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Liver Transplantation Anesthesiology Service
Clinical Program Clinical ProgramLiver Transplantation surgery is an extremely complex procedure that requires special expertise by anesthesiologists to provide care for these patients. Outcomes of Liver Transplantation are published for public review. SMH has targeted the liver transplant program including live donor liver component as its "elite, state of the art" service. These factors make the care of the liver transplant patient very "high profile".The Division of Liver Transplantation Anesthesiology is a well-organized service which uses a "service manual" or guide to assist all clinicians, trainees and students. This collection of documents is not meant to serve as a tool to indoctrinate residents into idiosyncratic local practices but to allow the description, through a "living" document which is created and routinely updated so that current patient care and medical practices are delineated. The liver transplantation anesthesia team members are:
Patient CarePatient care on the Liver Transplantation Anesthesiology Service is currently carried out by 5 faculty members (reflecting 4.5 FTEs), residents in training, and one dedicated liver anesthesia technician. In the past and from time to time a liver transplantation anesthesia fellow is also involved in the delivery of patient care.Care and team issues are discussed at periodic team meetings, which are scheduled when all team members are available to participate. Development of "care-maps" and "care-guides" that are evidence and/or consensus driven, either nationally, or within the institution, are frequently used and continue to be considered. These documents can be seen on the departmental web-site or in the divisional packet each resident receives. These guides allow for the definition and incorporation of certain standards of care, especially those that are nationally recognized, to allow for surgeon's and patient's expectations to be met and care to be as consistently excellent as possible. Standards of care represent the highest standards and therefore defining any practice as a standard should be done with much thought as to whether or not the evidence is strong enough to merit such a position. Thus there are instructional guides for teaching purposes and care guides where evidence is sufficient.
Liver Transplantation Anesthesia and Surgical Volumes: Data are provided to me from the Division of Liver Transplant Surgery annually. Liver surgery volume continues to grow; the case mix is excellent for training purposes, the mortality and morbidity is better than the national average. Adult cases are 124 for 2003 and 121 for 2004. EducationResidency ProgramDirect one-on-one supervision of patient care in the Liver Transplantation Anesthesiology Division is practiced for virtually all patients. This allows for optimizing patient care and outcome while at the same time allowing for hands-on teaching and resident learning and training. The educational program is approved by the Residency Program Director. Documents outlining the divisional educational goals and format are in the resident packet. The educational format and training are consistent with the recommendations of the Residency Review Committee of the ACGME. The educational program is comprehensive in that it covers the knowledge and skills primary or specific to the division's subspecialty nature as defined by the Joint In-training Content Outline of the ABA/ASA as detailed along with the corresponding recommended reading assignments and in-OR teaching. In addition, periodic additions to resident education, such as discussion of key words on the questions in the in-training exam or advanced knowledge test where residents did not perform well are listed and targeted for discussion. Examples of the conservative management services provided are: The educational program provides written learning material (content) which is consistent with the Joint In-training (ABA / ASA) content outline for the specialty. The educational program includes faculty to resident feedback both on a daily basis (informal and/or formal) and departmental basis (formal). This is written and reported on every resident through the convenient use of the departmental web. Obtaining resident feedback concerning faculty teaching is done at the departmental level. Intra-divisional attempts to gain direct feedback from the residents concerning each faculty person have not been successful, presumably due to the concerns residents have about the impact of such a process. An extensive description of the educational programs including a detailed description of the protocol and rotation for residents, can be found on this web site by following the link below: Liver Transplantation Residency Rotation |
