Department of Anesthesia, Pain Management and ... · Department of Anesthesia, Pain Management and Perioperative Medicine Annual Report 2011-2012 9 phase of its mentorship program

Department of Anesthesia, Pain Management and Perioperative MedicineAnnual Report 2011-2012

Department of Anesthesia, Pain Management and Per ioperat ive Medicine Annual Report 2011-2012i

Department of Anesthesia, Pain Management and Per ioperat ive Medicine Annual Report 2011-2012 1

Vision & Mission

A culture of excellence...

Mission

To deliver anesthesia services through up-to-date clinical care based on the latest evidence(research) and knowledge (education).

The Department of Anesthesia, Pain Managementand Perioperative Medicine believes that:

• Patients are entitled to safe, evidence- informed, humanistic care

• Life-long learning is a pre-requisite to safe,competent care and professional, compassionate clinicians

• Scholarly curiosity is fundamental to the improvement and enhancement of patient care

• Stewardship of local and global resourcesis a departmental responsibility

• Transparency, accountability in combinationwith creative thinking, and leadership are imperative to the department’s quest for excellence

Vision

A culture of excellence in anesthesia clinicalpractice and programs, research and education.

“Leaf Angels”© by Anne Camozzi


ACADEMIC CLINICAL FISCAL

RPC ADMINASSISTANT

DATA ENTRYCLERKS

FINANCEASSISTANT

ADMINASSISTANT

ACADEMICCOORDINATOR

EDUCATIONCOORDINATOR

DATA ANALYST

WEBDEVELOPER

RESEARCHCOORDINATOR

DEAN, DALHOUSIE MED SCHOOL

VP, CLINICAL SERVICES, CDHA

ANSI

HEADDEPARTMENT OFANESTHESIA, DAL

CHIEFDEPARTMENT OFANESTHESIA, CDHA

PRESIDENT OF ANSI (AFP)

Department of Anesthesia Organization Chart

DIRECTOR OF RESIDENCY

ASSOCIATEDIRECTOR OF RESIDENCY

EXECUTIVEDIRECTOR

EQUIPMENTCOMMITTEE

HR SUBCOMMITTEE

OFFICE OF QUALITYASSURANCE/PATIENT

SAFETY

EXECUTIVE ADVISORY TEAM

COMPTROLLER

DALHOUSIE SITE CHIEFS

NB/IWK/CDHACRITICAL CARE

ANESTHESIARESIDENTS

MANAGING DIRECTOROFFICE OF EDUCATION

CDHASITE CHIEFS

COMMITTEE

INFORMATIONMANAGEMENT

MANAGING DIRECTOROFFICE OF RESEARCH

SUPORT

PROVINCIAL PROGRAMS

CDHA CLINCIAL SERVICESANESTHESIOLOGISTS


The Dalhousie Department of Anesthesia is now more appropriately titled the DalhousieDepartment of Anesthesia, Pain Manage-ment and Perioperative Medicine. The namechange was a result of department memberstaking stock of the breadth and depth of theirpatient care, education and research; consider-ing advances in their disciplines; and looking totheir vision for the department — all of whichwas undertaken because of the department’scommitment to strategic planning and operatingon the basis of strategic principles.

The Department of Anesthesia, Pain Manage-ment and Perioperative Medicine has a four-foldmandate encompassing safe, quality patientcare, education, research and stewardship ofpeople’s health at home and abroad. Created in1945, the department has grown to provide afull spectrum of critical care and general clinicalservices and administer leading edge programsin blood management, pain management andregional anesthesia. It subspecializes in cardiacsurgery, neurosurgery, women and obstetrics,pediatrics, thoracic surgery and transplantation.

Department members provide expertise locallythrough community-based initiatives, nationallythrough a variety of committees, boards andagencies, and internationally through outreachprograms.

Message from the Head & ChiefThis year’s annual report focuses on thedepartment’s efforts to teach all aspects ofmedicine related to anesthesia and acute caremedicine and illustrate the application of thebasic sciences of physiology, pharmacologyand anatomy to anesthesia. With more than 70 undergraduate students each year; 100 ap-plicants annually for five residency positions;and an ongoing commitment to continuouslearning for department members, our educationprogram is among the most robust in Canada.You will read more about the department’seducation program in the following pages, but Iwould like to commend the Office of Education’spostgraduate portfolio on earning yet anotherconsecutive full accreditation from the RoyalCollege of Physicians and Surgeons of Canada.I would also like to note the department’ssuccessful launch of the third phase of itsmentorship program, which introduces a flexibleprocess of matching department members inany role with a mentor from within or outside thedepartment. The mentorship program aims toensure that all staff can perform at theirmaximum potential and contribute to a cultureof excellence in anesthesia practice and programs, research and education. This year,the department also introduced a roster of professional development modules for admin-istrative staff.

(cont’d next page)

Department of Anesthesia, Pain Management and Per ioperat ive Medicine Annual Report 2011-20124

While the department’s commitment to educationis the focus of this year’s report, safe vigilantpatient care is the department’s hallmark. Overone hundred anesthesiologists perform morethan 49,000 procedures annually at five mainfacilities in Nova Scotia and New Brunswick:QEII Health Sciences Centre, IWK HealthCentre, Dartmouth General Hospital, HantsCommunity Hospital and Saint John RegionalHospital.

In the last year, the department added the mostadvanced medical equipment, began using TEEin liver transplantation, and played a leading rolein operational changes to improve OR efficiencyand the use of OR time.

The department also continued to advance itsresearch agenda, recording gains in researchfunding and peer-reviewed publications andcollaborative research projects. The departmentfocuses its research efforts primarily in pain,airway management, perioperative inflammationand organ protection. Outcomes research anddevice development have also been identifiedas areas of concentration. Increasingly depart-ment members are establishing collaborativeresearch groups with local, national and inter-national colleagues and seeking multiplegrants and awards for projects in the public andprivate sectors, helping to ensure sustainability

Message (Cont’d.)

The Department of Anesthesia,

Pain Management and Perio-

perative Medicine has a four-fold

mandate encompassing safe,

quality patient care, education,

research and stewardship of

people’s health at home and

abroad.

and expand the impact of their work. In 2011-2012, 20 per cent of funding was generatedfrom the private sector, the most of any year todate.

I invite you to review the following pages andvisit the department’s website, nsanesthesia.ca,to learn more about the work we’re doing toimprove patient care and the health of peoplehere and around the world; to educate thehealth leaders of today and tomorrow; and toadvance our knowledge and understanding ofthe science and practice of anesthesia.

Dr. Romesh Shukla


Awards & Accolades

Dr. Romesh Shukla Honoured forProfessionalism

Dr. Romesh Shukla (top right) was among thefirst nominees for the Dalhousie Faculty ofMedicine's Professionalism Kudos. Profession-alism, according to the Faculty of MedicineProfessionalism Policy, is demonstrated byindividuals who show in their actions andinteractions with others: respect for others,honesty and integrity, compassion and empathy,and duty and responsibility.

Dr. Patty Livingston: Leadership in GlobalHealth

Dr. Patty Livingston (bottom right) was namedthe 2012 recipient of the Dr. John SavageMemorial Award, which recognizes a Dalhousiefaculty member who demonstrates leadershipin global health. Patty’s ongoing commitment toglobal health, several teaching missions toRwanda and her research to improve ed-ucation in Rwanda and here at home made herthe winning candidate among many excellentnominations for the award.

AwardsJill Chorney: Emerging Professional

Jill Chorney, PhD (right) was the recipient of theEmerging Professional award at the 9th annualDiscovery Awards for Science and Technology.The award recognizes an individual under age35 who demonstrates intellectual achievements,excellence and potential for on-going growthand development.

Long Service Award Recipients

Amber Kelly, Administrative Assistant

Dr. Stephen Beed, Professor, Critical Care

Dr. Kevin Bent, Scheduler, Dartmouth GeneralHospital

Dr. Chris Berger, Lecturer, Staff Anesthesiologist

Dr. Alison Kelland, Assistant Professor,Anesthesia Site Chief, Hants CommunityHospital

Dr. Bruce MacAulay, Assistant Professor,Staff Anesthesiologist

10 Years



Retirees

Dr. Des Writer

Dr. Don Morrison

Dan Cashen

Hires

Dr. Shawn Hicks, Assistant Professor, staffanesthesiologist

Dr. James Starodub (locum), AssistantProfessor, staff anesthesiologist

Dr. Genevieve McKinnon (locum), Lecturer,staff anesthesiologist

Dr. Rochelle MacLellan, Assistant Professor,staff anesthesiologist

Dr. Ayman Hendy, Assistant Professor, staffanesthesiologist

Dr. Robyn Doucet, Lecturer, staffanesthesiologist

Retirees & New HiresAwards (Cont’d.)

Dr. Peter MacDougall, Associate Professor,Medical Director of Continuing ProfessionalDevelopment

Dr. Robert Paterson, Anesthesia Site Chief,Dartmouth General Hospital

Dr. Ian Beauprie, Associate Professor, Chiefof Neuroanesthesia (interim)

Dr. Sharon Litz, Assistant Professor, staffanesthesiologist

Dr. Ward Patrick, Professor, Chief of CriticalCare

Dr. Chris Soder, Associate Professor, staffanesthesiologist

Jason McDougall, PhD, Associate Professor,(joint appointment with the DalhousieDepartment of Pharmacology)

Heather Butler, PhD, Managing Director ofResearch Services

Bill Hill, Anesthesia Services Manager15 Years



phase of its mentorship program. The Applauserecognition strategy is designed to aptlyrecognize, celebrate and support members ofthe department for their commitment toexcellence in patient care, education andresearch, and in management and admin-istrative practices. The Talent Developmentperformance management process was de-signed to support and grow the considerabletalent found in the department. The mentorshipprogram, initially launched in 2010, aims toensure all staff can perform at their maximumpotential and contribute to a culture of excel-lence in anesthesia practice and programs,research and education. Its third phase intro-duces a flexible process of matching departmentmembers in any role with a mentor from withinor outside the department.

The Department of Anesthesia first establisheda strategic plan in 2007, bringing together more than 100 members of the department todevelop a shared vision, mission and priorities.The department’s strategic plan is reported on,revised, updated and added to annually,effectively making it a “living document” thatguides the department’s actions in all areas:patient care, education and research.

The department’s most significant initiativeslaunched, expanded or completed in 2011-2012 stemmed from its strategic plan.

The governance renewal working group re-viewed the department’s governance model andput forward recommendations for revisedorganizational structures, position descriptions,renewed policies and terms of reference thattouched all aspects of the department. Theresult has been a reorganization of the depart-ment’s structure to better support its coreservices of patient care, education and researchwhile strengthening quality assurance. The groupis also leading a review of the department’spolicies and procedures to provide greaterconsistency and accountability in departmentaloperations. Its work contributed to a change inthe department’s name from the Department ofAnesthesia to the Department of Anesthesia,Pain Management and Perioperative Medicine,

Outcomes of Strategic Thinking & Planningwhich more appropriately reflects and recog-nizes the breadth and depth of the department’sactivity and contributions to medicine.

Another of the objectives outlined through thestrategic planning process was earning fullaccreditation of the department’s postgraduateprogram from the Royal College of Physiciansand Surgeons of Canada. The department didjust that in February 2012 following a two-yearpreparation process.

The department also successfully recruited fourfellows in 2011-2012 after formally launching itsfellowship program in 2010. The program nowincludes fellowship positions in airway, cardiacanesthesia, chronic pain, global health, regionaland acute pain, and women’s & obstetricanesthesia. Drs. Jeanette Scott and TimMullen joined the department as airway fellows,Dr. Magnus Brietling as a chronic pain fellowand Dr. Kim Wong as a regional and acute painfellow.

One of the highest priorities established andthen reinforced through the department’sstrategic planning process is investment in the professional development and growth ofdepartment members. To that end, the depart-ment launched a recognition strategy, a per-formance management program and the third

A snapshot of the strategic plan is availableon the Department of Anesthesia, PainManagement and Perioperative Medicinewebsite, www.nsanesthesia.ca

Department of Anesthesia, Pain Management and Per ioperat ive Medicine Education Annual Report 2011-201210

Department of Anesthesia, Pain Management and Per ioperat ive Medicine Education Annual Report 2011-2012 11

What is becoming a full-fledged anesthesiologisttoday like? Is it as challenging as portrayed intelevision’s hottest medical dramas? Is it still asdemanding as being a resident in years past?

Dr. Austin Lamb (far left) is in his third year oflearning just how challenging (and interesting,and fun and rewarding, he says) becoming ananesthesiologist is. He’s a resident, almost halfway to completing the five-year Dalhousie anes-thesia residency program.

Most of Dr. Lamb’s days begin at about 5:45a.m. with a shower, coffee and the journal articlehe didn’t quite get through the night before, thenhe’s off to the fifth floor of the Halifax Infirmaryor the 10th floor of the Victoria General to reviewthe schedule again and help set up the OR he’sbeen assigned.

Soon after, he’s meeting with the first patient ofthe day to address any issues or questions andto outline what can be expected from him, theanesthesia team and the anesthetics they willadminister before, during and after surgery. Theroutine repeats itself several times until lateafternoon or early evening. Before leaving thehospital, Dr. Lamb reviews the next day’s ORcases to find out what journals, cases,procedures and/or skills he should study athome to prepare.

Becoming a Full Fledged Anesthesiologist



perative Medicine includes 27

residents who are in the process

of becoming anesthesiologists.

The department’s 97 physician

members are Dalhousie University

faculty members who are res-

ponsible for helping residents

and medical students to become

highly competent, compassionate

and skilled physicians.

“Being as prepared as possible for the next day helps me maximize my learning. I can askinformed questions and best use my time in theOR and with faculty members to absorb more ofthe experience,” he says. “Though we receive alot of support and guidance, much of theresidency experience and learning is defined byresidents.”

Dr. Lamb’s evenings are mostly reserved for thatpreparation. He spends an average of two tothree hours daily researching anesthesia care.He also makes time for preparing presentations,working on a research project and prepping forexams. It’s lights out at about 11 p.m.

This is not everyday, of course. There are “oncall” days when Dr. Lamb is called into thehospital long after the standard workday orstays on-site until the early morning. There arealso academic days when he and his fellowresidents attend lectures on specific topics orspend time in the skills lab.



She’s young, she’s new, she’s keen and shemay just be an anesthesia resident’s best friend. Dr. Robyn Doucet (left) is fresh out ofpostgraduate anesthesia and a chief residentposition, and is now applying her skills, know-ledge and crisp perspective to patient care and to education. A staff anesthesiologist andLecturer, she joined the Dalhousie Departmentof Anesthesia, Pain Management and Peri-operative Medicine in 2011 after having spentthe last five years at the University of Calgary.

While going about providing anesthesia care on a daily basis, Dr. Doucet works with residents to help them develop the skills andknowledge necessary to become competentand compassionate anesthesiologists, with anenthusiasm for doing so that is palpable.

“I’ve had a keen interest in medical educationfrom the first time I realized I could inspireothers’ learning. It’s a great feeling for me to know that I can encourage others’ interestand knowledge of subjects,” says Dr. Doucet.“Teachers and mentors can have a profoundimpact on us. If I can make some level of impactin a resident’s or student’s learning, I know I’mdoing something right.”

Dr. Doucet is a graduate of Dalhousie MedicalSchool and hails from Halifax. She is currently

A Keen Interest in Medical Educationpursuing a graduate degree in medicaleducation (The University of Dundee, Scotland)and will begin teaching undergraduate medicalstudents in addition to anesthesia residents in the fall 2012.



perative Medicine includes 97

members who are also faculty

members at Dalhousie University.

They teach 27 anesthesia resi-

dents and Dalhousie Medical

School students on a daily basis.



Dr. Andrew Jarvie (near left) keeps it simple.“My job as a clinical faculty member is to makestudents’ experiences as pleasant as possible.If I can make it fun and de-stress a stressedstudent, I’ve done my job,” he says. “Of course,there’s the part about teaching the students, butthat’s the easy stuff. They are overwhelminglyeager to learn.”

Dr. Jarvie routinely works with residents, helpingthem to hone their anesthesia skills and ex-pand their breadth and depth of anesthesiaknowledge, but he is also a popular teacheramong undergraduate medical students whohave the opportunity to choose their electiveexperiences. He has taught elective studentseach year since joining Dalhousie Anesthesia,Pain Management and Perioperative Med-icine in 2005. The most recent was SteveScales, a second-year student at DalhousieMedical School.

“When the students choose to do an elective inanesthesia, it’s because they want to learn moreabout the discipline. I try to impart as much ofmy enthusiasm for anesthesia as possible byexposing students to multiple experiences(without risk to patients) while fostering theircritical thinking skills and expanding theirtechnical skills,” says Dr. Jarvie. “After even shortelective experiences of two to three weeks,

Not All About the Students’ Learningstudents often tell me there is much more toanesthesia than they thought.”

It isn’t all about students’ learning though. Dr. Jarvie notes that being an active facultymember encourages you to open the medicaljournals more often, study best practices andthe latest developments in the discipline, and bean exceptional physician.



perative Medicine hosted 79

elective students from Dalhousie

Medical School and medical

schools across Canada in 2011

– 2012.



Steve Scales (left with Med III student, Mary Beth Bissell) is a second year medicalstudent navigating his way to becoming aphysician. On his first day at Dalhousie Med-ical School he met Dr. Ian Beauprie, staffanesthesiologist and Associate Professor, aspart of “shadow a physician day.” The two wererandomly assigned – a stroke of luck for Stevewho found himself in his comfort zone.

“I decided on that day that my first electivewould be in anesthesia and submitted my name to the department shortly thereafter,” saysSteve.

For about three months in the fall of 2011, Stevespent half a day per week with Dr. KonstantinLorenz, staff anesthesiologist and associateprofessor, in the OR at the QEII Health SciencesCentre, meeting with patients, studying anddiscussing anesthesia cases and reviewing drugtherapies.

A Stroke of Luck“Dr. Lorenz allowed me to ‘get right in there,’which I enjoyed and appreciated,” says Steve.“It’s too soon to decide on a favourite medicaldiscipline, but I’m thrilled to know I found aspecific area of medicine that I really like, whichI didn’t think would happen so early on.”

Steve is one of 16 first and

second year medical students

who studied anesthesia as an

elective of their choosing in

2011-2012. He will return to the

department in his fourth year

of medical school as a medical

clerk, learning more about the

breadth and depth of the dis-

cipline and gaining valuable

experience and knowledge to

become a highly skilled and

compassionate physician.



On the day of her interview for this piece,Megan Chipp, at left with Laura HarrisBuffett (right), intently worked through thedetails of job descriptions for two manage-ment positions at the Rwanda Simulation andSkills Centre; consulted with colleague, CyndiLushman, curriculum renewal coordinator, todecide upon the best way of organizing thedepartment’s residency curriculum in the newlypurchased mapping software; came to therescue of another colleague who needed animpromptu Excel tutorial; checked off a fewitems on her to do list for the non-technical skillscontinuing professional development workshopseries to be offered to department staff; andchased missing information as a result of herreview of the faculty promotion applicationsfrom department members.

She also made final arrangements for a newstaff orientation session, responded to emailsfrom two Rwandan anesthesia residents whowill spend six months in the department in 2013increasing their knowledge and experience inanesthesia, and submitted information to the department’s internal information system(IIS) to ensure department members are awareof what is happening in the many portfolios she coordinates. Megan is the academic coordinator responsible for supporting the

All in a Daydepartment’s global health efforts, mentorshipprogram, faculty appointments and promotions,and overseeing the curriculum renewal initiative.

In January 2013 she will head to Rwanda tofacilitate the Building SAFE Teams module of the SAFE Obstetrical Anesthesia Course, led by Dr. Patty Livingston, medical director ofglobal health.

“The diverse responsibilities in this position, thedepartment’s understanding of the importanceof educational opportunities as a contributor to its vision of anesthesia excellence, and thechance to broaden my experience in globalhealth drew me to this position and to thedepartment,” says Megan. She joined the de-partment as education coordinator in 2010.

Megan is one of three full-time

department members who make

up the Department of Anes-

thesia, Pain Management and

Perioperative Medicine Office of

Education. The office manages

all of the department’s education

activities, including under-

graduate and postgraduate

medical education, fellowships,

continuing professional dev-

elopment, simulation, mentor-

ship, global health and faculty

appointments and promotions.

Now in the third year of an established Office of Education, the education portfolio en-compasses undergraduate medical education,postgraduate medical education, fellowships,continuing professional development, mentor-ship, simulation, global health, and promotionand tenure.

This inclusive education portfolio puts theDepartment of Anesthesia, Pain Managementand Perioperative Medicine in the advantageousposition of coordinating all education efforts,resulting in outstanding educational programsand initiatives at all levels.

Much of the focus in the last year has been onfostering solid programs in each area, forexample, filling fellowship positions and suc-cessfully managing program requirements such as the accreditation process for thepostgraduate education program. The ed-ucation portfolio grew amid staffing changes,which included the need for a temporarymanaging director and a vacancy in theeducation coordinator position because ofscheduled leaves, the establishment of amedical director and a new medical director offellowships.

Robust Diversified Education ProgramsThe new medical director for education is Dr. Romesh Shukla, head & chief, Departmentof Anesthesia, Pain Management and Perio-perative Medicine. Dr. Shukla’s leadership in thisrole ensures a strong link to the department’soverall operations. Dr. Jane Henderson becamemedical director for the fellowship programsfollowing Dr. Ian Beauprie’s leadership in thatarea. Jane Bolivar served as managing directorof education for much of 2011 – 2012, keepingthe office in good stead for Laura HarrisBuffett’s return in early 2012.

In the last year, the Office of Education:

• Guided four fellows through airway, regional and acute pain, and chronic pain fellowships;

• Graduated four residents, two of whom remained with the department in staff positions;

• Accepted four residents from among more than 90 applicants to the postgraduate program;

• Offered more than 140 learning experiencesto elective students from Dalhousie University’s faculties of medicine, health professions and nursing and medical


schools across Canada;• Supported five department staff and

resident volunteers travelling on teaching missions to Kigali, Rwanda through the CASIEF-Rwanda Sustainable Anesthesia Teaching Program;

• Held the fifth annual Global Outreach: Anesthesia in Challenging Environments course for leaders in global health across North America – the course consistently boasts full enrollments and generates revenues;

• Supported department members to provide education, research, clinical service and advocacy in countries such as Rwanda, Ghana, Bolivia, Jordan, Thailand, China and Brazil;

• Held the second annual Faculty Development Day together with the Department of Surgery;

• Facilitated professional and work life balance sessions for administrative staff;

• Fulfilled all of the requirements of the Royal College of Physicians and Surgeons accreditation process, earning full approval for six years;


• Launched a curriculum renewal initiative that will review and assess all of the department’s postgraduate education offerings and make recommendations for further aligning the postgraduate program with outcomes set by the Royal College of Physician and Surgeons;

• Submitted a formal request to Dalhousie Undergraduate Medical Education for the inclusion of a selective anesthesia rotation within its clerkship program; and

• Initiated planning for an anesthesia simulation centre as a result of the pendingreorganization of the Atlantic Health Training Simulation Centre.

There are a number of trends and excitingdevelopments in medical and health educationand professional development that theDepartment of Anesthesia, Pain Managementand Perioperative Medicine is monitoring orembarking on as it looks to the future.

The department launched the third phase of its mentorship program, which introduces aflexible process of matching department members in any role with a mentor from within or outside the department. The mentorship

program aims to ensure that all staff canperform at their maximum potential andcontribute to a culture of excellence in anes-thesia practice and programs, research andeducation. The department also continues toseek opportunities to collaborate with otherDalhousie Faculty of Medicine departments in areas such as simulation, skills training,faculty development and global health, activelyexploring new partnerships to offer many andvaried education opportunities to anesthesiamembers and colleagues in areas beyondanesthesia. The 2011-2012 Faculty Develop-ment Day, which attracted participants fromsurgery, anesthesia, respirology, emergencymedicine and more, was a direct result of sucha partnership. An emphasis on collaborationbegins within the department though. Thisyear’s Research Day, which featured keynote Dr. Michael Cousins, was produced by theOffice of Research with support from the Officeof Education. These two offices continue toexplore ways to collaborate on other initiatives,such as the department’s recently launchedrecognition program.

The Dalhousie Faculty ofMedicine recently renewed itsundergraduate curriculum re-sulting in a two hour per weekreduction in anesthesia class-room teaching. However, thedepartment is working to maxi-mize the quality of teaching in the reduced time allotments,through other teaching activitiessuch as the Med I Shadow Day,Anesthesia Interest Group andthe Med III elective.

Teaching Awards (Pictured top right)

Dr. Ben Schelew: Clinical Teacher of the YearDr. Myron Kwapisz: Undergraduate Teacher ofthe YearDr. Orlando Hung: Mentor/Role Model of theYear (new award!)Dr. Fiona Roper: Resident Advocate of the Year(new award!)

Promotions

Five department members went through theDalhousie University faculty promotions processin 2011-2012. Congratulations to:

Dr. Ron George, Associate ProfessorDr. Alison Kelland, Assistant ProfessorDr. Myron Kwapisz, Associate ProfessorDr. Rob Nunn, Associate ProfessorDr. Tobias Witter, Associate Professor

Congratulations are in Order2011 Graduating Residents (Pictured bottom right, l-r, with Dr. JaniceChisholm, Medical Director, PostgraduateProgram)

Dr. Kwesi KwofieDr. Genevieve McKinnonDr. Ariane FieldingDr. Rosario Hernandez

Welcome

The Office of Education welcomed LeighThibideau (right), Education Coordinator, in2011-2012. Leigh is responsible for co-ordinating activities related to undergraduateand postgraduate medical education andcontinuing professional development.



Education by the Numbers • 2011- 2012 Academic Year

Number of Grand Rounds 31

Undergraduate

Postgrad Continuing Professional Development

Undergraduate Learners 79

Halifax 64

Moncton 4

Charlottetown 3

Sydney 3

Amherst 2

Saint John 1

Miramichi 1

Fredericton 1

Eighty-nine learners from disciplines other than

medicine, including nursing, paramedicine, res-

piratory therapy, etc.

Respiratory Therapy 10

Lifeflight 8

Perioperative nurses 5

Anesthesia assistant students 15

Anesthesia technicians 2

Holland College 19

Other 30

Anesthesia Elective Course Participation

Year 1 course 6 medical student participants

Year 2 course 10 medical student participants

Number of Department Member

Undergraduate Tutors at Dalhousie Medical

School

15 Tutors 464 hours

Number of Residents

PGY 1 5

PGY 2 6

PGY 3 6

PGY 4 4

PGY 5 8

Number of Fellows 4

Postgraduate Off-Service/Elective Rotations

Halifax, IWK Health Centre

10 Residents Total Weeks: 40

Saint John


Moncton


Halifax, QEII Health Sciences Centre


Number of Applicants to Residency Program

Can. Resident Matching System (CaRMS) 99

Number of M&M Rounds 6

Number of Journal Club 5

Number of other CME and/or events 10

Faculty Speakers 8

Resident Speakers 7

Fellow Speakers 4

Visiting Professors 8

Seventy-nine medical students in eight cities

and towns: Halifax, Moncton, Charlottetown,

Sydney, Amherst, Saint John, Miramichi,

Fredericton

Department of Anesthesia, Pain Management and Per ioperat ive Medicine Patient Care Annual Report 2011-201224

Department of Anesthesia, Pain Management and Per ioperat ive Medicine Patient Care Annual Report 2011-2012 25

High quality patient care and patient safety arehallmarks of the Department of Anesthesia, PainManagement and Perioperative Medicine. In thepast year, the department continued investingin this area guided by the department’s ClinicalAccountability Framework, priorities outlinedin its strategic plan and recommendations bythe department’s governance renewal workinggroup. The intent is to strengthen data collectionand systems, reporting, and research to furtherimprove the quality of anesthesia care andpatient safety.

Through its quality assurance office, the depart-ment refined and developed a number of methodsand processes for collecting, reporting andtracking prerequisite information for measuringperformance against the 13 quality and safetytargets outlined in the Clinical AccountabilityFramework, which was adopted in 2010. Thetargets range from ensuring all patients have apreoperative assessment completed to ensuringall patients have a body temperature greaterthan or equal to 36°C when transferred from theOR to the post anesthesia care unit. Increasingand improving data collection will allow thedepartment to better monitor, research andimprove anesthesia care and safety.

The most significant enabler of the department’srobust and growing data collection methods

Highest Quality Patient Careand compliance is Innovian, the anesthesiainformation system implemented by thedepartment in late 2010. Innovian hosts andprovides physicians with access to a widevariety of information, everything from apatient’s height and weight to who deliveredanesthesia care, what care was provided, whenand for how long. While a patient is in the OR,Innovian records their physiological data, suchas blood pressure and heart rate, every 15seconds, which enables the anesthesiologist tocarefully monitor the patient. It links to otherinformation systems throughout Capital Healthand the IWK enabling physicians access to labresults, diagnostic scans, x-rays and other teststhe second they are available. All of this betterenables the department to capture data it usesto improve patient care and safety and toconduct research.

A significant part of delivering high quality care and ensuring patient safety is to do soaccording to best practice and to obtain thenecessary equipment and training. In 2011-2012, Dr. Arnim Vlatten, Assistant Professorand staff anesthesiologist, became a coremember of the liver transplantation team,strengthening the team’s expertise in the useof trans-esophageal echocardiography (TEE).He is leading the full implementation of TEEin liver transplantation surgery.

High quality patient care and

patient safety are hallmarks of

the Department of Anesthesia,


perative Medicine.


The TEE probe was purchased in 2010 and itsuse introduced for limited cases, pendingfurther evidence of its efficacy. It is currentlyused as a standard piece of equipment. Theliver transplantation team also began using thelatest technology in rapid transfusion this yearfollowing the acquisition of a Belmont RapidInfuser. This new equipment is used to quicklyadminister higher amounts of blood, medi-cations and other fluids during surgery and intrauma treatment situations. The department also secured a new fleet of anesthesia machinesfor use by the women’s & obstetric anesthesiateam at the IWK Health Centre beginning in fall 2012. The cardiac team will introduce new techniques in minimally invasive heart valve surgery and transcatheter aortic valvetransplantation (TAVI) in the fall 2012 follow-ing site visits in early 2012 by Dr. Blaine Kent, subspecialty chief, to Robert WoodJohnson University Hospital (New Jersey) and Saint Paul’s (Vancouver) to gain skills andknowledge in the techniques.

The anesthesia team has been instrumental inimplementing recommendations for improvingOR practices and procedures put forward by anexternal consultant group, achieving efficien-cies at the QEII Health Sciences Centre (part ofCapital Health). Coordination of anesthesiaservices and patient flow by the AnesthesiaCoordinator role has continued to prove veryvaluable as Capital Health moves to further

increase efficiencies. Further, departmentmembers were involved in the selection andimplementation of a system for the wirelesstelemetric monitoring of obstructive sleep apneapatients postoperatively. Implementation of thesystem in November 2011 has allowed patientswith obstructive sleep apnea to be cared for onunits outside of the intermediate medical careunit (IMCU), thus making intermediate level careavailable to others and decreasing OR delaysand cancellations. The delivery of anesthesiacare, however, was hampered in 2011-2012 bya shortage in the supply and number of drugsused for anesthesia. While in most cases,alternate drugs were found and used, thedepartment’s office of quality and patient safetyis continuing to monitor the impact, in any, onpatient safety.


It takes a team – or rather teams – ofprofessionals to help things run as smoothlyas possible in the ORs at the QEII HealthSciences Centre; there are tens of thousandsof surgeries performed each year, many ofwhich are the most complex in AtlanticCanada. There is also a growing emphasis onOR efficiency so as to meet the needs ofcitizens in our community within constrainedhealthcare budgets. Anesthesia assistantsand anesthesia technologists are integralteam members, working with physicians and nurses to ensure patient safety whileincreasing efficiency. The two professionalgroups are little known beyond the OR andtertiary care hospitals but in their elements,they are considered critical to quality patientcare.

Anesthesia assistants

Anesthesia assistants are specially trainedhealth professionals who provide anesthesiacare, such as the insertion of intravenouslines, administration of intravenous drugs,and airway management and assessmentunder the supervision of an anesthesiologist.They also provide relief to anesthesiologists,

The Role of Anesthesia Assistants andAnesthesia Technicians in the Delivery ofHigh Quality Patient Care

observing stable patients in the OR, to allowfor breaks – necessary to combat fatigue andthus increase patient safety, especially duringlong surgeries. The provision of relief foranesthesiologists also allows the ORs tofunction continuously throughout the day andnot be interrupted.

Kathryn Ingram, a 10-year anesthesiaassistant, works in the “block room” at theHalifax Infirmary where she provides clinicalsupport to the anesthesiologists who areresponsible for the administration of regionalblocks* to patients just prior to surgery. In sodoing, she cares for patients directly andassists the anesthesiologists. Far beyond aset of helping hands, Kathryn says part ofwhat she values most about her work is theexpectation that she offer her clinical opinionsbased on her professional skills, experienceand critical thinking. Like all anesthesia assis-tants Kathryn, is a trained and experiencedrespiratory therapist, a prerequisite of be-coming an anesthesia assistant.

“After working as a respiratory therapist for 15 years, I wanted to increase my clinicalexpertise and fulfill my desire to work in the


OR setting so, I enrolled in an anesthesiaassistant training program and started withthe anesthesia department shortly there-after,” says Kathryn. She is one of 10 full-timeanesthesia assistants who work at the QEII.

*Regional anesthesia techniques, also knownas regional blocks, are used in select general,orthopaedic, thoracic, plastic, urology andvascular surgeries. Regional anesthesia ischaracterized by the loss of sensation to aspecific region of the body, caused byinjecting a local anesthetic around a peri-pheral nerve or the spinal cord.

Anesthesia technicians

Anesthesia technicians are the technicalexperts in the provision of anesthesia care in the OR. They have the highest level of knowledge and familiarity with the verysophisticated and critical anesthesia ma-chines and equipment used by anes-thesiologists.

“We are the trusted experts on the anesthesiamachines and equipment, which includes theinteraction between the machines and thepatients,” says Jacqueline Beck (previouspage), a 22-year anesthesia technician.“While the anesthesia machines and equip-ment are static, their use varies by surgeryand patient as does a patient’s reaction to

Anesthesia technicians train at

the QEII through a nine-month

theory and practical based

program administered by the

Department of Anesthesia, Pain

Management and Perioperative

Medicine. Candidates must have

Licensed Practical Nurse train-

ing and experience.

the machines. This necessitates intimatetechnical knowledge, the ability to react andproblem solve quickly, and a great relation-ship with the anesthesiologists and surgeryteam.”

Anesthesia technicians set up the ORs at theQEII Health Sciences Centre according to thetypes of surgeries on the schedule and whatteams will be in the ORs, a process that cantake between 30 minutes and two hours andincludes the inspection of all anesthesiamachines and equipment. They also assistanesthesiologists as they administer anes-thesia care in the OR, on-call within the ORsuite at the Halifax Infirmary and VictoriaGeneral to enter the ORs as needed.

“We are constantly thinking about patientsafety,” says Kim Betts (previous page), aneight-year anesthesia technician. “The betterwe do our jobs, the safer surgeries are. If weset up a room incorrectly, miss an equipmentor machine issue, or misread a monitor whenthe anesthesiologist is inserting lines wedecrease the efficiency of the OR at best andput patients in jeopardy at worst.”

Kim and Jacqueline are two of 19 full-timeanesthesia technicians who work at the QEII.


Patient Care by the Numbers • 2011- 2012

Service Delivery

In 2011-2012, anesthesiologists provided anes-thesia care for more than 49,000 procedures at the QEII Health Sciences Centre, the IWKHealth Centre, the Saint John RegionalHospital, the Dartmouth General Hospital andthe Hants Community Hospital.

Within the Anesthesia specialty, there exists anumber of subspecialties for which anesthe-siologists receive extended skills training toprovide the necessary anesthesia care.

Department of Anesthesia subspecialtyareas include:

• Anesthesia for liver, kidney and kidney pancreas transplantation

• Blood management• Cardiac anesthesia• Neuroanesthesia• Pain management

• Chronic• Acute, including regional block

• Pediatric anesthesia• Thoracic anesthesia• Women’s & Obstetric anesthesia

A great majority of the anesthesia care providedfor the more than 49,000 annual procedureswas performed at the QEII Health SciencesCentre and IWK Health Centre. The following isa breakdown of OR procedures by anesthesiasubspecialty area for the 2011-2012 fiscal year:

Anesthesia for liver, kidney and 154kidney-pancreas transplantation

*In addition to the surgical procedures re-presented above, tens of thousands of othersperformed during the 2011-2012 fiscal yearrequired general anesthesia support. Thoseinclude orthopaedic surgeries (6,492), ENT (ear,nose, throat) surgeries (1,712), ophthalmological(eye) surgeries (7,161),urological surgeries (6,653),and others.

Blood Management Services

Pain Management Services (Adult)

Outside of the OR, two of the Department of Anesthesia’s largest services are BloodManagement Services and Pain Manage-ment Services. Here is a breakdown of theirnumbers:

New patient consults at the QEII 260Health Sciences Centre

Patient visits 1,450

Acute inpatient consults at the QEII 467Health Sciences Centre (March-July, 2012)

Regional blocks performed at the HI 2,417 Site, QEII Health Sciences Centre

Chronic pain inpatient consults at the 73QEII Health Sciences Centre

Patients seen by the chronic pain team 6,874

New referrals to the chronic pain team 796

Cardiac anesthesia 2,118

Neuroanesthesia 1,076

Pediatric anesthesia 5,814

Thoracic anesthesia 824

Women’s & Obstetric anesthesia 3,905

General anesthesia* 34,535

Department of Anesthesia, Pain Management and Per ioperat ive Medicine Research Annual Report 2011-201230

Department of Anesthesia, Pain Management and Per ioperat ive Medicine Research Annual Report 2011-2012 31

The story of research in the Department ofAnesthesia, Pain Management, and Perio-perative Medicine could be titled “small butmighty.” A culture of research permeates thedepartment, resulting in a quantity and qualityof research work that is comparable with much larger departments. The number of peer-reviewed manuscripts produced by departmentmembers has grown in the last year as hasfunding, despite a decline in the availability ofCanadian research funds. Many departmentmembers sought multiple grants and awards fortheir projects in the public and private sectors.Consequently, 20 per cent of funding was gen-erated from the private sector, the most of anyyear to date.

Part of what helps grow and strengthen re-search in the Department of Anesthesia, PainManagement and Perioperative Medicine is itsmembers’ increasing collaborations with col-leagues across Canada and around the world.Drs. Mary Lynch and Orlando Hung, as part ofa multidisciplinary Dalhousie University team,are leading work to develop novel treatments forpain — an effort that includes colleagues fromaround the world, including the HebrewUniversity (Israel); Dr. Patty Livingston launchedan innovative study using low-fidelity simulationto teach anesthesiologists non-technical skillsin partnership with the National University of

A Culture of Research ExcellenceRwanda; and Dr. Christian Lehmann (at leftwith Juan Zhou, PhD, and Sara Whynot), hasmultiple projects underway in the area of sepsiswith colleagues at the University of Berlin. Heand departmental colleague, Dr. DietrichHenzler, have also trained 20 internationalstudents, most of who hail from Germany,continuing to cultivate relationships with up andcoming researchers abroad. Dr. Allen Finley(at left with Jill Chorney, PhD) is working withcolleagues across Canada and in Thailand and Brazil to improve the treatment andmanagement of children’s pain around the worldby establishing standards for care throughseveral international studies. In Canada, aCanadian Institutes of Health Research-fundedmulti-level, multi-site study was renewed in2011 enabling a research team, led by Dr.Bonnie Stevens (University of Toronto) and agroup of renowned children’s pain expertsincluding Dr. Finley, to continue its work toimprove the treatment and management ofchildren’s acute pain. This study puts into prac-tice significant advancements in children’s painresearch.

The value of collaboration begins within thedepartment and extends to colleagues in many departments and faculties at DalhousieUniversity. The Dalhousie Women’s Pain Group,(bottom left) established in 2011-2012 by

Dr. Ron George, is a multidisciplinary researchgroup dedicated to pain associated withchildbirth. Its preliminary work aims todetermine whether the pain of labour anddelivery has an impact on the severity,prevalence and response to women’s futurepain experience. Dr. John Clark, Dr. Mary Lynchand Jason McDougall, PhD are leading thecharge to establish the Dalhousie Institute forthe Study of Pain. The goal is to contribute to better prevention, diagnosis, treatment and management of pain by organizing re-searchers, clinicians, educators and othersacross disciplines via a formal institute. Theinstitute would encourage and facilitate moreinterdisciplinary research collaboration andincrease the quantity and quality of educationabout pain in the academic health sciencessector and among citizens. Jill Chorney,PhD, collaborates with a team of IWK research-ers and works with industrial engineers andaugmented reality companies to developevidence based approaches to reduce child-ren's pain and anxiety associated with medicalprocedures.


The collaborative culture is beginning to paydividends. The Nova Scotia Chronic PainCollaborative Care Network, which linksprimary health care providers to chronic painand addiction specialists to improve painmanagement through mentorship, receivedfunding in 2011–2012 from the Nova ScotiaDepartment of Health and Wellness and theprivate sector to foster knowledge translationresearch and program evaluation. The network,which is led by Dr. Peter MacDougall, alsoexpanded to double its membership andincludes international members.

The department received confirmation of spacefor the Perioperative Research Team (PORT)lab in 2011-2012. The lab will be home toDalhousie faculty from many basic science andclinical disciplines who will work together onstudies and to develop medical technologiesand devices to improve care of people duringsurgery. Dr. Orlando Hung (bottom left) pub-lished the second edition of Management of theDifficult and Failed Airway together with Dr. MikeMurphy (University of Alberta). The book isconsidered the definitive text on airway man-agement worldwide and features contributionsfrom more than 15 other department members.

When Jason McDougall, PhD (top left), joinedthe Departments of Anesthesia, Pain Manage-ment and Perioperative Medicine, and Pharmacology he cited the collegial spirit of

Dalhousie and its reputation for pain researchas the main reasons for his relocation. Dr.McDougall explores the mechanisms of jointinflammation and the resultant pain. In 2011-2012, he published 13 manuscripts on hisstudies in the area. He and his work may just bean osteoarthritis sufferer’s greatest hope forrelief from debilitating pain.

In addition to adding Dr. McDougall to theresearch team, the department also welcomedHeather Butler, PhD, as managing director,Office of Research, and appointed Dr. RonGeorge as associate medical director of research. Part of the role of the Office ofResearch is to support the cultivation ofclinician researchers within the department. Drs. Jennifer Szerb, Myron Kwapisz andPatty Livingston are budding researchers whohave up to the past year focused mainly onclinical care. They have studies underway toassess the frequency of intraneural injection, the potential of concentrated fibrinogen to be used initially to slow or stop post-operative bleeding, and the SAFE ObstetricAnesthesia Course and Anesthesia PracticeNetwork in Rwanda as a Model forKnowledge Translation, re-spectively.

Department of Anesthesia, Pain Management and Per ioperat ive Medicine Research Annual Report 2011-2012 33

DMF Medical Receives Award

DMF Medical Inc. was presented with anAtlantic Innovation Fund (AIF) research and development (R&D) award by the AtlanticCanada Opportunities Agency. The AIF isaimed at supporting and promoting innovationand research and development. This includesfunding for projects to enhance Nova Scotia’sreputation in sectors such as medical tech-nology and marine sciences.

DMF Medical is a spin-off company of Dr.Michael Schmidt's research group in theDepartment of Anesthesia, Pain Managementand Perioperative Medicine. DMF Medical hasset out to refine and optimize ZeroSorb, aninnovative CO2 removal device for anestheticcircuits, which uses mechanical technologyrather than traditional absorbent chemicalsthereby reducing harmful environmental chem-icals for both the OR team and patients.

Anesthesia Research Day 2012

Pictured clockwise from top left: Dr. Romesh Shukla with keynote speaker, Dr. MichaelCousins, Professor, Northern Clinical School, Kolling Institute of Medical Research, Universityof Sydney (Australia); Karim Mukhida, 1st place prize for resident research; Allana Munro, 2ndplace prize for resident research; Katherine Mifflin, 2nd place prize for student research.

Not pictured: Thomas Toguri, 1st place prize for student research

A Snapshot of Research Excellence


2009 2010 2011

Grant

Industry

Total

1,587,645 2,133,283 1,813,420

162,304 35,000 455,000

1,749,949 2,168,283 2,268,420

$ 2,500,000

2,000,000

1,500,000

1,000,000

500,000

0

Research Funding Publications

2009 2010 2011

Articles

Books

BookChapters

Abstracts

Other

Total

36 49 59

0 0 1

2 0 9

19 13 31

3 5 9

60 67 109

120

100

80

60

40

20

0

#

Presentations

2009 2010 2011

Local

National

International

Total

13 30 24

16 20 28

21 43 46

50 93 98

100

80

60

40

20

0

#


Collaborative Publications

Collaborative % Independent %

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%2009 2010 2011

PR

OP

OR

TIO

N (

%)

Collaborative Research Projects

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%2009 2010 2011

PR

OP

OR

TIO

N (

%)

Collaborative Publications & Projects

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%2009 2010 2011

PR

OP

OR

TIO

N (

%)


Financial Overview20 1 1 - 2 0 12

ADMIN – OPERAT ING 3 . 2%

ADMIN – SALAR IES 3 . 7%

CL IN ICAL PAYMENTS 8 2 . 3%

RESEARCH 6 . 3%

EDUCAT ION 3 . 4%

GLOBAL HEALTH 0 . 2%

ASPENS 0 . 2%

PA IN 0 . 7%

The Department of Anesthesia's

operational funding for 2011-

2012 totalled $30,191,635 for

the provision of clinical services

at Capital Health and the IWK

Health Centre, and medical

teaching as part of Dalhousie

University.


“Leaf Angels”(detail) © by Anne Camozzi, aNova Scotian artist and participant in Resilienceand Art in Chronic Pain: A Qualitative Study, ledby Dr. Mary Lynch, Professor and Director ofthe QEII Pain Management Unit. The studydelves into the experience of a group of artistswho suffer from chronic pain conditions yetexhibit resilience in a way that allows them tocontinue to create in the face of this pain."

Documents

Department of Anesthesia, Pain Management and ... · Department of Anesthesia, Pain Management and Perioperative Medicine Annual Report 2011-2012 9 phase of its mentorship program