Pitt/UPMC Department of Anesthesiology News
February 2016

Message from the Chair
Volume to Value - Why UPMC Matters
In the coming year, there will be many changes in the healthcare landscape. We will see more health systems evolve into accountable care organizations (ACOs), nationwide utilization of greater clarity (hopefully) about quality and performance metrics, and the beginning of the switch from volume-based to value-based medical reimbursement.
What is meant by volume to value? Basically, this foretells a radical shift in how healthcare will be paid for in the future. Historically, hospitals, physicians, and other providers are reimbursed for providing services. Under this model, the more things you do or services you provide, the more you get paid (volume-based reimbursement). Fees for medical services have not been tightly regulated and can vary widely. In this model, private insurance companies and the government assume the financial risk of healthcare. The financial incentives to do more have driven the cost of healthcare in the US to over double the percentage of the economy (approximately 18%) in other countries. This explains the skyrocketing costs of health insurance and why so many employers can no longer afford to provide insurance for their employees and has set the stage for the emergence of the health insurance exchanges. It has also been clear for some time that the US cannot afford to spend this high a percentage of our GDP on healthcare, especially given the fact that our health outcomes are no better (and in some cases worse) than those of other countries.
This impending crisis set the stage for the adoption of "Obamacare." The major paradigm shift here is that the financial risk of providing healthcare is shifted from private insurance companies or the government to ACOs. Under this model, the ACOs themselves insure individuals. The underlying concept is that competition will drive down insurance costs, and the only way that ACOs will be able to compete is to provide needed services more efficiently and for a lower cost (value-based reimbursement).
UPMC has been leading the charge in this direction for over 20 years. Our leadership has been well ahead of the rest of the country in seeing these trends and strategically positioning us to not only compete effectively, but to model these changes for the rest of the country. This was one of the most important factors to me when I was deciding whether to take the Chair position here. 
What are the implications of these changes for our Department? While there are certainly challenges ahead, there are also tremendous opportunities. Our Department is already incredibly efficient, productive, and well managed. We are perfectly positioned to help the emerging Perioperative Service Line improve OR utilization and throughput system-wide. Preliminary results from the PEERS/ERAS initiative demonstrate that we can help drive substantial cost savings throughout the system by decreasing length of stay. Our involvement in the system-wide Perioperative Surgical Experience initiative provides us with the opportunity to streamline the evaluation and optimization of patients before surgery, while the acute pain service provides a basis for positive interventions in the postoperative period.
In my opinion, UPMC is the best place to be during these turbulent times. The system is visionary and proactive. We are far ahead of the curve in creating a sustainable, integrated healthcare system. Given that we interact with almost every clinical service at UPMC, our Department will be central to the success of this paradigm shift. We have a unique opportunity to drive changes that not only improve patient care, but also make it more efficient and cost-effective. I look forward to working with all of you to make this year an even better one for our Department and UPMC!
Dr. Philip Carullo Receives Funding for Two Research Grants

Congratulations to Philip Carullo, MD (PGY-1 resident), who was recently awarded two grants for the development of a medical device that would prevent aspirated products from entering the lungs during intubation.
Upon completing the First Gear Program run through the University of Pittsburgh Innovation Institute, Dr. Carullo received a $3,000 grant for his project. He was also awarded a one-year $20,000 pilot grant from the University of Pittsburgh Center of Medical Innovation for production of a functional prototype.

Dr. Andrea Ibarra Accepted into Competitive Health Disparities Research Course

Congratulations to Andrea Ibarra, MD (PGY-1 resident), who was accepted into the course "Health Disparities: A Translational Research Approach," which will take place January 11-April 14, 2016. The course was limited to only 15 participants. As a selected applicant, Dr. Ibarra also received a $1,000 registration fee award.
The course is the result of a multidisciplinary and multi-institutional effort of representatives from five institutions participating in the Research Centers in Minority Institutions Translational Research Network: University of Puerto Rico as the leader together with Morehouse School of Medicine, Charles Drew, University of Hawaii, and Meharry School of Medicine.

Dr. Tetsuro Sakai Appointed Chair Designee of SEA Research in Education Committee  
Congratulations to Tetsuro Sakai, MD, PhD, who was appointed Committee Chair Designee of Society for Education in Anesthesia (SEA) Research in Education Committee.
The committee assists SEA and its members with promoting and developing medical education research as it relates to the field of Anesthesiology. Committee roles include organizing and grading abstracts for the SEA annual spring meeting, assisting authors with getting their abstracts published as manuscripts in peer-reviewed journals, and providing research-related resources to its members on the research portal at the SEA website.

Three Department Abstracts Accepted to ASA Practice Management Conference; One Wins First Place Award

Three abstracts were accepted under the direction of Mark E. Hudson, MD, MBA for the American Society of Anesthesiologists (ASA) Annual Conference on Practice Management.  The following abstracts were presented as posters in San Diego, California, from January 29 to 31, 2016:
Andrius Giedraitis, MD, MBA; Trent D. Emerick, MD; David F. Nelson, MD, MBA; Tetsuro Sakai, MD, PhD; Mark E. Hudson, MD, MBA: Anesthesiologist Operating Room Performance Metrics Based on Pairing with Resident vs. CRNA in a Large, Multi-Specialty Health Care System
David F. Nelson, MD, MBA; Trent D. Emerick, MD; Andrius Giedraitis, MD, MBA; Tetsuro Sakai, MD, PhD; Mark E. Hudson, MD, MBA: Does a Dedicated Charge Anesthesiologist Affect OR Performance Metrics in a Large Tertiary-Care Teaching Hospital?
Trent D. Emerick, MD; David F. Nelson, MD, MBA; Andrius Giedraitis, MD, MBA; Mark E. Hudson, MD, MBA: Perceived Work Hours versus Actual Work Hours in a Large Multi-Specialty Hospital

The poster by Emerick et al. won the first place poster prize at the conference. 

The Hudson research team has won seven out of 15 awards at this annual conference over the last five years. Congratulations to all the authors for continuing the department's legacy of awards.

Dr. William Simmons Receives Western Pennsylvania Executive Humanitarian Award

Congratulations to   Willi am Simmons, MD, who received the Western Pennsylvania Executive Hum anit arian Award from Achieving Greatness, Inc. (AGI)  at AGI's Pittsburgh City League Hall of Fame awards banquet on January 2, 2016 at the Pittsburgh Athletic Club. The event honored local sports heroes and those that star ted in Pittsburgh City Leagues and went pro, as well as many champions of local humanitarian efforts. Dr. Simmons is currently the President and Chairman of the Board of the Gateway Medical Society (GMS), as well as Chair of the department's Advisory Committee on Diversity and Co-chair of the UPMC/University of Pittsburgh Physician Inclusion Council Retention Committee. In his spare time, he is a mentor for GMS's academic mentorship program for African American males.

Dr. Yan Xu Invited for Visiting Professorship at University of Virginia

Congratulations to Yan Xu, PhD, who was invited to serve as a Visiting Professor with the University of Virginia Department of Anesthesiology in Charlottesville, VA on December 9, 2015. Dr. Xu presented three lectures during his visit: "Systemic Immune Modulations of Neuronal Injuries after Cardiac Arrest and Resuscitation," "RELIEPH: a New Approach to Treating Chronic Pain," and "Structure-based Drug Discovery and Glycine Receptor as a Therapeutic Target for Pain."

CRNA Chuck Giordano and Dr. David Seng Win Awards at 2015 Pitt Nurse Anesthesia Graduation

Congratulations to Mr. Chuck Giordano, MSN, CRNA and David Sen g, DO, who were presented with awards at the University of Pitts burgh Department of Nurse Anesthesia Fall Class of 2015 Graduation Ceremony on Saturday, December 19, 2015 at the University Club in Pittsburgh:
Mr. Chuck Giordano, MSN, CRNA
Mary DePaolis Lutzo Anesthetist of the Year Award
David Seng, DO
Stephen Finestone Anesthesiologist of the Year Award

Dr. Ajay Wasan Discusses Prescription Opioids on NPR News

Ajay D. Wasan, MD, MSc recently participated in a discussion about prescription opioids in the NPR segment Draft of CDC's New Prescribing Guidelines Stirs Debate. Listen to the show or read the transcript of the discussion at http://n.pr/1MFtzvq

Dr. K. Grace Lim Earns Several Accolades

Congratulations to K. Grace Lim, MD, who was invited for a Visiting Professorship with the University of Maryland Department of Anesthesiology from June 22-23, 2016 to share her expertise as an obstetric anesthesiologist. Dr. Lim presented grand rounds as part of her visit. 

She was also  invited to moderate a case report session at the 2016 Society for Obstetric Anesthesia and Perinatology (SOAP) Annual Meeting in Boston, MA on May 22, 2016. 

Dr. Lim was also accepted into the 2016 University of Pittsburgh Schools of the Health Sciences Leadership Academy for Early Career Faculty. The year-long professional development program is designed to cultivate a generation of transformative academic leaders through shared leadership training and will consist of nine separate educational sessions throughout 2016.

She was also featured in the  the article " If my doctor had ignored my intuition about my pregnancy, I'd be dead

Beverly Savage and Michael Zoffel Receive RACC Certification

Congratratula tions to our finance team members Beverly Savage and  Mich ael Zoffel, who both received certifications from the Research Administrators Certification Council (RACC) 
and are now CRAs (Certified Research Administrators). They took the certification exam in November 2015. Beverly handles all pre-award administration and specialized financial reporting and Mike manages all of the post-award accounting and financial analysis for the Department of Anesthesiology.  

UPMC Pain Medicine Fellowship Awarded National 2016 AAPM Pain Medicine Fellowship Excellence Award

Our UPMC Pain Medicine Fellowship Program, directed by Scott Brancolini, MD, MPH and overseen by Ajay D. Wasan, MD, MSc, was awarded a national "2016 Pain Medicine Fellowship Excellence Award" from the American Academy of Pain Medicine (AAPM). The award was one of only four given by the AAPM.

Dr. Jaymin Patel Wins AAPM 2016 Pain Medicine Fellowship Scholarship

Congratulations to Jaymin Patel, MD (Pain Medicine Fellow), who was selected to receive the American Academy of Pain Medicine (AAPM) 2016 Pain Medicine Fellowship Scholarship.

Dr. Scott Brancolini Appointed to APPD Board of Directors

Congratulations to Scott Brancolini, MD, MPH, who was appointed to the Board of Directors of the Association of Pain Program Directors (APPD).  


Department Abstracts and Workshops at the 2016 Society of Pediatric Anesthesiology Meeting

Congratulations to the following department members (names bolded), whose work was accepted to and will be presented at the Society of Pediatric Anesthesiology 2016 Meeting, April 1-3, 2016, Colorado Springs, CO.  
  • Pediatric Post Dural Puncture Headache (PBLD). Franklyn P. Cladis, MD; Adam J. Broussard, MD (2014-2015 Pediatric Anesthesiology Fellow).
  • Intraoperative Cardiac Arrest: A Case of Incidentally Discovered Tracheal Stenosis. Peter J. Davis, MD; Anne E. Kamarchik, MD (PGY-4 Resident).
  • Session II: High and Dry in the Centennial State. Moderator: Peter J. Davis MD.
  • L2 paravertebral blocks for postoperative alveolar bone graft pain. Keric Menes, MD; Denise M. Hall Burton, MD.
  • Anesthetic Management of Biventricular Device Explantation in a Child with LCHAD. Saifeldin Mahmoud, MD (Pediatric Anesthesiology Fellow); Patrick Callahan, MD; Brian Blasiole MD, PhD; Aparna Phadke, MD; Mahesh Sharma, MD; Peter Wearden MD; Khoa Nguyen, MD
  • Research Workshop. R. Blaine Easley MD; Richard J. Levy MD; Olubukola O. Nafiu MD, FRCA; Olutoyin Olutoye MD, M.Sc, FAAP; Jerome Parness MD, PhD, FAAP.
  • Walk Around Posters/Discussion Sessions. Moderator: Carlos Javier Campos Lopez MD, FAAP; Moderator: Nathaniel Greene MD; Moderator: Narasimhan Jagannathan MD; Moderator: Wanda C. Miller-Hance MD; Moderator: Philip G. Morgan MD; Moderator: Olubukola O. Nafiu MD, FRCA; Moderator: Jerome Parness MD, PhD, FAAP; Moderator: David M. Polaner MD, FAAP; Moderator: Mary C. Theroux MD; Moderator: Susan T. Verghese MD; Moderator: Mehernoor F. Watcha MD.
  • Ultrasound-guided Retrograde Sacral Interspinous Approach to Continuous Caudal Epidural: A Novel Approach to Preoperative Caudal Epidural Catheter Placement in Pediatric Patients. Ahmar Husain, MD (2014-2015 Pediatric Anesthesiology Fellow); Mihaela Visoiu MD; Denise M. Hall-Burton, MD. Also to be presented at theSociety for Pediatric Pain Medicine Annual Meeting, March 31, 2016, Colorado Springs, CO.
  • Disaster Recall: Optimizing Hospital Surge Capacity. Ali Hassanpour, MD (Pediatric Anesthesiology Fellow); Franklyn P. Cladis, MD; Peter J. Davis, MD

Recent Publications
Department Authors and Alumnus Contribute to Simulation Textbook

The second edition of the book Manual of Simulation in Healthcare (Editor Richard H. Riley, MBBS, FANZCA, Oxford University Press) was recently published. Dr. Riley is currently an anesthesiologist at University of Western Australia/ Royal Perth Hospital and an alumnus of our residency program (1984) and our Schertz Research Fellowship (1985).
The following department staff members authored chapters in the book:
Chapter 3: Simulation Centre Operations, Yue Mind Huang and Thomas Dongilli (Operations Director, WISER )
Chapter 9: Simulation in Nursing Education and Practice, Joseph S. Goode Jr., MSN, CRNA (UPMC Presbyterian) and John O'Donnell, CRNA, MSN, DrPH, RN (Director, University of Pittsburgh School of Nursing Nurse Anesthesia Program; Associate Director of Nursing Programs & Director of Research, WISER )

Borza JM, Kaufmann JA, Cline, TW. Reducing Intravenous Narcotic Documentation Errors on the Electronic Anesthesia Record: A Quality Improvement Project. Anesthesia eJournal . 2015; 3(2).  Open access link

Damian D, Esquenazi J, Duvvuri U, Johnson JT, Sakai T. Incidence, outcome, and risk factors for postoperative pulmonary complications in head and neck cancer surgery patients with free flap reconstructions.  Journal of Clinical Anesthesia. 2016;28:12-8.

Linn RL, Miller ES, Lim G, Ernst LM. Adherent basal plate myometrial fibers in the delivered placenta as a risk factor for development of subsequent   placenta accreta.  Placenta.   2015; 19(15):30064-3.  PubMed Link   

Cai X, Huang H, Kuzirian MS, Snyder LM, Matsushita M, Lee MC, Ferguson C, Homanics GE, Barth AL, Ross SE. Generation of a KOR-Cre Knockin Mouse Strain to Study Cells Involved in Kappa Opioid Signaling.  Genesis . E-pub date: 11/18/2015; doi: 10.1002/dvg.22910. PubMed Link
Collins RA, Wisniewski MK, Waters JH, Triulzi DJ, Alarcon LH, Yazer MH. Excessive Quantities of Red Blood Cells are Issued to the Operating Room. Transfusion Medicine. E-pub date:  12/15/2015; doi: 10.1111/tme.12263. PubMed Link
Trivedi D, Navid F, Balzer JR, Joshi R, Lacomis JM, Jovin TG, Althouse AD, Gleason TG. Aggressive Aortic Arch and Carotid Replacement Strategy for Type A Aortic Dissection Improves Neurologic Outcomes. Ann Thorac Surg. E-pub date: 11/07/2015; doi: 10.1016/j.athoracsur.2015.08.073. PubMed Link

Kinde MN, Bu W, Chen Q, Xu Y, Eckenhoff RG, Tang P. Common Anesthetic-binding Site for Inhibition of Pentameric Ligand-gated Ion Channels. Anesthesiology. E-pub 1/13/2016. PubMed Link

Ben-David B. Anaesthesia in Cancer Surgery: Can it Affect Cancer Survival? Curr Clin Pharmacol. 2016 2015/12/08. PubMed Link
Dept. Staff B rightens Days of Patients, Veterans, and the Community
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Children's Hospital of Pittsburgh of UPMC (CHP) Anesthesiology held a holiday gift card drive to benefit Jeremiah's Place, a crisis nursery located in East Liberty. The group raised over $600 in gift cards to help support the pediatric community outside of CHP. More information about the organization can be found at  http://jeremiahsplace.org

The CRNAs at UPMC Presbyterian organized a holiday cookie collection. They delivered cookies to the University Place Family House and Fisher House at the VA Pittsburgh Health Care System Oakland hospital. They also brought cookies to the UPMC Presbyterian family waiting rooms on 4F/G and 6F/G, as well as in those in the transplant and surgical ICUs and Same Day Surgery.

To celebrate National CRNA Week (January 24-30, 2016), our CRNAs at Magee-Womens Hospital of UPMC planned a volunteer project in Pittsburgh to demonstrate their care and concern for the community beyond the hospital setting. The group shared their time, donations, and supplies to help the Jubilee Kitchen on two Saturday mornings.The volunteers helped with food preparation, food service, and clean up.  

On Monday, January 25, CRNAs from UPMC Shadyside volunteered their time and cooking skills to the residents of the Shadyside Family House with a fiesta-themed dinner, also to celebrate National CRNA Week. 
Also in honor of CRNA week, the Nurse Anesthetists at Children's Hospital of Pittsburgh of UPMC (CHP) organized an effort to give back to the families of the children that they care for every day. They provided breakfast, afternoon snacks, and baked goods for patients and their families at multiple sites throughout the hospital during CRNA week. They were able to extend this service to the families of the Surgical Family Lounge at the CHP main hospital, the Surgical Family Lounge at the CHP North Surgery Center, and the Pediatric, Cardiac, and Neonatal Intensive Care Units.
Professorship Established in Honor of the late 
Dr. Richard Kuwik

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At the January 2016 department faculty meeting, our Chair Howard B. Gutstein, MD announced the establishment of a professorship named in honor of the late Richard J. Kuwik, MD, Chief of Anesthesiology at UPMC Mercy and 28-year physician and faculty member in our department. Mark E. Hudson, MD, MBA was named the inaugural holder of the Richard J. Kuwik Professorship of Anesthesiology.
Dr. Kuwik earned his BA and MD at Canisius College and   State University of New York at Buffalo, respectively. He completed a surgical internship, anesthesiology residency, and fellowship at Mary Hitchcock Memorial Hospital in Hanover, NH (now Dartmouth-Hitchcock Medical Center). He remained on the faculty there until Dr. Rick Siker, then Chair at Mercy, enticed him and his wife Sandy to come to Pittsburgh.
A letter from the Department of Anesthesiology at Dartmouth-Hitchcock Medical Center regarding the Professorship said that when Dr. Kuwik was a young physician there, he was an "outstanding academic clinician" who was "technically expert, compassionate to patients and their families, and a tireless and effective teacher in the operating room, classroom, and in the intensive care unit. He always provided help to whomever asked, whether faculty, house staff, nurse, or medical student. He was the one physician you wanted to care for you if you were ill. Clearly these characteristics persisted and grew throughout his career."
Sadly, Dr. Kuwik passed away on January 30, 2016. His tremendous impact on many physicians, nurses, and patients over his long career became evident when we announced the establishment of the Kuwik Professorship on our Facebook page. The post received an outpouring of comments of praise and thanks for Dr. Kuwick's mentorship and care, far more so than any other announcement we have ever posted. Many responses called him a "hero" and one of the best physicians they have ever worked with and thanked him for saving their lives.
Dr. Hudson and future holders of the Professorship "shall emulate the dedication to the Department of Anesthesiology and UPMC exhibited by Dr. Kuwik during his 28 years of service to the Department, his colleagues, and his patients."
Dr. Kuwik will be very sadly missed by all in the department, the many people he taught throughout his career, and the patients he cared for. At this time, details about a funeral or memorial service are not known. Information will be sent out as soon as it becomes available.
Pictures from 
Recent Resident Events
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Residents at Dr. Adler's Thanksgiving feast at Magee-Womens Hospital of UPMC

Anesthesiology residents at the Magee OB Gala - a team building event for all clinical staff

Our residents enjoying desert post application dinner

F or more information and updates on what our residents are up to, 
please follow 
Photos from the 2015 Department Holiday Party
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Phyllis Baska with daughter Erin and grandson Tanner on the carousel

Sherrie White, Mallory Mondry, and Joy Holden from Children's Hospital of Pittsburgh of UPMC

Dr. Joseph DeRenzo and his family at the giant Kennywood tree

KDKA's Dave Crawley reading "A Visit from St. Nicholas" 

Nicole Karpinski, Julie Montgomery, and Laura Kridler from UPMC St. Margaret

Dr. Gutstein with wife Dr. Jill Schumacher and Santa Claus
Essay by Dr. Richard 
Hubbard Published in 
Medical Literary Messenger

Congratulations to Richard Hubbard, MD (PGY-3), who shared his very personal experiences as an anesthesiology resident in his essay "Overnight," which was published in the Fall 2015 issue of Medical Literary Messenger.