Anesthesiology, Critical Care & Pain Management
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During the COVID-19 crisis, the Department of Anesthesiology, Critical Care & Pain Management was integral in every phase of the transformation to providing intensive care to critically ill patients. This involved directing the establishment of negative pressure for each operating room, telemetry, central station monitoring, video communication, PPE protocols, pharmacy kits, storage spaces, and retrofitted anesthesia machines to function as ventilators.
We established workflow for transfers from Weill Cornell Medicine as well as COVID-specific order sets for admission, vasoactive medications, acquired pulmonary vasodilators, rounding sheets, rounding workflow, and team coordination. We created COVID ICU-specific dashboards with continuously updated clinical data that was accessible 24/7 at a glance in the unit.
We also created a rounding team that would assess COVID patients on the floor, which included a dashboard that alerted our anesthesia teams about patients with a worsening pulmonary status. This allowed us to intervene early and, in some cases, prevent the need for more invasive therapies.
Our intensivists led multidisciplinary rounds on the COVID unit on a daily basis. Our team consisted of anesthesia intensivists, anesthesiology attendings, anesthesiology fellows, CRNAs, anesthesia PA/NPs, nurses, and interns, residents, fellows and attending orthopaedists. We established round-the-clock in house coverage, with ICU and anesthesia attendings at the bedside performing all high-risk procedures, including intubations, bronchoscopy, vascular access and point of care ultrasound. Our team managed all aspects of these critically ill patients’ care, including sedative management, ventilator management, extubation, vasopressor titration, fluid/electrolyte management, enteral feeding and end of life care. We coordinated care with consultants from HSS and NYP, including infectious disease, pulmonology, endocrinology and cardiology on a continuous basis.
Our pain management practitioners provided palliative care services and communicated directly with patients’ families, along with our novel family medical contact program, which allowed families to converse daily (sometimes more often) with members of our department, who served as their principal source of information.
In late 2019, HSS received a $3 million grant from the Starr Foundation to establish the C.V. Starr Endowed Chair in Pain Management. Seth A. Waldman, MD, Director of the Pain Management Division in the Department of Anesthesiology, Critical Care & Pain Management, will be the inaugural holder of the chair. This grant will enhance existing pain management studies and fund new studies, with the goal of expediting the translation of research findings into practice, improving safe prescribing practices, and exploring alternatives to opioids. The grant will also fund a full-time PhD researcher, Alexandra Sideris, who will coordinate these studies across HSS.
This grant will enhance existing pain management studies and fund new studies, with the goal of expediting the translation of research findings into practice.
Preoperative Pain Optimization, an addition to Perioperative Pain Services at HSS, has demonstrated success in optimizing pain control before surgery for patients who have pain management requirements outside of the normal standard of care. The service screens for those who may have difficulties with pain management, including patients who have high-dosage opioid use or opioid-tolerance, substance abuse, implanted devices such as intrathecal pumps, or who historically have difficulties with pain. Clinicians then work with these patients to taper down from high levels of opioids before surgery, and to create a tailored pain management approach intraoperatively and postoperatively. Preliminary data shows that this program may significantly decrease length of stay for patients who meet screening requirements and use the service versus those who meet requirements but do not use the service.
Launched in September 2019 by the Department’s quality assurance team, Q-Reviews sends patients a text message after surgery to assess their anesthesia experience. This survey contains a 5-star scale with a section for comments, and has had an average response rate of over 30%. This initiative enables the Department to address any negative comments in real time, and has also provided insights about patient opioid education, preoperative discussion points that are important to patients and more.
Swetha Pakala, MD, was named the 2020 recipient of the Andrew Swanson, MD, Alumni Spine Award. Dr. Pakala founded the Global Health Initiative in 2012 to provide sustainable education to anesthesia providers in resource-limited settings around the world. The award was developed in 2009 to honor the memory of an HSS alumnus from the resident class of 2005 known for his commitment to compassionate medical care and humanitarian work.
The Emerging Academician Award financially supports an additional day each week out of the operating room for the recipient to carry out academic initiatives. Since its inception, the EAA (previously known as the Young Investigator Award) has provided these resources for five attending anesthesiologists. Their research includes database research/Epic retrospective chart reviews, enhanced recovery pathways, opioid-sparing interventions, precision medicine-related study, and how structured caregiver involvement may affect functional outcomes after complex procedures. Since expanding and rebranding the award, three highly motivated junior attending anesthesiologists have received departmental support to pursue novel and high-impact initiatives. They will be conducting research on alternative and complementary therapies that may improve functional outcomes and reduce opioid use after orthopaedic procedures, global health initiatives and simulation and Acute Crisis Resource Management. Based on rigorous reviews of their applications and their continued dedication to their projects, we are confident that their efforts will change the way we teach and practice regional anesthesia at the national and international levels.
To advance collaborative opioid research, we are collaborating with the Department of Physiatry to create a joint registry of patients who have been treated for pain by either department. The creation of this registry will enable us to more easily conduct research on this group of patients to better identify treatment pathways, operational improvements, and improve the overall efficiency and efficacy of pain treatment at HSS.
Several of our anesthesiologists have designated days out of the operating room that they dedicate to academic activities, such as research, editorial board activities, professional society committee work, and more. This work contributes substantially to the academic mission of the department. A workgroup is currently being devised to create a mid-senior level clinician scientist program that would support and incentivize academic days for senior clinician scientists.