Clinical

CLINICAL: Pulmonary & Critical Care

Highlight: Innovative Idea Earns National Award

Over the last year, the division’s busy Medical Intensive Care Unit (MICU) has implemented a two-attending MICU model. This change has resulted in improved clinical care of patients, decreased stress and fatigue for attendings during and after each MICU rotation, and an increase in critical care billing—likely due to the increased availability of attendings to render patient care. The MICU nurses, medicine residents, and other staff have welcomed this change.

Thanks to the leadership and hard work of Max Weder, Kyle Enfield and the transplant surgeon team, the lung transplant service was removed from probationary status in early 2013 by the Centers for Medicare and Medicaid Services (CMS). This was due, in part, to substantial improvements in one-year post-transplantation survival rates. The division is working to continue strengthening and expanding this program.

The division has expanded its offerings in advanced bronchoscopy to include innovative procedures such as:

• navigational bronchoscopy — enables navigation and location of tumors at the periphery of the lungs, where bronchi are too small for standard bronchoscopes; uses technology similar to a car global positioning system (GPS) system

• endobronchial ultrasound (EBUS) – facilitates performance of transbronchial needle aspirations to obtain tissue or fluid samples from the lungs and surrounding lymph nodes without conventional surgery; used in the diagnosis of lung cancer, infections, and other diseases causing enlarged lymph nodes in the chest

• bronchial thermoplasty – novel outpatient procedure for patients with severe or persistent asthma, using a catheter inside a bronchoscope to deliver thermal energy to the airways

Division faculty Elizabeth Gay and Jamie Kennedy have established a multidisciplinary weekly clinic for assessment of patients with pulmonary hypertension; and the adult cystic fibrosis clinic, under the leadership of Veronica Indihar and Cindy Brown, has been flourishing and receiving high marks from patients.

One of the division’s quality and safety initiatives in the past year has been a focused morbidity and mortality conference that allows in-depth review of complications, deaths, and/or near misses occurring in patients cared for, or potentially cared for, by division faculty. Attendance is mandatory for attendings in critical care. Additionally, the MICU Quality Committee meets regularly to examine practices and develop protocols for improving patient care and safety, including enhancing the sepsis protocol and developing a sepsis simulator exercise for medicine residents that is led by faculty and fellows.