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FEBRUARY 2014

Special Points of Interest

Women Scholars Initiative Career Development Program

Anesthesia Communication Committee

New Children’s Hospital Brochure

TEE Simulation Training

Winter Storm Warning

MESSAGE FROM THE CHAIRMAN: -SCOTT T. REEVES, MD, MBA

A United Department

Over the past eight months, the hospital has had a consultant group, Huron, on campus to look at the clinical operations of all service lines and clinical departments. One area of concentration was Anesthesia services including the department. Huron ultimately concluded that the low anesthesia reimbursement in South Carolina posed significant challenges, and continued growth of surgical services at MUSC would require continued anesthesia hospital support.

Huron recognized the strong financial and personnel leadership of the department when they made their final recommendations to Dr. Pat Cawley, CEO MUHA. A significant component of their recommendation was the integration of the CRNAs and anesthesia techs into the department. On Tuesday morning, January 7th, Pat Cawley presented the plan to the CRNAs and the anesthesia techs. After considerable thought, Dr. Carlee Clark was chosen to lead this effort as Associate Chief Medical Officer of Anesthesia Services. Carlee will report up through the MUHA CMO as well as to me.

Immediately after the announcement, Carlee started working with the CRNA leaders at all three locations (Wendy Ewing, Jodi Weber, and Robin Buchanan) to review the staffing assumptions made by Huron. The initial Huron staffing grid was based on the July 2013 surgical block schedule. This comprehensive review will take several weeks but will allow the department to determine staffing numbers needed for the faculty, residents and CRNAs. Once confirmed, it will allow the department and institution the ability to make strategic decisions regarding anesthesia services. For example, if we hire 4 new orthopedic surgeons and increase the orthopedic surgical block, how many and of what mix of anesthesia providers will be needed for the expansion. This will be a powerful tool.

Following validation of the Huron grid, attention will turn to creating a single department program for CRNA, resident and faculty scheduling. Carlee and I know this is a major concern to many in the department. Significant input will be obtained from the CRNAs (Jodi Weber, Wendy Ewing, Robin Buchanan, Tina Willet, Jane Swing), residents (chief residents, GJ Guldan, Ryan Gunselman) and faculty (Cal Alpert, David Chandler) who currently individually create a schedule for each group. What program will be utilized to do the work (Spin Fusion, Ansos, Kronos or something entirely new)? The important thing is to select a scheduling tool that meets the needs of all of us. This will be a gradual process to allow for testing and the ability to anticipate unintended consequences. I hope to have a process complete by the summer. Ultimately it will be a vast improvement to our current silo systems and will allow greater flexibility with vacation and other time off requests.

Further integration of the anesthesia techs into the department is critical to improving OR efficiency and patient care goals. One of the first agenda items will be to critically review the new certification process and to align education and other incentives to reach these new milestones.

- Women Scholars Initia-tive Career Development Program

2

-Anesthesia Communication Committee

3-4

-New Children’s Hospital Brochure

5

-TEE Simulation Training 6

-Meet the Pre-Op Clinic Personnel

6

-Winter Storm Warning 7-10

-Safety Star Award 11

-National Nurse Anesthetists Week

12

-Regina’s Farewell Lunch 13

-Grand Rounds 14

-Hung The Moon 15

VOLUME 8, ISSUE 2

Inside this issue:

DEPARTMENT OF ANESTHESIA AND PERIOPERATIVE MEDICINE

SLEEPY TIMES

Despite the challenges that lie ahead, I am excited about the opportunities we will have to truly become more dependent upon each other for our success. As the old saying goes there is no “I” in team. By using all our collective strengths, our anesthesia care team will be significantly stronger and our daily work lives and those of our patients will be improved.

Associate Chief Medical Officer of Anesthesia Services: Carlee Clark, MD

I am honored and excited to be taking on this new role in the hospital and department. I hope to work with Drs. Guldan and Gunselman to improve staff allocation among all three sites, hoping to also make access for vacation more fluid and transparent. The new communication committee has been greatly successful, and I plan to continue the momentum towards improving communication and working relationships in the department. I look forward to the opportunity to work with the CRNAs and hope to better represent their interests to the hospital, improve their access to educational activities and showcase them as a vital part of our MUSC Anesthesia team.

Congratulations to Drs. Ilka Theruvath and Sylvia Wilson for being chosen to attend the Women Scholars Initiative Career Development Program being held March 10-11, 2014. The program will be focusing an entire afternoon on promotion and tenure. The first part of the promotion/tenure session will focus on writing/preparing a personal statement and CV followed by college-specific breakout sessions. The College of Medicine attendees will also be broken into specific career tracks (e.g. Academic Clinician, Academic Investigator, Non-tenure track Clinical Faculty, etc.). The career track-specific sessions will be lead by past or present members of the COM APT committee with experience in each specific career track and will provide small group discussions and/or one-on-one feedback/evaluation of your CV and personal statement with respect to your college's criteria for promotion/tenure.

This is a nice opportunity for some of our faculty to learn first hand of the promotion and tenure process. The information learned will be an asset to the remainder of the junior faculty.

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A UNITED DEPARTMENT CONTINUED...

Women Scholars Initiative Career Development Program

Dr. Ilka Theruvath Dr. Sylvia Wilson

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The Department Communications Counsel was established by Dr. Reeves and Wendy Ewing to facilitate better communication among the various groups within the department (faculty, residents and CRNA’s MUH) so that we can all work as a seamless workforce to take care of our patients in a safe and amicable environment. Each group is represented by 3-4 personnel chosen by their peers. We had our first meeting in early December and have met on a regular basis since then. The 3 groups were polled for any concerns they may have and then the counsel works at trying to find a solution to the problem. We are extremely pleased that we have made great strides in positively addressing most if not all of the issues which have been discussed.

Quality:

Problem: Timely completion of preop assessment prior to rolling back to the OR. Solution: Following email reminders there has been a definite improvement from 35% to 60%

completion. There is still room for improvement.

Problem: Breaks for breakfast/lunch not being given because of manpower issues.

Solution: a) CRNA coordinator to send out a page in the morning if they are short-staffed. b) TTP resident to help with breaks in both their rooms. If covering two rooms, please request one of your attendings to take over a room for supervision while you break the rooms. c) ECT resident to help with lunch breaks post ECT. d) Regional resident to help if there are no clinical commitments. e) Faculty with one room to break the room they are covering. f) Faculty covering two rooms use your judgment and provide breaks if needed with assistance from the DOD.

Problem: Resident and CRNA relief at the end of the day. Solution: a) Resident relief is determined by the DOD, based on lecture schedule.

b) Residents were polled and the call resident will be the last to be relieved. c) On call senior to meet with CRNA coordinator early evening and decide on the 7pm CRNA relief and staffing.

d) The ‘late CRNA’ will stay late if there are staffing needs or if preops for the next day need to be done.

Problem: What is the process for QA reporting for the department.

Solution: Preferred method is the bubble sheet (second choice is PSN). Will be reviewed by Dr. Harvey. Dr. Alpert is our faculty who leads the peer review group.

Personnel:

Problem: Lack of frequent communication between chief CRNA and chief residents which resulted in poor communication of key issues i.e. holiday breaks, etc.

Solution: Monthly/quarterly meeting between the two groups.

Problem: CRNA’s and residents having poor/negative images of each other because of lack of understanding of individual roles (resident poll by Dr. Covert).

Anesthesia Communication Committee; Latha Hebbar, MD and Heather Highland, CRNA

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Solution: a) Sutton sent out an email defining role of TTP and senior on call resident.

b) Implementation of a monthly Anesthesia Social Hour, Kim Kirby is the coordinator for this event. The first “Happy Hour” is on January 31st 7 pm at ‘Leaf” 15 Beaufaine Street.

c) Any change of resident ‘role’ in the perioperative setting which will impact the CRNA’s will be communicated thoroughly and in a timely manner.

Problem: Role of Peds CRNA on call.

Solution: It will be the decision of the in-house attending and peds anesthesia attending to determine and allocate ‘the most experienced’ person to help with the peds case. This may be the CRNA from the Peds Core group or the senior resident.

Problem: Coverage for staffing sick/post tx off rooms (CRNA vs Residents).

Solution: Needs to be a seamless group and best person available to cover, whether it is a CRNA or resident. CRNA coordinator communicates with TTP or chief resident.

Service:

Problem: Lack of help for anesthesia personnel in transferring STICU patients to the OR Solution: Hebbar communicated with Harvey and ICU Nurse manager. STICU RN’s will accompany

the patients to the OR.

Problem: Resident orientation for NORA sites. Solution: Dr Gunselman, Wendy and Laurie working on orientation packet. Have Laurie do an

orientation for Residents. Avoid peds travel cases for Residents. Department Communications Counsel CRNA’s Residents Faculty Kim Kirby Brian Covert Ilka Theruvath Heather Highland Brandon Sutton Tom Epperson Mike Sloan Ashley LeFevre Ryan Gunselman Sam Tripp Kam Wong Latha Hebbar Brystol Henderson Parker Gaddy

Anesthesia Communication Committee; Latha Hebbar, MD and Heather Highland, CRNA

Latha Hebbar, MD Heather Highland, CRNA

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Click Here for Full Article

New Children’s Hospital Brochure

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The clinical impact of perioperative echocardiography is well documented in the literature. Despite the known utility, many barriers exist to mastering, performing, and interpreting transesophageal echocardiography examinations. In an effort to overcome some of these obstacles, the department purchased a Vimedix TEE simulator (CAE Healthcare Montreal Canada) last year with the intent of teaching echocardiography through simulation. This simulator offers real time echo simulation and has the capability to simulate over 50 pathologies.

To learn how others have incorporated simulation into echocardiography education, Scott Reeves and I traveled to Beth Israel Deaconess hospital in Boston, MA to learn from the group there how they teach echocardiography with simulation. Going forward, we have agreed to collaborate with the hopes of performing research relating to TEE simulation.

Since that visit, a TEE Simulator Course has been organized, and a small group of five residents, fellows and faculty are partipating in the first course. The course is geared for echo naïve individuals and has the goal of teaching basic echocardiography skills over the course of 8 sessions. Each session is taught in the simulation center on Tuesday’s starting at 4 PM and consists of didactic lectures followed by hands on experience with the simulator. If you are interested in participating in a future course, please contact me at finleya@musc.edu.

TEE Simulation Training By: Dr. Alan Finley

Meet the Pre-Op Clinic Personnel

Front Row: Joyce Hatley, RN; Kelly Simpson, RN; Sharon Turner, Nurse Manager; Melody Fiddler, RN;

Tabitha Nolen, Charge Nurse

Back Row: Annie Williams, CA; Pamela Diamond, NP; Diane Miller, RN; Carla Harvey, RN; Soundra Lewis, Secretary; Valerie Bailey, Secretary; Audrey Wilder, RN and Annie Frasier, CA; Catherine West, RN

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January 27-30, 2014 was a unique experience for the department and the hospital. We had done our due diligence to develop an emergency disaster plan for hurricanes but had not really thought about what to do if we were shut down due to snow and ice. Using our hurricane plan as a template, a strategy was implemented. Over the next several weeks, the department will have conversations on what we did well and what we could improve upon. More on that in the weeks ahead. I thought you might enjoy reading the chain of informational emails that I sent. Also I want to thank Mike Sloan, CRNA for the pictures of the frozen Ravenel bridge that created the mess.

Monday, January 27, 2014 at 1:43 pm

Dear Department,

Many of you are asking about our weather plans for Tuesday and Wednesday. The University and Hospital leadership will be meeting today at 3 pm to develop a plan. Representatives from the department will be present to provide input. At this time the public schools remain open for Tuesday.

It appears that we will start receiving a possible winter mix of sleet and snow late tomorrow and into Wednesday. For those of you that have not been in Charleston during a winter travel advisory, the issue is that the bridges will be closed when the roads start to freeze. This will paralyze our ability to come onto the peninsula especially from Mt Pleasant. As such I will be initiating our disaster plan. I will be notifying the faculty, and GJ will be notifying the residents in a separate email about what to expect. However, the bottom line is if you are on call please make preparations to come to work tomorrow until you can be relieved on Wednesday which may be late afternoon. Our CRNAs scheduled overnight should also be prepared to stay late on Wednesday.

After the leadership team meets this afternoon, more data maybe available and will be emailed out to you.

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WINTER STORM WARNING

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Monday, January 27, 2014 at 4:00 pm

Dear Department,

A summary of the MUHA and University leadership meeting which occurred at 3 pm is as follows.

1. Tuesday will be business as usual in the morning. So everyone please come to grand rounds and prepare to start a typical day.

2. At 7:30 am another meeting of senior leadership will evaluate the weather and our ability to continue operations after lunch and into Wednesday. David Cole and I will be there and I will report shortly thereafter.

This will be a fluid process with decisions being made in approximately 12 hour increments. If you are part of the disaster plan for the department please continue to come prepared to stay through Wednesday. If you are on call on Wednesday more information will be forthcoming regarding Wednesday plans by late Tuesday. Please note that these plans are independent of what happens at the University and with the local school systems that will likely be more conservative.

Thank you all in advance for your patience as we work through this unique winter storm.

Tuesday, January 28, 2014 at 12:13 PM

Dear Department,

I wanted to update you all on where we stand currently.

Non designated non clinical employees will be able to leave today at noon. This includes our administrative staff.

The afternoon clinics at RT have been closed including our chronic pain clinic.

I have been working this morning with Drs. Harvey, Clark and Epperson to reduce staffing as appropriate at the three hospitals by late afternoon. We are making progress especially at RT and ART. Fortunately the weather is cooperating without any significant precipitation planned until 3-4 pm.

Today at 2 pm the hospital leadership will be making a decision on whether we will be open on Wednesday.

Just in case we are closed. The department has activated our disaster response teams. We will have two faculty, 4 residents and 3 CRNAs staying overnight at UH. At ART we have a 2 faculty, resident, fellow and ICU team available. These individuals understand that relief may not be forthcoming until late Wednesday or Thursday morning.

I truly appreciate the professionalism that the department has shown as we attempt to take care of our patients and each other. As soon as more information becomes available you will be notified via email.

Tuesday, January 28, 2014 at 3:34 pm

Dear Department,

The decision has been made to be close all the operating rooms and clinics tomorrow (Wednesday). We will be doing emergencies only hence the disaster team process will remain in place. It is my hope that tomorrow's call team and CRNAs will be able to eventually arrive to relieve our Tuesday call group. Drs Epperson and Rovner will be leading UH and Abernathy ART on Wednesday. If you are on call tomorrow, please check the weather and news in the am. When the bridges are open on the route you will take to arrive at the hospital please come in. The on call attending tonight (Dr McSwain) will prioritize the order of call relief for the residents and CRNAs on tonight. Please do not leave without checking with Julie and having her assure we have relief. Once Drs. Epperson or Rovner arrive he/she will assume responsibility for the process.

I hope this clarifies expectations tonight and tomorrow. The decision about Thursday will be made Wednesday morning.

WINTER STORM WARNING CONTINUED...

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Tuesday, January 28, 2014 at 5:29 pm

Dear Department,

I am happy to report that we have now relieved all non call departmental members. This is an amazing achievement across RT, ART and UH with it being only 5:30 pm. Fortunately the local roads and bridges are still passable. I want to thank all of you for working together to get a busy schedule completed for our patients.

Please keep our call teams in your prayers.

I will be emailing everyone tomorrow to update you on Thursday.

Wednesday, January 29, 2014 at 11:23 am

Dear Department,

It has been a long morning so for. Since all the residents live either West Ashley or Downtown they were successful in rotating on and off this morning. The Tuesday faculty and CRNAs are currently still working. It is our hope that as the weather warms in the next few hours that a way into Mt Pleasant will occur allowing the remaining team members the ability to switch.

Tomorrow will also be a challenge. The university will be making an announcement soon that we will be opening for patient care and classes at noon. This is to allow for safe travels of our staff and patients. What does that mean for us all?

1. We will remain on emergency only until around noon tomorrow 2. The call team will need to stay until relief can get in. I will be calling faculty, residents and CRNAs in the next

several hours to arrange for morning relief. (Would appreciate volunteers if you think you can walk or drive in, email me)

3. All clinical team members (Faculty, residents, CRNAs, anesthesia techs) need to be in by 11 am or earlier so we can start an OR schedule at noon.

4. We have a hospital full of OR cases pending and many scheduled cases. As such the plan is to run the ORs and clinics late to accommodate as many patients as possible. Please come prepared to stay later than usual regardless of whether you are on call.

Friday will also be busy as we attempt to reschedule patients into open time slots

It has been a big challenge for the department and university. Those that have worked have done an amazing job. Thank you…

Will email if additional information becomes available.

Wednesday, January 29, 2014 at 4:12 pm

Dear Department,

I believe we now have a definitive plan for tomorrow. I want to personally thank Jake and Julie for a job well done. The Don Holt bridge is scheduled to open in an hour, and they will finally be heading home. We have been successful in relieving the Tuesday resident and CRNA teams earlier in the day. Grayce Davis has taken over the helm.

WINTER STORM WARNING CONTINUED...

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Tomorrow we will be bringing staff in two shifts. A few individuals have volunteered to come in at our regular time to cover ART and UH emergencies. The institution has made the decision to run a full schedule at each location starting at noon. This has several consequences for us all. First, we will need to arrive by 10:30-11 am to prepare our rooms so that all patients can enter the room at noon. With a full schedule, many rooms will be running very late (10 pm). Please make plans now to be able to stay even if you are not on call. This includes us all (Faculty, residents, CRNAs, anesthesia techs)

This was done for a multitude of reasons.

1. Many patients have been stuck in the hospital for several days awaiting surgery. We need to get them done. 2. Many staff have lost a day or more of work and need not to loose any more hours that a short day would entail.

The surgical schedule is full going forward, and it will be difficult to accommodate the patents we did not do on Tuesday and Wednesday already.

For nonclinical staff, please report by noon also.

Please be extra careful in the morning. Watch the local news to evaluate the road conditions.

It will be a long day but together we will get through it.

Thursday, January 30, 2014 at 7:44 am

Dear Department,

Just a quick update.

The roads downtown are still icy but passable. The Ravenel Bridge out of Mt Pleasant is still shut down. All the entrance lanes to get on it are also iced over. I doubt it will be open any time soon.

I took the Dolt Holt bridge on 526 around this morning. It is also icy, especially on the entrances going up and down the bridge. This will probably be the only way to get to MUSC from Mt. Pleasant. Please allow an hour drive time and be careful.

Grayce and I will be attending a briefing at 8 am and will email more information if available.

Thursday, January 30, 2014 at 3:43 pm

Dear Department,

I am happy to report that the Ravenel bridge is open to traffic. We are also making good progress on clearing the case log today at all three locations. I am hopeful that by tomorrow morning we will be back to business as usual.

The last few days all of you have shown a special degree of commitment and professionalism.

It is an honor to be your chairman

WINTER STORM WARNING CONTINUED...

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SAFETY STAR AWARD: RACHEL LYNN, CRNA

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National Nurse Anesthetists Week; January 19-25, 2014

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Regina’s Farewell Lunch

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GRAND ROUNDS FOR THE MONTH OF DECEMBER

“Epic: A Day in the Life of a Peri-Operative Patient” February 4, 2014 Susan Harvey, MD, Associate Professor and Medical Director and Karen Weaver, RN, Director of Surgical Services Medical University of South Carolina

“Anesthesia Medically Challenging Case Conference” February 18, 2014 George Guldan, MD and Ryan Gunselman Medical University of South Carolina Assistant Professors Residency Program Director and Associate Residency Program Director

“Mastocytosis and Anesthetic Complications” February 11, 2014 Wendy Suhre, MD Medical University of South Carolina Clinical Instructor

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DEPARTMENT OF ANESTHESIA AND PERIOPERATIVE

MEDICINE

Medical University of South Carolina

167 Ashley Avenue

Email: kinmic@musc.edu Phone: 843-792-7503

Fax: 843-792-9314

C HECK OUT OUR WEBSITE AT: HTTP:// WWW. MUSC.EDU/ANESTHESIA

Future Events/Lectures

Intern 6/Feb—Bleeding and Transfusion, Dr. Roberts 20/Feb—Endocrinology, Dr. Tobin CA-1 5/Feb—Anesthetic Complications, Dr. Freely 12/Feb—Postanesthesia Care, Dr. Roberts 26/Feb—Geriatric Anesthesia, Dr. Skorke CA-2/3s 3/Feb—What’s New in OB Anesthesia, Dr. Hebbar 4/Feb—Epic: A Day in the Life of a Peri-Operative Patient, Dr. Harvey and Karen Weaver, RN 10/Feb—Nutritional Diseases and Inborn Errors of Metabolism (Stoelting Ch. 15-16), Dr. Hassid 11/Feb—Mastocytosis and Anesthetic Implications, Dr. Suhre 17/Feb—President’s Day, No Lecture 18/Feb—Anesthesia Medically Challenging Case Conference, Dr. Nobles 24/Feb—Skin and Musculoskeletal Disease (Stoelting Ch. 18),

I HUNG THE MOON Don’t forget to nominate your co-workers for going ‘Beyond the Call of Duty’. I Hung The Moon slips are

available at the 3rd floor front desk, and may be turned in to Kim Crisp. Thanks so much!!

Ilka Theruvath, MD: Going above and beyond without hesitation to help a friend and colleague.

Parker Gaddy, MD; Greg Ivy, CRNA; and Christine Coe, CRNA: Thanks for being a great help and being a team player during the winter storm.

Beth Jennings, CRNA: Staying past shift to help with a trauma.

Resident and Fellow Graduation: June 20, 2014

Location: Mills House Hotel at 6:00pm

Christmas Party: Friday, December 12, 2014 at 7:00pm, at the Carolina Yacht Club

We Would Love to Hear From You!

If you have ideas or would like to contribute to Sleepy Times, the deadline for the March edition will be

February24, 2014.

SLEEPY TIMES