Page 17 - CASA Bulletin of Anesthesiology 2019 Issue 1

Though, changes also bring more opportunities. In order to compete for the decreasing cardiac surgery patients, many programs started to bring in new technologies and improve surgery outcomes to attract patients. In 2005-2006, we started doing robotic coronary bypass and mitral valve surgeries, mitral valve repair instead of replacement, mini-thoracotomy for
all valve surgeries instead of sternotomy, and aortic valve sparing root replacement instead of Bentall procedure. We also started using more and newer generations of mechanic supporting devices which are now managed by the cardiac anesthesia team. We also participated in the STS database and the New York state reporting system to improve our outcomes by comparing our results with ~1000 cardiac surgery programs around the country.
All these new technologies require the cardiac team to work with each other, along with greater reliance on the cardiac anesthesia. Cardiac anesthesiologists do not just put patients
to sleep or place central lines. Now, they need to adjust anesthesia for early extubation, do
lung isolation with single lung ventilation, place transvenous pacing wire, guide peripheral cannulation, perform intraoperative transesophageal echocardiogram, and manage the ICU patients to improve extubation time and ICU length of stay. It took a few years to accomplish, but the outcome was rewarding. Last year, our hospital was one of the only three hospitals (among ~1000 US cardiac surgery programs) that achieved the highest rating in all five categories (CABG, CABG+AVR, CABG+MVR, AVR, MVR). Today, we are ranked one of the best regional hospitals by US News and Reports, as well as one of the top 10 cardiac surgery programs by Health grade in coronary bypass surgeries and valve surgeries. Therefore, the relationship between cardiac surgery and anesthesia is critical, as our outcome is closely related to our team efforts. The anesthesiologist candidates interviewed in our hospital often feel that the cardiac surgery team is more of attraction, not something that will turn them away. Here are a few important points.
1. Working with administration to get funding for cardiac anesthesia
Cardiac surgery is the flagship of our hospital and accounts for about 10% of the hospital revenue. However, the CMS reimbursement for cardiac anesthesia may not be adequate. We helped the anesthesia department secure funding for new equipment, attain training for TEE certificates, receive adequate compensation for cardiac anesthesiologists, call pay, and acquire management skills of the mechanical supporting devices. These efforts have attracted more people to be part of the team and recruited more anesthesiologists in the last few years.
2. Communication
Like any other specialty or a sports team, communication is not just to coordinate the members of the team to expect what role for each individual to play, but also show respect for each other. Open heart surgery needs a big team that includes surgeons, physician assistants, anesthesia attendings, CRNAs, perfusionists, scrub technicians, and circulating nurses. Every morning before we start a case, we have a brief discussion about the plan for the surgery with all
Vol.6, No.1,2019
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