Assert yourself as a leader:

1. Thank you to all department members for your incredible dedication and hard work and achievement of excellence.

2. Assert yourself as a leader: Everyday and with every opportunity

3. Vision • Clinical Care: Perfect outcomes; Complete patient satisfaction with care and communication; Leaders of innovations in care • Education/Training: Most sought after graduates; Leaders of innovative education approaches; Most competent and up-to-date faculty and staff • Research/Scholarly work: Well funded, translational and clinically-oriented research; Consistent culture of Discovery • Administrative core: Perfect, transparent processes that assures a strong financial and administrative foundation

4. Mission • Recruit and retain talented members of our team, from diverse backgrounds, who are driven to achieve • Provide appropriate financial/administrative resources to allow everyone on the team to be successful. • Provide educational/training resources to allow all members of the team to be successful in their position • Foster a culture of collaboration, respect, innovation and scholarship.

5. The way I think

6. Just to be clear: what really matters? • Outstanding care for our patients • Well-being of our team members • Building the foundation of knowledge in anesthesiology (research) • Educating the next generation within anesthesiology, with the appropriate tools for clinical care, leadership and scholarship.

7. OHSU Investment in the department during recovery from 2008/2009 economic downturn • OPEX/LEAN: reduces waste and improves structure to allow more efficient work, with less frustration • Hospital support to offset burden of weekend call. • Salary stability for full-time scientists • Work-environment improvement for staff (better printers, computers, lighting) • Expansion of clinical staff to better support academic days and break help. • Growth in compensation for all department members

8. New Leadership Responsibilities • Ansgar Brambrink - Vice Chair for Faculty Development and Advancement • Michele Noles – Director of Quality Management • Ines Kroener – Medical Director of Neuro-ICU

9. CRNA Contributions • Implementation of LC4 position • Development & Implementation of break shift • Cortney Blakemore • Danielle Freeman • David Bullock • EP/Cath Lab Team • LVAD Team • Committee Members • CQI: Diane Knapp • CME: Jim Hilliard • Kaizen • Michelle Livingston • Kendall Snow • LaDawn Reid

10. Pediatric Anesthesia • Awards • Michael Seropian - The Presidential Citation from The Society for Simulation in Healthcare for Significant Contributions to Healthcare Simulation • Angela Kendrick - Clinical Service Award at the Women in Academic Medicine Conference • Promotions • Kirk Lalwani – Professor • Berklee Robins – Associate Professor

11. Pediatric Anesthesia • Planning clinical growth • Increased presence in cardiac cath lab • Outpatient surgery at CHH • Intraoperative MRI OR being built – opens 10/2015 • Clinical research • Perioperative experience of autistic children; participation in national databases for sedation, regional, cranialfacial surgery; acupuncture and postop nausea; intraop neuromonitoring in infants; post spinal fusion pain management

12. Vascular Anesthesia Ann Bingham Ryan Anderson Peripheralartery.net • We have increased interdepartmental communication • Our team is involved in exciting treatment techniques: • Endovascular advancements, Angiovac thrombectomy device • Practice suggestions are in the works: • collaborating on perioperative K+, Aspirin • Regional anesthesia team co-produced helpful suggestions for your reference • We welcome your collaborative ideas for improvement in safety and efficiency Vascular Surgery Team http://www.ohsu.edu/xd/health/services/heart-vascular/services/vascular-surgery/our-team.cfm

13. 8C-ICU Process Improvement Projects • SOR – ICU Transfer of Care • Expansion of cardiac surgery admission standard to all direct to ICU admission in all adult ICUs • Partnering with PICU staff to adapt similar process • Vocera for ICU providers on CSI team (pilot) • OPEX: Implementation of several Management Standards (including): • TAVR: mandatory team huddles (post admission, 4h, 8h, twice daily) • Use of renal replacement therapy for volume management in acute RV failure • AM huddle (next slide) pilot (now expanding to all Adult ICU

14. AY 2015: OHSU future conceptKnight CVICU CVICU Physical union in 1 location 12K • Majority requires ICU admission due to advanced cardiovascular comorbidities • Patient with EGS involvement will be admitted to SICU • Ortho Spine has already been merged with NSICU to group all spine surgeries

15. New CVICU – Collaboration between Anesthesiology, Surgery and Cardiology • CVICU Leadership: Matthias Merkel • Teams: • 2 day teams • 1 night team • 26 ICU beds • Faculty changes: • APOM: • 7 MD faculty members • APP: additional 3.5 FTE (total 8.5 FTE • Pulmonary Critical Care: • 5 Faculty members • Cardiology: • Planned 3 additional FTE • 1 ICU fellowship trained cardiologist recruited

16. Regional Anesthesia 2013-2014 Year in ReviewGlenn Woodworth, MD Director Regional Anesthesia Department of Anesthesiology and Perioperative Medicine

17. 2013-2014 Regional Anesthesia Projects • Improve team communications • regional service, primary anesthesia team, surgical service, nursing • Improve Patient Care • Evaluation in the PACU before hand-off to APS • Better intraoperative management of catheters • First case starts • Coordination with preop nursing, regional service and primary anesthesia team to facilitate on-time first case starts

18. 2013-2014 Regional Anesthesia Projects • Develop, Refine and Implement Clinical Care Pathways (Perioperative surgical home?) • Vascular surgery • Bariatric surgery • Total Joints • Patients with potential peripheral nerve injury • Handling of home pump telephone calls • Evaluation of the efficacy of a new drug (Exparel: bupi-liposome suspension) against standard care in a clinical or translational model

19. 2013-2014 Regional Anesthesia Projects • Develop and Implement an organized curriculum for regional anesthesia training • Core Regional Rotation • Advanced Regional Rotation • Regional Fellow • Research • Validation of an Ultrasound Skills assessment • Validation of a Needling Skills assessment • Evaluation of the effects of Tens stimulation on PNB onset

20. 2014-2015 • Faculty Development • Recruit additional regional faculty • Encourage and support research in regional anesthesia and acute pain medicine • Establish OHSU as a National Leader in Regional Anesthesia Education • Better Collaboration with our Surgical Colleagues Clinical Education Research

21. Pain Medicine • The Pain Division continues to be busy both in and outpatient. • New efforts to increase clinical and research collaboration with Knight Cancer Center. • Research ~ 7 papers: fibromyalgia and light sensitivity assessed with fMRI, new spinal cord stimulation device, Yoga and cancer.  Presentations at American Pain Society, American Academy of Pain Medicine, and American Society of Regional Anesthesia, with Andrei Sdrulla winning the Best of Meeting award for his abstract. • Future move

22. Adult Inpatient Anesthesia

23. Properly Prepared Patient (patient is ready for surgery and OHSU is ready for the patient) Surgical Patient Flow & Experience Improvement Events (Kaizen) - completed Information to patient & family Recovery duration Properly prepared patient 2.0 On-time 1st case start O.R. Turnover Time PMC capacity Properly prepared patient 1.0 Intra-op documentation Procedure card Work place organization Inventory Management Standard Work and Daily Management Systems (DMS) future Tray replenish. Proc Start to Close Level loading across the week Level loading within the day In room to Anesth Ready Anesth Ready to Proc Start Close to patient out Consolidate instrum.

24. SOR/PACU Accomplishments • Opex Kaizen events complete: • Turnover time • First case start time • PACU phase 1 and 2 time • Properly prepared patient (scheduling) • Procedure cards, item file (equipment) • Events launched • In room to anesthesia ready • Anesthesia ready to cut

25. SOR/PACU Accomplishments • Improved SCIP performance metrics (antibiotic administration, patient warming/temp, beta blocker administration) • Improved patient satisfaction metrics • Improved first case start times • Improved OR/ICU transfer process • Expanded specialized care teams (VAD patients) • Restructured weekend staffing model

26. Standard Work for First Case Starts: Patients, 6A Staff, SOR RNs Anesthesia, and Surgeons • Consistently monitor and countermeasure • Highlights: • Daily Huddles leading to interdisciplinary communication and collaboration • Daily Management Systems trending and addressing abnormalities • Focus on evaluating standard work and workarounds

28. SOR/PACU Goals • Launch further Opex Kaizen events: • Cut to close • Close to out of room • Other patient and equipment prep projects • Further metrics to tackle: • Reduce ambulatory volume in SOR from 15% to 10% • 10% reduction in case cost • Smooth the schedule: ‘level load’ • Better impact on turnover time

29. Standard work for eight different roles • Initial improvement, sustained • Larger barriers had specific work to: • Address gaps in schedule • Signaling for the next patient • Next steps to address “longer” delays

30. Be a Leader Initiate theTEAM HUDDLE

31. SOR/PACU Goals • Better socialize standard work from Kaizen events- emails, grand rounds, direct feedback • Streamline clinical care pathways and create easier online accessibility to this information • Extend patient education and preparation to PMC

32. Perioperative Pacemaker Program: 2013-2014 Accomplishments • Ongoing expansion of program • We are currently training our 6th team member (Ryan Anderson) • In collaboration with EP, ICU and palliative care, developed new protocol for PM deactivation for end of life care • The program now provides near 100% of periop. coverage, average >2 consults per day • Ongoing funded clinical research study • Completed several associated publications, internal and external presentations

33. Out of OR: 2013-2014 Accomplishments • New collaborative agreement with GI to improve efficiency • New collaborative agreement with Cardiac Cath. Lab to increase block time, improve efficiency • New INR activation protocol – APOM now only mobilized when actually needed • Improved compliance with deep sedation policy & developed “rescue sedation” protocol for cath lab

34. Out of OR: 2014-2015 Goals • Cont. to work to improve efficiency and processes of care at OOR sites, especially in light of significant growth in OOR volume that is anticipated over coming year • Develop more defined protocols (systems based care) for OOR cases • Improve OOR experience for residents: expand and improve OOR rotation curriculum • Complete MRI improvement project (PI=Doug Arditi)

35. Center for Health & Healing Ambulatory Surgery Center

36. Accomplishments for the past year • Installed High Definition Nu Boom in OR # 5 to expand Urology capability. • Initiated Opex huddle to improve facility administration. • Reduced work hours to realign staffing with actual surgical volumes.

37. Goals for the Coming Year • Continue to recruit new surgical volume • Improve efficiency of care delivery and facility through-put • Expand and improve team-building through didactic and clinical training • Participate in long-range planning for expansion of Ambulatory Surgery Services at OHSU by participating in the planning and design of CHH2 (CHH South).

38. NOR Goals • Improve patient experience by: • Distributing patients between A and D pods to enhance patient privacy • Additional training for DayStay nurses • Maintain 18 month record of best on-time, first-case starts. • Install new privacy curtains for all patient bays. • Upgrade monitors in B and C pods

39. Portland VAMC Dept of Anesthesia- Highlights 2013-2014

40. Personnel changes: Grace Chien stepped down as Chief of Anesthesiology in Nov 2013. Mini Dogra currently the Acting Chief. PVAMC Anesthesiology Residency Site Director and Director of CBY:  David Wilson took over from Linda Wylie

41. Access and Backlog reduction in Operative Care • Prior to recent allegations, PVAMC approved for staged expansion from 9 to 11 ORs/day and additional out-of-OR anesthesia resources • Will be able to add 1600 cases per year with increasing to 11 rooms by 2015 • Restructuring of the Pre-Operative clinic: Added a new pre-op clinic specific to certain cases to increase throughput . • Expansion of out of OR Anesthesia care in sites e.g. GI for endoscopy

42. VA Research • Research protocol for rotator cuff surgery and Acupuncture for post-operative pain submitted. • Diane Miller:Feasibility and Acceptability of Group Acupuncture in Veterans with Hepatitis C:A Pilot Study: • Drew Oken: Aliskiren: A New Harbinger of Hypotension? • Eric Schnell: 4 publications related to mechanisms of injury from head trauma

43. VA Education • Interns: David Wilson has developed a curriculum to help interns study for their in-training examination. • Drs. Wilson and Mitchell have mentored Dr. Vega in developing a curriculum for “perioperative surgical home models” within the peri-operative rotation. • Faculty continue to be resident advisers

44. APOM CQI Committee 2013 Highlights

45. Dr. L. Michele Noles • Joined the CQI team in February 2014 as Chief Quality Officer and Chair of CQI Committee • Goals • Improve turnaround times for CQI case reviews • Work with Education Office to involve residents in educational Quality Improvement Projects • Create Quality ASPIRE track • Work with hospital QEC and national data to ensure APOM’s standing as a quality leader • Identify, measure, improve and publish Quality initiatives.

46. Grand Rounds:Value assessment by attendees Scale of 1 (poor) to 5 (excellent)

47. 2013-14 Committee Productivity Committee Members: Michele Noles, MD (Chair) Ed Kahl, MD Glenn Woodworth, MD Julio Gonzalez, MD Karen Hand, MD Lars Hegnell, MD Mark Zornow, MD Mary Blanchette, MD Matthias Merkel, MD Andi Orfanakis, MD Rebecca Hall, MD Diane Knapp, CRNA Jamie Eastman, PhD Matt Schreiner • 229 Cases reported, reviewed and logged for CQI between July 1, 2013 and May 1, 2014 • 41 Grand Rounds featuring 30 internal speakers and visiting professors from Universities such as Stanford, Columbia, and Michigan

48. Accomplishments and Goals Research

49. Research – Accomplishments • Made important scientific advances related to: • Understanding mechanisms of stroke (N. Alkayed) • Biomarker discovery in Alzheimer’s Disease (J. Saugstad) • CSF dynamics in Traumatic Brain Injury (J. Iliff) • Neuro-inflammatory mechanisms after cardiac arrest (I. Koerner) • Anesthetic effects on the developing brain (A. Brambrink) • Mechanism of epilepsy after traumatic brain injury (E. Schnell) • Acute Kidney Injury (M. Hutchens) • Airway Management (M. Aziz) • Cardiac implantable electronic devices (P. Schulman) • Anesthesia Educational Research (G. Woodworth) • Anesthetic effects in the aging brain (K. Schenning)

50. Research – Accomplishments • Received more than 3 million dollars of grant funding • Published more than 40 original peer-reviewed research articles • 2 patents • Developed an innovative process and accounting system to support use of shared core resources • Fostered interdisciplinary collaborations throughout OHSU