External Validation of the Risk Quantification Index
Daniel Lonergan, MD: Opioid Detoxification Outcomes in an Outpatient Chronic Pain Clinic
Letha Mathews, MD: Radiographically Measured Neck Motion during Intubation with MILS by Two Different Video Laryngoscopes
Matthew McEvoy, MD: Effect of a Cognitive Aid on Adherence to
the American Society of Regional Anesthesia Guidelines for Management of Patients on Anticoagulation
Evaluation of Electronic Screening Tools for Preoperative Assessment
Factors Influencing Resident Case Preference
Impact of GasChart Notifications on Anesthesia Provider Behavior
Utilization of Perioperative Antiplatelet Drugs in Patients with Coronary Stents
Understanding The Use of Electronic Pre-operative Notes through
EMR Audit Logs
Prediction of Airway Management Difficulty from Patient Photographs
Perioperative Fluid Management and Outcomes
Quantification of Variability in Anesthesia Residency Training
Test of Automated Device for Code Recording
Scott Watkins, MD: Improving Team Performance in Simulated Pediatric Emergencies Through Incorporation of Non-Technical Skills
into an Electronic Decision Support Tool
Effect of a Cognitive Aid on Adherence to Perioperative Guideline
Thanh Nguyen, MD: Phase IV, Open-Label, Safety Study Evaluating the Use of Dexmedetomidine in Pediatric Subjects Undergoing
Procedure-type Sedation
What is the Prevalence of Vitamin D Deficiency Among Children
Undergoing Posterior Spinal Fusion?
Michael Pilla, MD: A Study of Belmont Rapid Infusion Devices
Michael Richardson, MD: Quality Emergency Obstetric Care: Evaluation of the Obstetric Emergency Team (OBET) Response System
Warren Sandberg, MD, PhD: Assessment of FAER’s Investment in
the Career Development of Anesthesiologists
Survey of Departmental Approaches to Meeting JC Ongoing Professional Practice Valuation and Focused Professional Practice Evaluation Requirements
42
Edward Sherwood, MD: The Introduction of Quantitative Neuromuscular Monitoring in the PACU: Impact on Residual Blockade and
Postoperative Recovery
Liza Weavind, MD: Phase III, Randomized, Double-Blind, PlaceboControlled, Adaptive Design Study of the Efficacy, Safety, and
Tolerability of a Single Infusion of MK-3415 (Human Monoclonal
Antibody to Clostridium difficile toxin A), MK-6072 (Human Monoclonal Antibody to Clostridium difficile toxin B), and MK-3415A
(Human Monoclonal Antibodies to Clostridium difficile toxin A and
toxin B) in Patients Receiving Antibiotic Therapy for Clostridium
difficile Infection
Vanderbilt Lands Patient-centered Research Grant
Thanks to a federal grant received by Vanderbilt University Medical
Center, researchers, patients and their families now have an active
role and voice in research designed to improve the quality and safety
of patient care.
VUMC investigators were awarded a two-year, $750,000 grant from
the Patient Centered Outcomes Research Institute (PCORI), one of
the first grants awarded by the nonprofit institute established by the
Patient Protection and Affordable Care Act of 2010 and the first such
grant awarded in Tennessee. The PCORI’s mission is to help patients,
providers and other healthcare stakeholders make informed care
decisions by producing and promoting information resulting from
research guided by patients, caregivers and the broader healthcare
community.
The Vanderbilt research will track both patients’/patient families’
and clinicians’ reports of “non-routine” events in four different
clinical areas: elective pediatric cardiac surgery, outpatient pediatric
oncology (chemotherapy administration), adult day surgery, and
adult patients with acute coronary syndrome who are undergoing
cardiac catheterization. A non-routine event is defined as any event
that deviates from optimal or expected care for a specific patient in
a specific clinical situation. A multidisciplinary team of nearly 30
Vanderbilt faculty/physicians and staff, including nurses, surgeons,
anesthesiologists, oncologists, cardiologists, pediatricians, engineers,
psychologists, anthropologists, statisticians and informatics
personnel, are working together on the project. Select patients and
patient family members who are members of Vanderbilt’s PatientFamily Advisory Council also are part of the research team.
“I’m excited that Vanderbilt received one of these highly competitive
grants,” said U.S. Representative Jim Cooper (D-Tenn.), a strong
supporter of the mission of the PCORI. “This important research,
done right here in Nashville, will help improve health care delivery
and outcomes for patients and their families all over the country.”
Matthew Weinger, MD, professor of Anesthesiology, Biomedical
Informatics, and Medical Education, and director of the Center for
Research and Innovation in Systems Safety (CRISS), is the study’s
principal investigator. Dr. Weinger and his staff had previously
developed a standardized process for capturing reports of non-routine
events from clinicians, and the PCORI-funded study is building on
this knowledge to also capture and understand what patients and their
families consider non-routine events.
Non-routine events in clinical settings have been shown to occur
frequently and are typically due to multiple factors. In a previous
study of 910 elective surgical cases representing a cross-section of
anesthesia techniques, surgical procedures, and patient complexity,
39% of cases contained at least one non-routine event, and of those
cases, 42% included more than one non-routine event. In another
study, 107 intensive care unit nurses reported medication-related nonroutine events (incorrect medication or dosage) in 31 of 153 fourhour observation periods in three different hospitals.
“This project is important because we will be able to determine what
aspects of their interaction with the healthcare system patients and
families feel reflect lower quality of care and safety,” said Weinger,
who is also the Norman Ty Smith Chair in Patient Safety & Medical
Simulation. “I believe we will also show that patients and their
families will provide important new information about ways to
change how we deliver care so that it is safer and better meets their
needs.
“A unique aspect of this research will be the involvement of patients
in designing the studies and analyzing the results,” added Weinger.
Only 50 pilot projects out of more than 1,000 applications were
selected to receive this first round of PCORI funding. Awards
approved include those for projects designed to develop a range
of tools and techniques aimed at improving patient-centered care
and decision-making; create new patient-centered care measures;
and improve delivery of patient-centered counseling in health care
settings.
A federal grant awarded to VUMC researchers actively involves patients and patient families in a study hoped to improve the quality and safety of
patient care. Members of the research team include Diane H. Buckberg, Jessica Pasley, principal investigator Matthew Weinger, MD of the Department of Anesthesiology, and Susan Morley. Buckberg, Pasley and Morley are Vanderbilt Patient-Family Advisory Council members.
43
Putting the Power of Technology into Practice
The Vanderbilt Department of Anesthesiology has long been a
national leader in the development and advancement of perioperative
informatics, and there’s been an increased focus in recent years to
further strengthen the informatics initiatives at Vanderbilt.
“This department has always had a very strong commitment to
informatics, and many notable accomplishments in the field,” said
Department Chairman Dr. Warren Sandberg. “By bringing some key
talent on board and by providing the faculty already here the dedicated
time and necessary staff to expand and improve our informatics
programs, we are looking forward to dramatically impacting our
specialty, and patient care in total, through new research and
technology.”
A combination of world-class research, active software development,
and utilization of the latest clinical applications allows the
department to drive the use of technology within anesthesiology to
improve patient safety and quality. Advances in both research and
clinical care are being facilitated by several faculty members in the
department, many of whom have additional faculty appointments
in the Department of Biomedical Informatics. The two key groups
affiliated with the department driving this effort are the Vanderbilt
Anesthesiology & Perioperative Informatics Research (VAPIR)
Division and Perioperative Informatics.
Perioperative Informatics
Patients at VUMC who are either diabetic or to whom glucose is being
administered are closely monitored through use of a tool developed
through a collaboration between the VAPIR Division and Perioperative
Informatics. As seen in this pop-up, medical providers are notified about
a patient’s glucose monitoring status at appropriate intervals.
their awareness of patients who were at risk of having OSA so
that the increased anesthetic and perioperative risks could be
proactively mitigated as much as possible. This tool was also
combined with new preoperative nursing screening questions
to further help identify those patients with OSA to support
postoperative evaluation and intervention by respiratory therapy
before leaving the perioperative space.
•
Integrated Presence: Perioperative Informatics has partnered
with Vanderbilt’s Informatics Center to pilot a new web-based
version of Vigilance TM, Integrated Presence. Vigilance TM
has delivered situational awareness in the perioperative
environment since 2004. Integrated Presence was created to
bring situational awareness to the bedside for every provider.
Situational awareness is an understanding and awareness of what
is happening around you, accomplished by the perception of
environmental elements, comprehension of their meaning and
prediction of a future state based on those elements and their
meaning. Improving situational awareness is thought to improve
patient safety and work efficiency while reducing costs and is
especially effective when providers are responsible for more than
one active care location.
It is expected that the
advantages realized in the
perioperative space will
be seen in the inpatient
care environments across
Vanderbilt in conjunction
with a bedside monitoring
initiative.
•
Phases of Care: The
time patients spend in the
Postoperative Anesthesia
Care Unit (PACU) is
dependent on the type
of surgery performed,
patient comorbidities,
and the planned
disposition. Significant
enhancements to VPIMS’
postoperative nursing
electronic documentation
Perioperative Informatics, a group directed by Brian Rothman, MD,
Medical Director of Perioperative Informatics, is a hospital entity
that develops and manages the clinical applications used within
the perioperative setting. The Vanderbilt Perioperative Information
Management System (VPIMS) application suite developed and
commercialized by Vanderbilt includes GasChartTM for electronic
anesthesia documentation, VigilanceTM which improves clinicians’
situational awareness, the iOS-based situational awareness mobile
application VigiVUTM, and PatientTrackerTM for electronic nursing
documentation during each perioperative phase of care.
“Our job is to solve known or previously unidentified issues related
to workflow and system functionality while understanding how these
two elements intersect,” said Rothman. “We are identifying unique
solutions that improve patient safety, operating room efficiency, the
quality and character of the data collected, staff workflow, and that
decrease cognitive workload on our staff through a combination of
creative software design and development, with a particular focus on
user interface.”
Following are a few recent Perioperative Informatics successes.
•
44
Electronic Obstructive Sleep Apnea (OSA) Screening:
Identifying our obstructive sleep apnea (OSA) patients in
2013 has been more important than ever with OSA now seen
as a growing, silent epidemic. Armed with the STOP-Bang
screening tool that has been used manually at other institutions,
the Perioperative Informatics team used existing data from their
electronic preoperative evaluation tool, along with new data
introduced through module enhancements, to create a complete
electronic OSA screening tool in six weeks. The result was an
automated STOP-Bang score delivered to providers, heightening
An innovative hand hygiene
monitoring application was
developed internally at Vanderbilt.
module now support postoperative nursing’s ideal workflow. The
accumulation of discrete, contemporaneous data related to patient
location, phase of care, and planned disposition paves the way
for improved PACU efficiency, patient care, and throughput. This
data will soon be externalized to VUMC’s bed management team
to aid in efforts to improve patient throughput throughout the
institution.
•
Documentation Compliance: The VPIMS anesthesia
documentation module, GasChartTM, effectively collects a large
amount of data for compliance and billing purposes. However,
in response to recent changes in compliance regulations,
the Perioperative Informatics team has further improved the
documentation processes. Implementation of a forced function
now ensures that attendings document what emergency surgery
is planned and the indication that qualifies it as an emergency.
In addition, the development team has implemented case
checks to ensure that minute-by-minute, in-room provider times
are accurate and reasonable. These changes have resulted in
improved documentation quality and significant time savings for
Vanderbilt’s billing staff. Over the next year, the development
team will improve documenting lines and monitors and regional
anesthesia procedures while reducing ambiguity, which will
further improve the clinical documentation quality.
On a much larger scale, Perioperative Informatics is working toward
data “interoperability” by providing patient information collected
through VPIMS in a useful form to the institution. Exchanging data
with the Core Data institutional information database and Star are
examples of how the group is opening doors to exchange information
throughout the continuum of patient care.
Hand hygiene observations are quickly and accurately
recorded to track compliance with this critical patient safety
measure.
“The interoperability with the institution is
essential,” said Rothman. “Because we have
such a large volume of Vanderbilt patients
passing through our area, we see it as our
vital mission to communicate data we collect
to other care providers across the institution.
Likewise, the availability of important care
information when a patient receives care in
the perioperative space is equally vital. We
don’t focus on inbound or outbound data. We
focus on bi-directional communication with
all systems. That is our goal in the years to
come.”
Taken together, the informatics effort in
the Department of Anesthesiology seeks
to close the loop, ensuring that patients are
fully protected from harm and that beneficial
interventions are always executed. Because
Vanderbilt “owns” its information systems,
both literally and figuratively, rapid cycle
processes of hypothesis generation, pilot
demonstration and full scale implementation
of quality improvement projects are uniquely
supported.
An improved electronic nursing assessment now includes automated process monitoring for alcohol
and abuse screenings.
45
Perioperative Clinical Research Institute (PCRI)
Members of the Perioperative Clinical Research Institute: Front row, left to right, Emily Brink, RN, BSN; Kelen Taylor; Jennifer Morse; Sue Walsh,
RN; Donna Nelson, RN, CAPA; and Kristie Lee. Second row, Edward Sherwood, MD, PhD; Damon Michaels, CCRP; Elizabeth Card, RN, CPAN,
CCRP; Misty Hale; Christine Goldsberry; William Hardeman, CCRP; and Cleo Carter. Not pictured: James Berry, MD; Kiersten Card, Brian Donahue, MD, PhD; and Patricia Hendricks, RN.
Navigating through countless regulations, mastering the nuances of
grant writing, and properly managing finances in order to conduct
clinical research is enough to fray the nerves of any fledgling
investigator. To keep the process running smoothly, from initial
concept to published research, the Department of Anesthesiology’s
Perioperative Clinical Research Institute provides a full range
of support services, including regulatory management, data
management, contracts management, biostatistics, bioinformatics, and
financial oversight. The group also trains new investigators so they
can grow to the point of having their own funded research that leads
to major publications.
“We are here to facilitate the research process for our investigators,”
said Clinical Trials Manager Damon Michaels. “We assist with
compliance with federal, state, and local regulations and other details
so the investigators can focus on their science. The end goal is
stronger research, with an eye toward publication in leading journals.”
Clinical research within the department includes both industrysponsored and investigator-initiated clinical projects and focuses on
the advancement of medical practice in the fields of perioperative
care, chronic pain, and medical devices. Most of the department’s
investigators are practicing physicians who use their clinical expertise
to develop research protocols that seek to answer clinically significant
questions.
The PCRI oversees more than 85 active clinical trials, with many
more studies in development. PCRI is directed by Vice Chair for
Research Edward Sherwood, MD, PhD, and Clinical Trials Manager
Damon Michaels. The team consists of highly trained and broadly
experienced research professionals, including five research nurse
specialists, one research assistant, two clinical trials associates, and
one research analyst.
“It has been exciting to see the growth in clinical research since
PCRI was founded in 2007,” said Michaels. “When I started,
the department was mainly focused on basic science research.
We added industry-funded studies to help new investigators
46
learn about the research process. As they’ve progressed in their
research careers, our investigators have started developing their
own complex questions that will improve the quality of patient
care for years to come.”
PCRI Supported Nursing Research
The Perioperative Clinical Research Institute includes five
research nurse specialists who are all practicing registered
nurses with specialized training in conducting clinical research.
The research nurse specialists provide support for clinical
investigators, assisting in the design of clinical research and
ensuring the integrity and quality of clinical research trials.
Over the past two years, the nurses’ role has expanded to the
point that they are now presenting their own research at national
conferences and have published in the academic press.
“These individuals support our ongoing investigations, and their
contributions are invaluable,” said Michaels. “They are often the
critical contact point ‘in the trenches,’ and are able to make sure
nothing falls through the cracks or lags for any reason. They have
been growing professionally so that they are more responsible,
and are now pursuing their own research.”
The role of the research nurse practitioner is also being developed
within the Department of Anesthesiology to expand the
responsibility that nurses have traditionally played in support of
clinical trials. This role will allow nurses with advanced degrees
and appropriate licensure to have increased responsibilities in
research. Unlike other NPs who primarily work in a clinical
role, the research NP will focus primarily on research. The
department envisions utilizing research nurse practitioners as subinvestigators working closely with their principal investigators.
They will also be PIs on their own research studies and will apply
for grants, obtain their own extramural funding, and participate in
the dissemination of research findings.
Steve Klintworth, RN
The clinical research nurses in PCRI are:
Elizabeth Card, RN, CPAN,
CCRP
A practicing registered nurse
since 1990, Elizabeth’s nursing
background includes ICU,
CVICU, PACU, holding room,
pediatrics, transplant, and
vascular case management. She
has served as a sub-investigator
or key study personnel in more
than 45 clinical research studies
at Vanderbilt involving drugs,
devices, observational, or survey
studies. Her research includes
two ongoing studies on delirium
Elizabeth Card, RN, CPAN, CCRP or cognitive impairment.
Presently, Elizabeth serves as
president for the Tennessee Society for PeriAnesthesia Nurses
(TSPAN) and as Middle Tennessee Society for PeriAnesthesia
Nurses (MTSPAN) Education Chair. In 2012, Elizabeth won the
Vivien Thomas Award for Excellence in Clinical Research, an
annual award presented by the Vanderbilt University Medical
Center’s Office of Research.
A practicing registered nurse
since 1986, Steve’s nursing
background includes critical
care in MICU and SICU, general
surgery, and nursing supervision.
He’s been a sub-investigator or
key study personnel in more than
25 clinical research studies at
Vanderbilt involving drugs and
devices. Steve’s current focus is
on chronic pain research.
Steve Klintworth, RN
Donna Nelson, RN, CAPA
Mary Hamilton Chestnut,
FNP
Mary Hamilton Chestnut, NP
Mary Hamilton joined the
Anesthesiology Department
in November 2012. She
is involved with several
perioperative clinical research
projects at Vanderbilt, primarily
in the area of pediatrics,
including studies on liquid
oxymorphone for acute
postoperative pain and on the
safety of oxycodone CR tablets
in opioid-experienced children.
Donna Nelson, RN, CAPA
A practicing registered nurse
since 1980, Donna’s nursing
background includes PACU,
holding room, pediatrics, and
labor & delivery. She has
served as a sub-investigator
or key study personnel in
more than 15 clinical research
studies at Vanderbilt involving
drugs, devices, observational,
or survey studies. She is
working on an ongoing study
on delirium or cognitive
impairment.
Patricia Hendricks, RN
Patricia Hendricks, RN
A practicing registered nurse since
1978, Patty’s nursing background
includes ICU, PACU/holding
room, cancer pain and symptom
management therapies, and home
health care. She has served as
a sub-investigator or key study
personnel in more than 15 clinical
research studies at Vanderbilt
involving drugs, devices,
observational, or survey studies.
Patty works exclusively with Josh
Billings, MD, on a study focusing
on acute kidney injury and
delirium following cardiac bypass
surgery.
47
Vanderbilt Anesthesiology & Perioperative Informatics Research (VAPIR) Division
The Vanderbilt Anesthesiology & Perioperative Informatics Research
(VAPIR) Division, led by Jesse M. Ehrenfeld, MD, MPH, focuses
on utilization of information technology within the perioperative
environment to improve patient safety and the quality of care
delivered. The multidisciplinary group, which has grown from three
full-time research support staff in 2010 to eight in 2013, manages
more than seventy active clinical research projects and has taken
the lead on developing methodologies for evaluating the impact
of technology and information management systems within the
operating room.
Milestones Achieved
Major achievements have included successful competition for a
grant from the Anesthesia Patient Safety Foundation (APSF), a
complete redesign of the Perioperative Data Warehouse (the elevenyear historical archive of data from the Vanderbilt Perioperative
Information Management System), and recruitment of five new
full-time employees. Realization of these steps was an important
milestone for the group, as demand for perioperative data continues
to grow in support of the Anesthesiology Department’s research
mission. Additionally, VAPIR has supported a number of important
operational initiatives, such as the development, launch and
maintenance of the Perioperative Dashboard Project, which provides
a real-time overview of a series of OR management and cost metrics
to front-line managers and clinicians.
“We have successfully positioned the VAPIR group to lead
informatics research at Vanderbilt,” said Department Chairman
Warren Sandberg, MD, PhD. “It is rewarding to know that our
efforts in informatics research will ensure that the decisions made
by researchers based on the information we are able to provide
them will help ensure the safety and quality of patient care is never
compromised.”
Novel Collaborations, Here and Abroad
The work accomplished by VAPIR has led to recognition of
Vanderbilt as home to one of the premier anesthesia informatics
research programs in the world, and this has resulted in many fruitful
partnerships and collaborations.
“We are appreciative for the opportunities for our group to partner
not only with collaborators at Vanderbilt, but also with colleagues
performing research across the nation and the world,” said Dr.
Ehrenfeld. “Through these collaborations, we have been able to
establish and strengthen our group’s mission to promote patient
safety and quality of care, both here and abroad.”
One such collaboration is with the National Institutes of Healthsponsored U.S. Critical Illness and Injury Trials Group, in which
Vanderbilt is co-leading an effort to bring together de-identified,
high-resolution intensive care unit data from a consortium of medical
centers. This unprecedented effort is allowing researchers across
the country to quickly and efficiently answer important questions
about how to best care for critically ill patients. One example project
centers around determining what post-surgical blood pressure is ideal
to prevent the development of acute renal failure after surgery.
Innovations in Quality and Delivery of Care
Discoveries made by researchers in
the VAPIR group have led not just to
the creation of new knowledge, but in
many cases have resulted in the direct
improvement of care and operative
outcomes of Vanderbilt patients — and
thousands of patients undergoing surgery
and anesthesia worldwide. Three projects
are highlighted below.
Better Care for Diabetic Patients
Vanderbilt is leading a multicenter effort
to understand the impact of providing
real-time clinical decision support for the
management of glucose during surgery.
Preliminary results from the study have
demonstrated an improvement in a variety
of outcomes and, most notably, a reduction
in post-surgical readmission rates in
diabetic patients at Vanderbilt.
Cost Containment of Anesthesia
VAPIR Division Research Director Jesse Ehrenfeld, MD, MPH, discusses ongoing clinical research
projects with Database Administrator Michaelene Johnson.
48
This two-phase study is geared toward
providing a mechanism to decrease the
average cost of anesthesia for surgery. The
first phase, which was completed in 2012,
consisted of the creation and verification of
an accurate system to tabulate and display
anesthesia-related costs for operative cases.
This has allowed VAPIR to understand the magnitude of and factors
leading to significant cost variability. The second phase of the study
will test several ways of sharing this information with providers and
assess methods to actively manage anesthesia and surgical costs.
Preventing Post-Operative Deterioration
While the morbidity and mortality attributed to anesthesia is low,
there continues to be a high post-operative complication rate.
Supported by a grant from the Anesthesia Patient Safety Foundation
(APSF), VAPIR members have set out to identify characteristics that
may be predictive of adverse events in the immediate post-operative
setting (i.e., within 72 hours of surgery). To date, VAPIR researchers
have identified a cohort of 35,090 adult patients who had a surgical
procedure and were admitted to the hospital after surgery. Of these
patients, 689 had an unanticipated transfer to the ICU within 72
hours. The team is now modeling the differences between patients
who experienced these unexpected transfers and those who did not.
Ultimately, the plan is to automate a predictive model in order to
provide real-time model output to clinicians in the OR.
Teaching the Next Generation
Consistent with the department’s educational mission, VAPIR is
actively engaged in the education and training of students, residents,
and fellows through a variety of mechanisms including seminars,
journal clubs, and a successful summer research training program.
During the 2012-2013 academic year, VAPIR provided mentorship
and research opportunities for more than 20 students – including
undergraduate, medical, and graduate students – who joined VAPIR
from Vanderbilt and seven other academic institutions.
VAPIR continues to attract renowned experts in the fields of
biomedical informatics and clinical research to Vanderbilt’s
campus as visiting scholars. At the monthly Anesthesia Informatics
Research Seminar, which is open to the entire Vanderbilt University
community, these specialists share their research findings and
expertise.
Vanderbilt Anesthesiology and Perioperative Informatics
Research (VAPIR) Division, by the Numbers
VAPIR Research Protocols
Approved Research Protocols..................................................................................................................................................................... 49
Pending Research Protocols.......................................................................................................................................................................... 4
Total Research Protocols............................................................................................................................................................................. 53
Active VAPIR Projects
Clinical Research & Quality Improvement Projects................................................................................................................................... 70
Technical Team Projects............................................................................................................................................................................. 36
Grant Applications
Applications Submitted............................................................................................................................................................................... 15
Applications Funded..................................................................................................................................................................................... 2
Manuscripts
Papers Under Review.................................................................................................................................................................................. 20
Papers Accepted.......................................................................................................................................................................................... 18
Total Papers................................................................................................................................................................................................. 38
Abstracts & Podium Presentations at Scientific Meetings
National Meetings....................................................................................................................................................................................... 71
International Meetings.................................................................................................................................................................................. 8
Total Original Research Presentations........................................................................................................................................................ 79
Collaborations
Vanderbilt Departments.............................................................................................................................................................................. 15
Departments at other U.S. Institutions.......................................................................................................................................................... 9
International Departments............................................................................................................................................................................. 5
49
Center for Research and Innovation in Systems Safety (CRISS)
Vanderbilt University School of Medicine’s Center for Research
and Innovation in Systems Safety (CRISS), directed by Matthew
B. Weinger, MD, is an institution-wide resource for human
factors, usability and systems engineering and design located
within the Department of Anesthesiology. CRISS is an integral
part of Vanderbilt’s Institute for Medicine and Public Health
(IMPH), led by Robert Dittus, MD.
To fulfill its mission of enhancing healthcare quality and safety,
CRISS conducts basic and applied research in healthcare
informatics, patient safety and clinical quality; designs, assesses
and improves care processes, medical technology and electronic
health record (EHR) user interfaces; and utilizes state-of-the-art
simulation facilities to test and analyze medical equipment and
procedures.
Current research includes an Agency for Healthcare Research and
Quality (AHRQ)-funded multicenter study to develop and deploy
standardized simulation scenarios to assess the performance of
board-certified physicians. In July 2012, CRISS was the recipient
of one of only 50 pilot grants (out of 1,400 applicants) from the
Patient Centered Outcomes Research Institute (PCORI). In this
project, the group is analyzing the occurrence of non-routine
events reported concurrently by patients and their clinicians
in four different domains – pediatric cardiac surgery, pediatric
oncology, adult cardiac catheterization, and adult ambulatory
surgery. CRISS is also actively involved in two federal contracts
to conduct informatics research: a National Institute of Standards
and Technology (NIST)-funded project to define best practices
for the design of Electronic Medical Records (EMRs), and
an AHRQ-funded project to study the relationship between
workflow and Electronic Health Record (EHR) use in ambulatory
settings. Finally, CRISS researcher Richard Holden, PhD,
received a federal career development award (KL2) through the
Vanderbilt Institute for Clinical and Translational Research to
design a home-based software tool for patients with congestive
heart failure to manage their symptoms and therapy.
Previously, in an AHRQ-funded study, CRISS members showed
that a simulation-based training intervention enhanced the quality
of handovers and communication between anesthesia providers
and PACU nurses. In another VA-funded study of 1,000 surgical
cases, CRISS investigators found that OR teams’ workload
ratings were strongly associated with reported intraoperative
events; the relationship of workload and reported events to 30day morbidity and mortality is being analyzed. For a National
Heart, Lung, and Blood Institute (NHLBI) R21 grant, Dan
France, PhD, modeled the factors affecting the ability of patients
presenting to the emergency department with acute coronary
syndrome to receive evidence-based care. In a study funded by
the Anesthesia Patient Safety Foundation, Anne Miller, PhD, and
her colleagues implemented and evaluated goal-directed care
protocols in the cardiovascular ICU.
CRISS involvement with Vanderbilt University Medical Center
operational initiatives in quality improvement range from
participating in the review and analysis of most serious clinical
events at VUMC, to re-engineering blood transfusion processes,
improving clinician handovers, and enhancing compliance with
perioperative timeouts and checklists.
50
CRISS faculty and staff are integrally involved in user interface
design and evaluation on numerous applications for VUMC’s
Informatics, including the next-generation EHR, SmartVU™,
which will be a platform independent, web-browser compliant,
highly usable application that is being designed to model
clinicians’ mental models of care and their workflow. SmartVU™
includes application modules for patient intake, clinical note
writing, medication and order management, results tracking,
patient education/communication, and clinician communication.
SmartVU™ includes state-of-the-art clinical decision support.
CRISS is also helping to design several perioperative informatics
(i.e., VPIMS) modules including the new preoperative
application, PREP. Finally, CRISS is assisting Vanderbilt
Informatics in obtaining Meaningful Use certification from the
federal government for its clinical applications.
CRISS faculty members include Director Matthew B. Weinger,
MD, MS; Arna Banerjee, MD; Daniel France, PhD, MPH;
Richard Holden, PhD; Kevin Johnson, MD; Amanda Lorinc, MD;
Anne Miller, PhD; Laurie Lovett Novak, PhD, MHSA; Jason
Slagle, PhD; Matt Shotwell, PhD; Theodore Speroff, PhD; Scott
Watkins, MD; Jonathan Wanderer, MD; Kim Unertl, PhD; and
Gina Whitney, MD. CRISS staff include: Russ Beebe; Christine
Buchanan; Eva Cassedy; Krys Dworski; Christine Goldsberry;
Jeff Hottle; Andrew Kline; Eric Porterfield, MS; and Christopher
Simpson, MS.
CRISS staff worked with members of Perioperative Informatics to
develop a Universal Protocol/Time Out (UP/TO) at VUMC which
increases patient safety by prompting clinicians – though easily
followed visual check lists – to confirm important patient data.
Selected Publications, 2012-2013
Original Research
Agarwal H, Hardison D, Saville B, Donahue B, Lamb F, Bichell D, Harris Z. Residual
lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal
membrane oxygenation support. J Thorac Cardiovasc Surg. 2013 Apr 15. pii: S00225223(13)00324-3.
Agarwal H, Saville B, Slayton J, Donahue B, Daves S, Christian K, Bichell D, Harris
Z. Standardized postoperative handover process improves outcomes in the intensive care
unit: a model for operational sustainability and improved team performance*. Crit Care
Med. 2012 Jul;40(7):2109-15.
Alamanda V, Delisca G, Mathis S, Archer K, Ehrenfeld J, Miller M, Homlar K, Halpern
J, Schwartz H, Holt G. The financial burden of reexcising incompletely excised soft
tissue sarcomas: a cost analysis. Ann Surg Oncol. 2013 Apr [Epub].
Ares G, Haque M, Delpire E, Ortiz P. Hyperphosphorylation of Na-K-2Cl
cotransporter in thick ascending limbs of Dahl salt-sensitive rats. Hypertension. 2012
Dec;60(6):1464-70.
Backman E, Triant V, Ehrenfeld J, Lu Z, Arpino P, Losina E, Gandhi R. Safety of
midazolam for sedation of HIV-positive patients undergoing colonoscopy. HIV Med.
2013 Jan [Epub].
Balaguer J, Yu C, Byrne J, Ball S, Petracek M, Brown N, Pretorius M. Contribution
of endogenous bradykinin to fibrinolysis, inflammation and blood product transfusion
following cardiac surgery: A randomized clinical trial. Clin Pharmacol Ther. 2013
Apr;93(4):326-34.
Bateman B, Mhyre J, Ehrenfeld J, Kheterpal S, Abbey K, Argalious M, Berman M,
St. Jacques P, Levy W, Loeb R, Paganelli W, Smith K, Wethington K, Wax D, Pace
N, Tremper K, Sandberg W. The risk and outcomes of epidural hematomas after
perioperative and obstetric epidural catheterization: a report from the Multicenter
Perioperative Outcomes Group Research Consortium. Anesth Analg. 2013
Jun;116(6):1380-5.
Billings F, Balaguer J, Yu C, Wright P, Petracek, M, Byrne J, Brown, N, Pretorius
M. Comparative effects of angiotensin receptor blockade and ACE inhibition on the
fibrinolytic and inflammatory responses to cardiopulmonary bypass. Clin Pharmacol
Ther. 2012 Jun;91(6):1065-73.
Billings F IV, Pretorius M, Schildcrout J, Mercaldo N, Byrne J, Ikizler T, Brown N.
Obesity and oxidative stress predict AKI after cardiac surgery. J Am Soc Nephrol.
2012 Jul; 23(7):1221-8.
Bruehl S, Apkarian A, Ballantyne J, Berger A, Borsook D, Chen W, Farrar J,
Haythornthwaite J, Horn S, Iadarola M, Inturrisi C, Lao L, Mackey S, Mao J, Sawczuk
A, Uhl G, Witter J, Woolf C, Zubieta J, Lin Y. Personalized medicine and opioid
analgesic prescribing for chronic pain: opportunities and challenges. J Pain. 2013
Feb;14(2):103-13.
Bruehl S, Burns J, Gupta R, Buvanendran A, Chont M, Kinner E, Schuster E, Passik
S, France C. Endogenous opioid function mediates the association between laboratoryevoked pain sensitivity and morphine analgesic responses. Pain. 2013 Jun [Epub].
Bruehl S, Liu X, Burns J, Chont M, Jamison R. Associations between daily chronic
pain intensity, daily anger expression, and trait anger expressiveness: an ecological
momentary assessment study Pain. 2012 Dec;153(12):2352-8.
Brummel N, Jackson J, Girard T, Pandharipande P, Schiro E, Work B, Pun B, Boehm
L, Gill T, Ely E. A Combined Early Cognitive and Physical Rehabilitation Program for
People Who Are Critically Ill: The Activity and Cognitive Therapy in the Intensive Care
Unit (ACT-ICU) Trial. Phys Ther. 2012 Dec;92(12):1580-92.
Burkle F, Nickerson J, von Schreeb J, Redmond A, McQueen K, Norton I, Roy
N. Emergency surgery data and documentation reporting forms for sudden-onset
humanitarian crises, natural disasters and the existing burden of surgical disease.
Prehosp Disaster Med. 2012 Sep;1-6.
Burns J, Bruehl S, Chont M. Anger regulation style, anger arousal and acute pain
sensitivity: evidence for an endogenous opioid “triggering” model. J Behav Med. 2013
Apr [Epub].
Carpenter L, Baysinger C. Maintaining perioperative normothermia in the patient
undergoing cesarean delivery. Obstet Gynecol Surv. 2012 Sept; 67(7):436-446.
Chao T, Burdic M, Ganjawalla K, Derbew M, Keshian C, Meara J, McQueen K.
Survey of surgery and anesthesia infrastructure in Ethiopia. World J Surg. 2012
Nov;36(11):2545-53.
Collins S, Starr S, Bishop J, Baysinger C. Nitrous oxide for labor analgesia: expanding
analgesic options for women in the United States. Rev Obstet Gynecol. 2012
Oct;5(3):131-134.
Delpire E, Baranczak A, Waterson A, Kim K, Kett N, Morrison R, Scott Daniels J,
David Weaver C, Lindsley C. Further optimization of the K-Cl cotransporter KCC2
antagonist ML077: Development of a highly selective and more potent in vitro probe.
Bioorg Med Chem Lett. 2012 Jul;22(14):4532-5.
Ding J, Ponce-Coria J, Delpire E. A trafficking-deficient mutant of KCC3
reveals dominant-negative effects on K-Cl cotransport function. PloS One. 2013
Apr;8(4):e61112.
Douglas S, Cartmill R, Brown R, Hoonakker P, Slagle J, Schultz Van Roy K, Walker J,
Weinger M, Wetterneck T, Carayon P. The work of adult and pediatric intensive care
unit nurses. Nurs Res. 2013 Jan-Feb;62(1):50-8.
Downing J, Baysinger C, Johnson R, Paschall R. Review: potential druggable targets
for the treatment of early onset preeclampsia. Pregnancy Hypertens. 2013 May [Epub].
doi: 10.1016/j.preghy.2013.4.120.
Epstein R, Dexter F, Rothman B. Communication latencies of wireless devices
suitable for time-critical messaging to anesthesia providers. Anesth Analg. 2013
Apr;116(4):911-8.
Epstein R, St Jacques P, Stockin M, Rothman B, Ehrenfeld J, Denny J. Automated
identification of drug and food allergies entered using non-standard terminology. J Am
Med Inform Assoc. 2013 Jun [Epub].
Fletcher K, Visotcky A, Slagle J, Tarima S, Weinger M, Schapira M. The composition
of intern work while on call. J Gen Intern Med. 2012 Nov;27(11):1432-7.
Franklin A, Hays S. Successful Management of a Thoracic Cerebrospinal Fluid
Cutaneous Fistula in a Two Year-Old Child Using a Thoracic Epidural Blood Patch. J
Clin Anesth. 2013 Jun;25(4).
Franklin A, Lorinc A, Donahue B. Malignant Hyperthermia-Like Manifestations in
a Two-Month Old Child with Holt-Oram Syndrome Undergoing Cardiac Surgery. J
Cardiothorac Vasc Anesth. 2013 Mar [Epub].
Gagnon K, Delpire E. Molecular physiology of SPAK and OSR1: two Ste20-related
protein kinases regulating ion transport. Physiological Rev. 2012 Oct;92(4):15771617.
Gagnon K, Delpire E. Physiology of SLC12 transporters: lessons from inherited human
genetic mutations and genetically engineered mouse knockouts. Am J Physiol Cell
Physiol. 2013 Apr;304(8):C693-714.
Garcia A, Bonnaig J, Yoneda Z, Richards J, Ehrenfeld J, Obremskey W, Jahangir A,
Sethi M. Patient variables which may predict length of stay and hospital costs in elderly
patients with hip fracture. J Orthop Trauma. 2012 Nov;26(11):620-3.
Garg S, Kumar A. Successful echocardiography-guided management of refractory
postoperative hypotension after alfieri repair of the mitral valve. J Cardiothorac Vasc
Anesth. 2013 Jun;27(3):e21-2.
Girard T, Ware L, Bernard G, Pandharipande P, Thompson J, Shintani A, Jackson J,
Dittus R, Ely E. Associations of markers of inflammation and coagulation with delirium
during critical illness. Intensive Care Med. 2012 Dec;38(12):1965-73.
Gonzalez-Villalobos R, Janjoulia T, Fletcher N, Giani J, Nguyen M, Riquier-Brison
A, Seth D, Fuchs S, Eladari D, Picard N, Bachmann S, Delpire E, Peti-Peterdi J,
Navar L, Bernstein K, McDonough A. The absence of intrarenal ACE protects against
hypertension. J Clin Invest. 2013 May;123(5):2011-23.
Grimm P, Taneja T, Liu J, Coleman R, Chen Y, Delpire E, Wade J, Welling P. SPAK
isoforms and OSR1 regulate sodium-chloride co-transporters in a nephron-specific
manner. J Bio Chem. 2012 Nov;387(45):37673-37690.
Grosse-Sundrup M, Henneman J, Sandberg W, Bateman B, Uribe J, Nguyen N,
Ehrenfeld J, Martinez E, Kurth T, Eikermann M. Intermediate acting non-depolarizing
neuromuscular blocking agents and risk of postoperative respiratory complications:
prospective propensity score matched cohort study. BMJ. 2012 Oct 15.345:e6329.
Grueter B, Robison A, Neve R, Nestler E, Malenka R. ∆FosB differentially modulates
nucleus accumbens direct and indirect pathway function. Proc Natl Acad Sci U S A.
2013 Jan;110(5):1923-8.
Gupta R. Using an electronic clinical decision support system to reduce the risk of
epidural hematoma. Am J Ther. 2012 Oct [Epub].
Gupta R, Lane J, Allen B, Shi Y, Schildcrout J. Improving needle visualization by
novice residents during an in-plane ultrasound nerve block simulation using an in-plane
multiangle needle guide. Pain Med. 2013 Jun [epub].
Haas J, Winter H, Lim E, Kirby A, Blumenstiel B, DeFelice M, Gabriel S, Jalas C,
Branski D, Grueter C, Toporovski M, Walther T, Daly M, Farese R Jr. DGAT1 mutation
is linked to a congenital diarrheal disorder. J Clin Invest. 2012 Dec;122(12):4680-4.
Hain P, Gay J, Berutti T, Whitney G, Wang W, Saville B. Preventability of early
readmissions at a children’s hospital. Pediatrics. 2013 Jan;131(1):e171-81.
Harden R, Oaklander A, Burton A, Perez R, Richardson K, Swan M, Barthel J, Costa B,
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Harden R, Wallach G, Gagnon C, Zereshki A, Mukai A, Saracoglu M, Kuroda M,
Graciosa J, Bruehl S. The osteoarthritis knee model: psychophysical characteristics and
putative outcomes. J Pain. 2013 Mar;14(3):281-9.
Kynes J, Schildcrout J, Hickson G, Pichert J, Han X, Ehrenfeld J, Westlake M, Catron
T, St. Jacques P. An analysis of risk factors for patient complaints about ambulatory
anesthesiology care. Anesth Analg. 2013 Jun;116(6):1325-32.
Hata J, Togashi K, Kumar A, Hodges L, Kaiser E, Tessmann P, Faust C, Sessler D.
Effect of the Pressure-Volume Curve (PVC) for PEEP Titration on Clinical Outcomes in
Acute Lung Injury and the Acute Respiratory Distress Syndrome: A Systematic Review.
J Intensive Care Med. 2013 Jun [Epub].
Lane J, Sandberg W, Rothman B. Development and implementation of an integrated
mobile situational awareness iPhone application VigiVU™ at an academic medical
center. Int J Comput Assist Radiol Surg. 2012 Sep;7(5):721-35.
Hays S, Deshpande J. Newly postulated neurodevelopmental risks of pediatric
anesthesia: theories that could rock our world. J Urol. 2013 Apr;189(4):1222-8.
Helwani M, Saied N. Intraoperative plateau pressure measurement using modern
anesthesia machine ventilators. Can J Anaesth. 2013 Apr;60(4):404-6.
Helwani M, Saied N, Asaad B, Rasmussen S, Fingerman M. The current role of
ultrasound use in teaching regional anesthesia: a survey of residency programs in the
United States. Pain Med. 2012 Oct;13(10):1342-6.
Hernandez A, Cogdill R, Hinojosa-Laborde C, Restrepo M. Comparison of silicone
spray versus water soluble lubricating jelly for the aid in bronchoscopic examination.
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Hester D, McGrane S, Higgins M. Respiratory parameters as a surrogate marker for
duration of intubation: potential application of automated vital sign collection. J Clin
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Hill J, Ashit P, Del Corral G, Sexton, K, Ehrenfeld J, Guillamondegui O, Shack
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Hollenbeck R, Wells Q, Pollock J, Kelley M, Wagner C, Cash M, Scott C, Burns
K, Jones I, Fredi J, McPherson J. Implementation of a standardized pathway for the
treatment of cardiac arrest patients using therapeutic hypothermia: “CODE ICE”. Crit
Pathw Cardiol. 2012 Sep;11(3):91-8.
Hughes C, Brummel N, Vasilevskis E, Girard T, Pandharipande P. Future directions
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Hughes C, McGrane S, Pandharipande P. Sedation in the intensive care setting. Clin
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Hughes C, Patel M, Pandharipande P. Pathophysiology of acute brain dysfunction:
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Jackson T, Lonergan D, Todd R, Martin P. Intentional intrathecal opioid detoxification
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Krupka D, Sandberg W, Weeks W. The impact on hospitals of reducing surgical
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Kumar A, Hata J, Bayman E, Krishnan S. Implementing a Hybrid Web-Based
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Kumar A, Schweiger H. Intraoperative Use of a Chest Physiotherapy System During
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Levin S, Harley E, Fackler J, Lehmann C, Custer J, France D, Zeger S. Real-time
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Li F, Sexton K, Hocking K, Osgood M, Eagle S, Cheung-Flynn J, Brophy C,
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Lonergan D, Ehrenfeld J. Advancement of information technology in outpatient
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Maltais S, Costello W, Billings F IV, Bick J, Byrne J, Ahmad R, Wagner C. Episodic
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Mandell M, Pomfret E, Steadman R, Hirose R, Reich D, Schumann R, Walia
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Apr;19(4):425-30.
Mao S, Garzon-Muvdi T, Di Fulvio M, Chen Y, Delpire E, Alvarez F, Alvarez-Leefmans
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Baysinger, C. Committee Reports: Economics and Governmental Affaris Committee:
Local Action is Needed Now. SOAP Newsletter. 2012 Summer.
Baysinger, C. Editorial Comment on: McDonald S, Fernando R, Ashpole K, Columb
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2011 Oct;113(4) Obstetric Anesthesia Digest. 2012 Dec;32(4):240-240.
Baysinger, C. Editorial Comment on: Murphy J, Togioka B. Aspiration in early
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Digest. 2012 Sep;32(3):169-169.
Baysigner C. Editorial Comment on: Wolfson A, Lee A, Wong R, Arheart K, Penning
D. Bilateral multi-injection iliohypogastric-ilioinguinal nerve block in conjunction with
neuraxial morphine is superior to neuraxial morphine alone for postcesarean analgesia. J
Clin Obstetric Anesthesi Digest. 2013; 33(2).
Newsletter Articles
Brockway E, Westman A, Robertson A. PreAnesthetic Assessment of the Patient with
Cirrhosis-Related Pulmonary Complications. Anesthesiology News. 2012 Apr;28-32.
Baysinger C. Nitrous oxide for labor analgesia. SOAP Newsletter. 2012 Summer.
Easdown J. Great Books on Education. SEA Newsletter. 2012 Fall;31(2).
Easdown J. Resources for Scholarly Curriculum Development. SEA Newsletter. 2013
Spring;32(1).
McQueen K. Awarding Outstanding Humanitarianism: The 2nd Annual Nicholas M.
Greene, M.D. Award. ASA Newsletter. 2012 Dec;76(12):24.
McQueen K. Central America Lifebox Initative. ASA Newsletter. 2013 Mar;77(3):50.
McQueen K. Evolving Expectations of Providing Anesthesia in Humanitarian Settings.
ASA Newsletter. 2013 Jan;77(1):26-28.
Nesbitt K. Juvenile Diabetes: An Update. SPA News. 2013 Mar;26(1).
Nesbitt K. Pediatric Anesthesiology 2013 Meeting Reviews - Sunday, March 17 Session I. SPA News. 2013 July;26(2).
Rothman B. Cloud Computing: What is the ‘Cloud?’. ASA Newsletter. 2012
Aug;76(8):24-26.
Starr S, Baysinger C. Inhaled nitrous oxide for labor: utilizing a blender device to
provide patient-controlled analgesia. Sensor Online. 2013 Jan;24: 6-9.
Letters
Ehrenfeld J. Which is the original and which is the modified rapid sequence induction
and intubation? Let history be the judge!---author’s reply. Anesth Analg. 2013
Jan;116(1):265.
Huntoon M. A humble farmer-on fertile ground. Reg Anesth Pain Med . 2013 JanFeb;38(1):1-2.
Krupka D, Sandberg W. The correct business case for the Michigan Keystone Patient
Safety Program in ICUs. Am J Med Qual. 2012 Mar-Apr;27(2):175.
Huntoon M. Case reports, cover updates, statistics, and targeted intrathecal infusions.
Reg Anesth Pain Med. 2013 Mar-Apr;38(2):89-90.
McPherson J, Boehm L, Wagner C, Ely E, Pandharipande P. The authors reply. Crit
Care Med. 2013 Jun;41(6):e101-2.
Richardson M, Litman R. In utero myelomeningocele repair: baby steps and giant leaps
for fetal surgery. Anesthesiology. 2013 May;118(5):1016-1018.
Richardson M, Ikeda A, Isono S, Litman R. In Reply (Facemask ventilation
and neuromuscular blockade in anesthetized patients). Anesthesiology. 2013
Apr;118(4):994-996.
Richardson M, Litman R. Ventilation before paralysis: crossing the rubicon, slowly.
Anesthesiology. 2012 Sep;117(3):1-3.
Thompson A, Mahajan A. Perioperative Management of Cardiovascular Implantable
Electronic Devices (CIEDs): What every anesthesiologist needs to know. Anesth Analg.
2013 Feb;116:276-277.
Watkins S. A simulation-based trial of surgical-crisis checklists. N Engl J Med. 2013
Apr 11;368(15):1459.
Wilson J, Bick J, Thompson A. Another use for transesophageal echocardiography
during aortic valve bypass surgery. J Cardiothorac Vasc Anesth. 2012 Oct.
Editorial Reviews
Poems
Baysinger C. Commentary on: Abdallah F, Halpern S, Margarido C. Transversus
abdominis plane block for postoperative analgesia after Caesarean delivery performed
under spinal anaesthesia? A systematic review and meta-analysis. Br J Anaesth.
2012 Nov;109(5):679-87. Faculty of 1000 Reviews. 2013 April. http://f1000.com/
prime/717954821.
Harvey S. Family Quartet. Able Muse. 2012 Winter;14.
Baysinger C. Commentary on: Bauchat J, McCarthy R, Koski T, Cambic C, Lee A,
Wong C. Prior lumbar discectomy surgery does not alter the efficacy of neuraxial labor
analgesia. Anesth Analg. 2012 Aug;115(2):348-53. Faculty of 1000 Reviews. 2012 Nov.
Baysinger C. Commentary on: Dean G, Jacobs A, Goldstein R, Gevirtz C, Paul M. The
safety of deep sedation without intubation for abortion in the outpatient setting. J Clin
Anesth. 2011 Sep;23(6):437-42. Faculty of 100 Reveiws. 2012 July. http://f1000.
com/717949613.
Baysinger C. Commentary on: Srofenyoh E, Ivester T, Engmann C, Olufolabi A,
Bookman L, Owen M. Advancing obstetric and neonatal care in a regional hospital in
Ghana via continuous quality improvement. Int J Gynaecol Obstet. 2012 Jan;116(1):1721. Obstetric Anesthesia Digest. 2013; 33(1).
Harvey S. Deposition in New York. Anesthesiology. 2012 Aug;117(2): 422. doi:
10.1097/ALN.0b013e3182531b88.
Harvey S. From Auschwitz with love. Pharos Alpha Omega Alpha Honor Med Soc.
2012 Summer;75(3):25.
Harvey S. Poet’s Plight. Chest. 2012;142(5):1352. doi:10.1378/chest.11-3087.
Harvey S. The Meditation Garden. JAMA. 2012;308(11):1072. doi:10.1001/
jama.2012.9881.
Harvey S. University Clinic. Chest. 2012;142(5):1352. doi:10.1378/chest.1103137
Hester D. First case with Adèle and Aegis. Anesthesiology. 2012 Sep;117(3):669.
Hester D. Can’t Stop the Clock. Tabula Rasa. 2013 Jun; VII.
55
Achieving Balance
The Vanderbilt Department of Anesthesiology is a dynamic group, providing
the very best in patient care, presenting challenging educational programs
for our trainees, and leading our specialty in investigational research. But
productivity and career satisfaction isn’t all about work. We know how to
take that same energy and have a great time.
56
We gather regularly for family-friendly events, events to welcome new
residents, fundraisers for our Vanderbilt International Anesthesia program,
and other fun activities throughout the year. Here are just a few images from
our events.