Anesthesiology

 &  Periopera2ve  Care  

State  of  the  Department  
June  22,  2015  
 Road  Map  from  2008  to  Present  
Core  Values  
Clinical  Care  
Educa6on  
Research   Strategic  
Fiscal  Responsibility   Plan  
Posi6ve  Culture  

Department  Mission:    To  provide  a  con6nuum  of  excep6onal  

clinical  care  throughout  the  periopera6ve  period,  train  the  
next  genera6on  of  anesthesiologists  in  a  dynamic  
environment,  and  conduct  research  programs  dedicated  to  
both  basic  and  transla6onal  projects.    
2   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  
Annual  Retreats    
Cri6cal  component  of  success…  
  2008:    Strategic  Planning  for  Next  3-­‐5  years  
2009:    Rules  of  Engagement  for  Department  
2010:    Team  building  and  Communica6on    
2011:    Strategic  Planning  for  Next  3-­‐5  years  
2012:    Faculty  Teaching  Skills  Workshop  
2013:    Periopera6ve  Surgical  Home  
2014:    Quality  and  Safety  in  the  Department  

3  
 Department   Organiza2on  
Department of Anesthesiology & Perioperative Care Organization

Chair
Chief of Anesthesia

Vice Chair Vice Chair for

Vice Chair Vice Chair CAO, Associate Vice Chair Director of
Quality and Pain
Education Research Chair Clinical Affairs Sedation
Patient Safety Management

Residency Director Director

Operations Director Clinical Regional Inpatient Pain
Program Basic Science Admin Office Chief CRNA Perioperative Section Directors Section Directors Performance AIMS / IT Chronic Pain Pediatric Pain
Officers Affairs Anesthesia Service
Director Medicine Improvement

Associate
Clinical, QA/PI Gottschalk Plaza Gottschalk Plaza OR Regional Inpatient Pain
Program Billing CRNAs PSH Program Liaison Corp Section Directors Clinical Faculty Pediatrics
Translational Coordinator Clinic Clinic Team team
Directors

Fellowship PSH Pain

Inpatient PSH Orange
Program Finance CPC Development & Critical Care OB Cardiac PSH Coordinator Psychologist Pain NP
Service Procedure Clinic
Directors Implementation Plaza Clinic

Medical Student
Clinical PSH Metrics
Program PSH NP PACU/ Consult Neuro Tustin Pain Clinic CHOC Clinic
Scheduling/IT Team
Director

Simulation
Remote Cancer Center
Program OSS
Locations Clinic
Director

GHEI/Beckman

4  
1 Department   of  Anesthesiology
Department of Anesthesiology  
&&  Periopera2ve  
Perioperative Care| Care|  
MayJune   22,  2015  
21, 2015
Anesthesiology  Faculty  

16  

14  

12  
Number  of  Faculty  

10  

8  

6  

4  

2  

0  
HS  Clinical   HS  Clinical   HS  Clinical   Professor  Clinical   Assistant   Associate   Professor   Physician  
Assistant   Associate   Professor   X   Professor   Professor   Diplomate  
Professor   Professor  

5   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

 Faculty  Reten2on  Rates  
Faculty  Reten2on  
100  
90  
80  
Percentage  of  Faculty  

70  
60  
50  
40  
30  
20  
10  
0  
2008-­‐9   2009-­‐10   2010-­‐11   2011-­‐12   2012-­‐13   2013-­‐14   2014-­‐15  

Faculty  Recruitment  
10  
9  
8  
Number  of  Faculty  

7  
6  
5  
4  
3  
2  
1  
0  
6   2008-­‐9   2009-­‐10   2010-­‐11   2011-­‐12   2012-­‐13   2013-­‐14   2014-­‐15  
Department  Service  –  UC  Irvine  
Anesthesia  Faculty  serve  on  over  45  different  UCIMC,  SOM,  
and  Main  Campus  Commi\ees,  Including    
v School  of  Medicine  Merits  and   v QSOC    
Promo6ons  Commi\ee     v School  of  Medicine  Medical  
v UCI  Research  Council     Student  Admissions  Commi\ee  
v UPS  ICD-­‐10  Task  Force     v IRB  A    
v LGBT  Medical  Student  Support   v Academic  Senate  Rules,  
Group     Jurisdic6on,  and  Organiza6on  
Commi\ee  
v Creden6aling  commi\ee    
v Program  in  Ethics,  Medical  
v UCIMC  Clinical  Ethics  Commi\ee      
Humani6es,  and  Spiritual  Care  
v OR  Block  Commi\ee    
v UCIMC  Facili6es  Planning  
v Planning,  Budget  and  Facili6es   Commi\ee  
Commi\ee    
7   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

   
Department  Service  -­‐  Na2onal  
Name   Na2onal  Service  
Kyle  Ahn   American  Board  of  Anesthesiology  Wri\en  Board  Exam  Writer  
Maxime  Cannesson   Sec6on  Editor,  Anesthesia  Analgesia  
Maxime  Cannesson   Associate  Editor,  Journal  of  Clinical  Monitoring  and  Compu7ng  
Maxime  Cannesson   Associate  Editor,  Journal  of  Cardiothoracic  and  Vascular  Anesthesia  
Sco\  Engwall   Associa6on  of  Anesthesia  Clinical  Directors  (AACD),  Board  of  Directors  and  Treasurer  
Zeev  Kain   American  Society  of  Anesthesiology  (ASA)  Board  of  Directors  
Zeev  Kain   Founda6on  for  Anesthesia  Educa6on  (FAER)  and  Research  Board  of  Directors  
Zeev  Kain   Society  for  Academic  Anesthesiology  Associa6ons  (SAAA)  Board  of  Directors  
Editorial  Boards:  Journal  of  Clinical  Anesthesia,  Journal  of  Evidence  Based  
Zeev  Kain  
Complimentary  and  Alterna7ve  Medicine  
Richard  Kelly   American  Society  of  Anesthesiology  (ASA)  Commi\ee  on  Ethics  
Roger  Mecca   American  Board  of  Anesthesiology  Examiner  
Roger  Mecca   Anesthesia  Pa6ent  Safety  Founda6on    Board  of  Directors  
Deborah  Morrison   American  Society  of  Anesthesiology  (ASA)  Commi\ee  on  Pediatric  Anesthesia  
Cameron  Ricks   American  Society  of  Anesthesiology,  Alternate  Delegate  
Joseph  Rinehart   American  Board  of  Anesthesiology  Examiner  

8   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

 Discover  

9   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

 Discover  Dashboard  
$4,500,000  
Exis2ng  Grant  Dollars   30  
Number  of  Grants  
$4,000,000   Industry   Industry  
25   Other  
$3,500,000   Other  
$3,000,000   NIH   20   NIH  
$2,500,000  
15  
$2,000,000  
$1,500,000   10  
$1,000,000  
5  
$500,000  
$0   0  

70  
Number  of  Publica2ons   NIH  Ranking    
49  
45  
60  
41  
50   37  
33  
40  
29  
30   25  
21  
20   17  
10   13  
9  
0   5  
2006   2007   2008   2009   2010   2011   2012   2013   2014   2015   1  
(to  
2006   2007   2008   2009   2010   2011   2012   2013   2014  
date)  
Research  Programs  

Transla6onal  
Neuroscience,   Center  for  Stress  and  Health   Periopera6ve  Hemodynamics  
Molecular  Biology  of  Pain    

Simula6on     Educa6on  

11   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Transla2onal  and  Neuroscience  Programs  
Alkire  Lab     Cahill  Lab   Ostlund  Lab   Luo  Lab  

Mechanisms  by   Mechanisms   Neurochemical   Chronic  pain  

which  anesthe6cs   underlying  the   bases  of  behavior   changing  gene  
suppress  memory,   genesis  and   with    focus  on   expression  in  
consciousness  and   chronicity  of   Addici6on     sensory  pathways  
pain  processing   neuropathic  pain   leading  to  pain  
percep6on  changes    

Funding  Accomplishments:     Publica2ons:  

 Na6onal  Ins6tutes  of  Health  (R01,  R21,  R18,  K12)    Journal  of  Neuroscience  
 California  Ins6tute  for  Regenera6ve  Medicine    Nature  Neuroscience  
 Department  of  Defense    Cell  
 Reeve  Founda6on    Pain  
 Pfizer    Experimental  Neurology  
Edwards  Scien6fic  
12  
 Center  on  Stress  and  Health  

Innova2ve  
Technology:  
Mobile  Tablet/
WebTips  
Salivary  
NICU:    CHOC/   Biomarkers:  
UCIMC  
ICTS  &  CTSA  

Onocology:    
CHOC/Miller’s  
Children’s  

Periopera6ve  :   Healthcare  
CHOC/  St   Dispari2es:  
Joseph/UCIMC   Community  

Funding  Accomplishments:    
 Na6onal  Ins6tutes  of  Health  (R01,  R21,  K12)  
 American  Cancer  Society  5  year  Career  Development  Award  
13   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  
Periopera2ve  Hemodynamic  Program  

Reliable  Indices  
Less  Invasive  
Closed  Loop  
Outcome  Oriented  
Quality  
Improvement  

 Goal  Directed  Therapy  

Funding  Accomplishments:    
UCOP  CHQI  grants  
Masimo  Corpora6on  
Edwards  Scien6fic  
14  
 Simula2on  Research  

$1.1  Million  AHRQ  Seda6on  Simula6on  Grant  

v  Researching  the  curricular  success  of  a  simula6on  based  seda6on  training  
v  Assessing  and  training  non-­‐anesthesiologist  nurses  and  physicians  in  moderate/deep  
seda6on  troubleshoo6ng  
v  Current  focus  on  IR  and  GI  
15   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  
 Teach  

16   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

 Educa2on  Dashboard  
Residency  Program   Resident  Medical  Schools  
12   14  
2008-­‐2009  
10   12  
2014-­‐2015  
8   10  
6   8   Top  25  

4   25-­‐50  
6  
2   Below  50  
4  
0  
Accredita6on   Program  Length   Class  Size   Fellowship  aler   2  
(yrs)   (yrs)   Gradua6on  
0  
Fellowships   2010   2011   2012   2013   2014   2015   2016   2017   2018   2019  

Class  
Program   Size   ACGME   Accredita2on  (yrs)  
Chronic  Pain   2   Yes   4   Our  Resident’s  Medical  Schools    
Cri6cal  Care   2   Yes   2  
OREGON
Regional/Acute  Pain   1   2016/17   (Pending)   UTAH
COLORADO IOWA
ILLINOIS
Simula6on   1   No   KANSAS NEW HAMPSHIRE

OHIO
Periop  Management   1   No   MASSACHUSETTS

NEW YORK

Resident  Applicants  from  Top  10  Med  Schools   NEW JERSEY

80  
PENNSYLVANIA

60   VIRGINIA

CALIFORNIA NORTH
40   CAROLINA

GEORGIA
20   LOUISIANA

ARIZONA
TEXAS
0  
HAWAII
2008  -­‐  2011   2012-­‐2015   2016-­‐2019  
Growth  in  Knowledge  Report  from  the  ABA  

18   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Resident  Educa2on  by  the  Numbers:  2013-­‐14  

192  Resident  Didac6c  Sessions  

48  Grand  Rounds  

48  Chair’s  Keyword  sessions    

37  Simula6on  sessions  

12  Visi6ng  Professors  

4  Workshops  
2    Resident  Retreats  

19   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

We’re  “Apple”  and  not  “Microso`”  

Our  training  program  is:  

u  Innova6ve  

u  Wellness  focused  

u  Technology  focused  

u  At  the  cunng  edge  

u  We  do  things  that  other  programs  just  talk  about…  

 
20   Department  of  Anesthesiology  &  Periopera2ve  Care|  JUNE  22,  2015  
4-­‐U  Curriculum  
•  Progression  to   •  Preparing  for  
Advanced   Independent  
Periopera6ve   Prac6ce  
Care  

CA-­‐2   CA-­‐3  
U    U  

 
 
CA-­‐1   CLINICAL  
BASE    
U  
U  
•  Fundamentals   •  Founda6ons  for  
of  Anesthesia  &   the  
Periopera6ve   Periopera6ve  
Care   Physician    

21   Department  of  Anesthesiology  &  Periopera2ve  Care|  May  8,  2015  

Typical  4-­‐U  Day  

DIDACTICS   BOARD  PREP   HANDS-­‐ON  

Independent  Reading   Wri\en  Board   Simula6on  

Online  Lectures   Review  by  key  faculty   Workshops  
Online  Pre/Post   Oral  Board  Review  by   Ultrasound  Training  
Exams   ABA  Examiners  
Keywords/Cases  

22   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Resident  Retreats  

Winter  
Residents  as  Educators  

Summer  
Team  Building,  Mentoring  

23   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

SRNA  Program    
v  Excellent  learning  experience    
v  Clinical  opportuni6es  to  apply  anesthesia  
principles    
v  Technical  skills  necessary  for  
periopera6ve  anesthesia  management  
and  safe  pa6ent  care  
v  Program  Director  Ann  Singleton,  CRNA,  
DNAP  awarded  Clinical  Instructor  of  the  
Year  by  the  Kaiser  School  of  Nurse  
Anesthesia  SRNAs  
   

24   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Medical  Student  Programs  
Anesthesiology  Advanced  Clinical  
Rota2on  (course  605A)  -­‐  4  weeks  
70  
60  

Number  of  students  

50  
40  
30  
20  
10  
0  
2010/2011   2011/12   2012/13   2013/14   2014/15  
 
Anesthesia  Interest  Group    
Very  ac2ve  
²  started  a  na6onal  
conference  
²  2014  host  was  UCSD  
²  They  gave  it  back  to  us!    

25   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Contribu2ons  to  the  Simula2on  Center  

26   Department  of  Anesthesiology  &  Periopera2ve  Care|  JUNE  22,  2015  

Lean  Six  Sigma  Training  for  all  CA-­‐1s  

Define  

Control   Measure  

Improve   Analyze  

27   Department  of  Anesthesiology  &  Periopera2ve  Care|  JUNE  22,  2015  

Fellowships  

Pain   Acute  Pain   Simula6on   Periopera6ve   Cri6cal  Care  

Management   and  Regional   Fellowship   Medicine   Fellowship  
Fellowship   Fellowship   Fellowship  

2007    2009                          2011                    2012  2014  

28   Department  of  Anesthesiology  &  Periopera2ve  Care|  JUNE  22,  2015  

Educa2on  Leadership  Team  

Acute  Pain/Regional  
Vice  Chair,  Educa6on     Residency  Program  Director    
Fellowship  PD  
Cindy  Anderson   Suzanne  Strom  
Kyle  Ahn  

Associate  Residency   Associate  Residency  PD&   Cri6cal  Care  Fellowship  

Program  Director     Medical  Student  Director   Program  Director    
Joseph  Rinehart   Ashley  Broussard   Trung  Vu  

Pain  Medicine  Fellowship   Periop  Medicine  Fellowship   Simula6on  Fellowship  

Program  Director     Program  Director     Program  Director      
Padma  Gulur   Sco\  Engwall   Cameron  Ricks  

Residency  Coordinator       Fellowship  Coordinator      

Quin  Johnson   Chloe  Tran  

29  
 HEAL  

30   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

 Heal  Dashboard   Same  Day  Cancela2ons  
3  
2.5  
Case  Volume  by  Loca2on   2  

Percent  
25000  
GHEI   1.5  
Beckman   1  
20000  
0.5  
OB  
Number  of  Cases  

0  
15000   CDDC   2011/12   2012/13   2013/14   2014/15  
OSS  
10000  
MOR/Anc  
First  Case  Starts:    On  Time  %  
5000   100  
90  

Percent  
0   80  
70  
60  
50  
2011/12   2012/13   2013/14   2014/15  

Pa2ent  Sa2sfac2on:   UCI  

Your  Anesthesiologist...   Na6onal  

5  
Scale  of  1  to  5  

4  

3  

2  

1  
Ensured  yoour  
31   Department   Eased  
f  Anesthesiology   yeriopera2ve  
&  P our   Helped  
Care|  yMou  
ay  m
8,  ake  
2015   Overall  
comfort   Anxiety   informed   sa6sfac6on  
decisions  
Anesthesia  Clinical  Coverage  

2004-­‐15  
OR  Coverage  
19  +  1  
CDDC  Coverage  
Case  Volume     Remote  Loca2ons  
Case  Volume    
Up  from  last  year  
Up  from  last  year  
Increased  coverage  
Call  Coverage  
to  Radiology  
MOR  /  Trauma  
 
OB  
Opened  GHEI  
Neonatal  
Cardiac  
Transplant  
Surgical  Home  
Acute  Pain  /  Regional  

32   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Opera2ons  Officers  

33   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

 Surgeon  Sa2sfac2on  Survey  2013  

n = 31 UCIMC Surgeons Would  you  recommend  the  

Anesthesia  Care  Team  at  UC  
Irvine  Health  to  your  friends  and  
Rate  Dept  of  Anesthesiology  &  Periopera2ve  Care  on...   family?  
10   100%  
9   90%  
Scale  of  1-­‐10,  10  is  Best    

8   80%  
7   70%  
6   60%  
5   50%  
4   40%  
3   30%  
2   20%  
1   10%  
0   0%  
Service  provided  you   Collegiality  of  Dept   Service  your  liaison   Yes   No  
and  your  pa6ents   members   provides  you  

34   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Clinical  Care  Team:    CRNAs  

t  Professionalism  

t  Excep6onal  clinical  

skills  and  care  

t  Integral  members  of  

Department  
t Serve  on  
Department  
Commi\ees  

 
35   Department  of  Anesthesiology  &  Periopera2ve  Care|  May  8,  2015  
Chronic  Pain  Program  
Complete  Renova6on!  

36   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Chronic  Pain  Program  
38%  increase  in  overall  pa6ent  visits  at  the  Go\schalk  Plaza  Pain  
Medicine  Clinic  

37   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Chronic  Pain  Program  
38%  increase  in  overall  pa6ent  visits  at  the  Go\schalk  Plaza  Pain  
Medicine  Clinic  

38   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Chronic  Pain  Program  
57%  increase  in  procedures  at  Go\schalk  Plaza  Pain  Medicine  Clinic  

39   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Inpa2ent  Pain  Service  
Significant  enhancements  in  pa6ent  care  and  provider  performance  

40   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Inpa2ent  Pain  Service  

150%  increase  in  pa6ent  

encounters  on  inpa6ent  
pain  service  

40%  increase  in  regional  

blocks  volume  in  the  
opera6ng  room    

41   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

42   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  
Anesthesia  Driven  SIS  Installa2ons  

Anesthesia Documentation
Scheduling
SIS Analytics
SIS Web OSS  
SIS Com
Seda6on   MOR  

Acute  
Pain   SIS     OB  L&D  

Radiology   CDDC  
Pre-admit Module
Cath  Lab   Pre, Intra and Post
Sedation Documentation
Sedation Pilot

43  
Clinical  Leadership  Team  

44   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

 Finance  
45   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  
 Periopera6ve  Surgical  Home  

46   Department  of  Anesthesiology  &  Periopera2ve  Care|  May  8,  2015  

VOICE  OF  THE  CUSTOMERS  (Pa2ents,  Hospital  Staff,  Physicians)  

High  Periopera2ve     Fragmented     Pa2ent  Care  Centered    

Care  Cost   Con2nuum  of  Care   on  Hospital  
(Est.  60%  Hospital  Expense)   (Hospital,  Clinic,  Labs  &  Physician  Services)   Reimbursement  

Process  Variability  based   Order  of    

upon  lack  of  Standardize   Consult  &  Lab  Tes2ng  
Outdated  Surgical   Periopera2ve   Variability  by    
Culture  and  Tradi2on  
Experience,  Skills,  &   Medical  &  Surgical  
Training   Services  

Post-­‐Opera2ve  Care  is  

Generally  Disorganized,   Poor  Accountability   Preventable  
Highly  Variable,  &  Skilled   Systems   Complica2ons  
Labor  Dependent  
47  
Periopera2ve  Surgical  Home  (PSH)  

PSH is a multi-departmental initiative aimed to

transform surgical care by improving quality,
lowering cost, and increasing patient and
provider satisfaction.

48  
UC  Irvine  PSH  Mission  

 Reduces  cost  of  care  &  

 Coordina6on  of  care  
 LOS  

 Standardiza6on  of    prac6ce  

 Reduce  complica6on  &    
 using  evidence  based  prac6ces  &  
 readmission  rates  
 guidelines  

 Provide  quality  &  

 Improve  overall  sa6sfac6on  of    performance  improvement  
 Surgeons,  Anesthesia,  Nursing,  &    measures  demonstra6ng  
 Pa6ents    success,  outcomes  based  on  
 research  (NASQUIP,SCIP)  

49   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  22,  2015  

Periopera2ve  Surgical  Home    

Preoperative   Intraoperative Postoperative Post-discharge

•  Patient Centric   •  Evidence based •  Evidence based • Transition to
protocols protocols appropriate level of care
•  Optimization (not
clearance)   •  Operations •  Team management • Education of patients
•  Evidence based management •  Right level of care and caregivers
protocols   (NNTV)
•  Reduced variation • Rehabilitation and
•  Patient Mind & •  Prevention of return to function
•  GDT complications
Body Preparation   • Reduced variation
•  ERAS •  Reduced variation
•  Care plan
 

mHealth          

 Suppor2ng  Microsystems*  

Physicians  Nurses  Administra2on    IT          Decision  Support          Case  Management          Pharmacy          

Blood  Bank  Dietary          Human  Resources          Pa2ent  Educa2on          Physical  Therapy    
50        
51  
Change  Management  

52  
The  PSH  is  a  Team  Sport  

PATIENT HUMAN
PERIOP PERIOPERATIVE HOSPITAL
PHYSICIANS NURSING QUALITY
ANESTHESIOLOGY
EXPERIENCE RESOURCES SERVICES LEADERSHIP

DECISION
CASE SUPPORT /
NURSING CRITICAL CARE MANAGEMENT IT / INFORMATICS PHARMACY
FINANCE

BLOOD PHYSICAL BUSINESS

QUALITY
ADMINISTRATORS
/ SAFETY BLOOD BANK
BANK ER THERAPY NUTRITION PLANNING

53  
LEAN  &  Six  Sigma  

54  
 PSH  SERVICE  TIME  LINE  

Launch  Schedule  

Live Live Live Live In

September February September November Development
2012 2014 2014 2014 February 2015

Orthopedic   Urology   Orthopedic   Orthopedic   Neurosurgery  

Elective   Elective   Outpa6ent   Elective  Spine   Service  lines  
Total  Joint   Cystectomy,   Services   tbd  
Replacments   Nephrectomy  

55  
Est. $1.6 Million
Total Operational
Cost Savings by
YR 2014

+  
Est 190 Plus
Opportunity Days
Gained by
YR 2014
PSH  Retreats  

Retreat  lays  the  founda6on  for  the  surgical  pathway…  

Retreat  Work  
PSH  State  
• Map  current   • How  does  each   Product  
processes   process  step  address  
• Map  ideal  processes   core  measures   • Results  of  Retreat  
• Preop,  Intraop,  
when  PSH  is   becomes  framework  
Postop,  Post  
implemented   for  PSH  process  map  
Discharge  

Metric  
Current  State  
Analysis  

57   Department  of  Anesthesiology  &  Periopera2ve  Care|  May  8,  2015  

Working  as  a  TEAM  

58   Department  of  Anesthesiology  &  Periopera2ve  Care|  June  16,  2015  

The  Perioperera2ve  Surgical  Home  Experience:  
Rota2ons  
CA-­‐3  Yr  Periopera6ve  Physician  
OR  Management   Clinical  Base  Introduc6on  
 PSH  Rounds   Preopera6ve  Clinic  &  OR  
Simula6on  Teaching   Immersion  Day  
Blood  Bank/Pharmacy/Billing/  
Nutri6on  
Ethics  Commi\ee  
 
 

CA-­‐2  Yr  PSH  Postopera6ve  Care   CA-­‐1  Yr  PSH  Preopera6ve  

Advanced  PACU   Rota6on  
POC  Ultrasound   PSH  Pa6ent  Preopera6ve  Care  
 Case  Manager   Pa6ent  Mindfulness  
Nutri6on   Pre-­‐Surgical  Sessions  
Acute  Rehab  Unit   ITT  Experience  
   
 
59    
 
Alignment  Between  Organiza2on  Goals  and  PSH  
UCIMC  FY  2015     PSH  FY  2015    
Organiza2onal  Goals   Organiza2onal  Goals  
Reduce  observed  /  expected  mortality   Decrease  Complica2ons  /  Mortality  
•  Early  Pa6ent  Assessment  &  Op6miza6on  (IT)  
Quality    /  Safety  

•  ERAS  
•  Evidence  Based  Clinical  Pathways  (IT)  
•  Standardiza6on  of  prac6ce  
Reduce  30-­‐day  readmissions   Prevent  Readmission    
•  Pre  /  Post  Pa6ent  Educa6on  
•  30  Day  Follow-­‐Up  Protocols  (IT)  
•  Synchronized  Collabora6ve    /  Transi6on  Care    
Increase  HCAHPS  Inpa2ent  “… Family  Centered  Care    
Service  /  Pa2ent  

recommend  the  hospital”  top  box  ra2ng   Coordinated  Pa2ent  /Family  Care  
Experience  

•  Educa6on:  Pre,  Intra,  Post  

•  Mul6-­‐Modal  Pain  Management  
Increase  CG-­‐CAHPS  “…recommend  this   •  Pa6ent  Centered    
provider  office”  top  box   •  Shared  Decision  Process  
•  Pa6ent  Centered  Care  
•  Data  Driven  Approach  
Finance  /  

Achieve  budgeted  cost  per  adjusted   Reduce  Cost  Per  Case  

Cost  

discharge   •  Clinical  Pathways  

•  Surgical  Opera6onal  Op6miza6on  
60  
•  Standardize  Implants  
PSH  Learning  Collabora2ve:  43  Hospitals  

61   Department  Name  |  Month  X,  201X  

Periopera2ve  Medicine:  Educa2onal  Opportuni2es      

Ø  Periopera2ve  Medicine  and  residency  program  curriculum  

Ø  ASA  Task  force,  ASA-­‐ABA-­‐ACGME  Task  Force,  New  annual  Track,  RRC  member  
Ø  Periopera2ve  Medicine  and  fellowship  program  curriculum  
Ø  There  are  3  programs  in  the  US  (UCI  has  4-­‐fellows  next  year)  
Ø  Periopera2ve  Medicine  and  medical  student  program  curriculum  
Ø  These  need  to  be  revised  and  include  the  en6re  con6nuum  of  care  
62  
Periopera2ve  Medicine:  Research  Opportuni2es      

Mul6ple  Research  
opportuni6es:  
u  AHRQ  R18  (Oct)  
u  PCORI  

63  
To  our….  
« Devoted  Faculty,  Fellows,  Residents,  CRNAs,  RNs,  Technicians  
« Hard  working  department  administra6on    
« Excep6onal  OR  colleagues,  Surgeons,  RNs,  IT,  Administrators    
« Outstanding  colleagues  from  other  departments    
« Highly  commi\ed  SOM  and  Hospital  leadership