Mayo Clinic - my experience

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Mayo Clinic - my experience

  1. 1. Rochester, Minnesota October 2009.Helga Komen Ušljebrka , MD anesthesiologist
  2. 2. Mayo Clinic Rochester, Minnesota 1889.Scottsdale,Arizona1987. Jacksonville, Florida 1986.
  3. 3. 1883. Tornado in Rochester, MN
  4. 4. St. Marys Hospital, 1889.
  5. 5. St. Marys Hospital, 1930s.
  6. 6. William and Charlie MayoDr. Will Mayo: ‘The best interest of the patient is the only interest to be considered’
  7. 7. Operating room, 1890s
  8. 8. First X-ray image on Mayo Clinic, 1897.
  9. 9. - 1901. First Clinic Business Manager- 1905. L. Wilson, quick-frozen tissuestained with methylene-blue- 1914. Isolated thyroxin- 1915. One of the world’s first formalgraduate training programs, many visitingphysicians- 1920. System for grading cancer (ACBroders)- 1920. Basal metabolic rate (WM Boothby)- 1934. Isolated cortisone (E. Kendall)- 1934. First use of thiopental (JS Lundy)- 1944. First application of streptomycin
  10. 10. Aero Medical Unit, 1942. (CA Lindbergh)...developing prototype oxygen mask for pilots
  11. 11. Aero Medical Unit - centrifuge
  12. 12. - 1950. Nobel prize (Kendall and Hench)- 1954. Methodist Hospital- 1955. First open heart surgery (JWKirklin)- 1969. Total hip replacement- 1973. First CT scanner in North America- 1975. Computerized system with barcodes- 1992. Mayo Health System – a regionalnetwork of clinics and hospitals- 2000. Mayo Clinic Transplant Center- 2002. Comprehensive Cancer Center- 2005. Electronical Medical Record
  13. 13. St. Marys Hospital
  14. 14. St. Marys Hospital
  15. 15. St. Marys Hospital
  16. 16. Plummer building, 1928.
  17. 17. Lobby of Plummer building
  18. 18. Library of Plummer building
  19. 19. Methodist Hospital, 1954.
  20. 20. Gonda building, 2001.
  21. 21. Lobby of Gonda building
  22. 22. Government- Private group practice- 33-member ‘Board of Trustees’-public members, Mayo physicians andadministrators-President and CEO of Mayo ClinicJohn Noseworthy, MD, Professor ofNeurology, Interests - multiple sclerosis,Editor-in-chief of ‘Neurology’
  23. 23. 2008. Personnel (MN)- 2.000 staff physicans and scientists- 2.800 residents, fellows and students- 28.000 health staff- 32.800 TOTALFlorida 4.869 total staffArizona 5.079 total staff
  24. 24. Mayo Clinic Hospitals Saint Marys Rochester Hospital Methodist HospitalLicensed beds 1,265 794availableAdmissions/ye 43,002 18,662arOperating 55 41roomsSurgical 28,071 24,421cases/year.......5 MILLION M2 .........
  25. 25. A typical day at Mayo Clinic:Outpatient visits 5,746Admissions to hospital 241Surgical procedures 205Lab tests 41.000Radiology procedures 3.779CT scans 647Chest X-rays 702MRIs 244Units of blood components used 213
  26. 26. 2008. Financial informationRevenue $7,222 millionsTotal Assets $8,333 millionsEducation and Research Funding Sources $763 m.(Government $372 m., Benefactors $391 m.)
  27. 27. ....Second best U.S. Hospital for 2009. (U.S.News&World Report, July 17, 2009.)No.1 hospital in: Digestive disorders Diabetes and endocrine disorders Neurology and Neurosurgery Orthopaedics
  28. 28. Mayo Clinic Model of CareClinical Researchpractice Education
  29. 29. Education Everyday lectures- Clinical Case Conferences- Core Curriculum Lectures- Introductory Lecture Series- Journal Clubs- Key Word Phrase Mini-lectures- Morbidity and Mortality Conferences- Oral Board Reviews- Formal practice oral examinations- Subspecialty Mini-lectures- Written Board Reviews- Multidisciplinary Simulation CenterOBLIGATE! – BLS, ALS
  30. 30. Education Evaluation.........Monthly evaluation of trainees by supervising faculty memebers........Quarterly each trainee meets with their faculty advisor to reviewprogress and goals........Twice a year chair of Clinical Competence Committee giveswritten clinical competence evaluation of trainee.........Trainees monthly evaluate faculty and rotations....American Board of Anesthesiology (ABA) In-Training Examinationyearly. ....nine members of Mayo’s current anesthesiology facultyCERTIFICATION – Written and oral exam by ABA
  31. 31. Clinical practice Patient orientated Dr. Will Mayo: ‘The best interest of thepatient is the only interest to be considered’
  32. 32. Clinical practice Patient orientated- Collegial staff teamwork .....’no one is bigenough to be independent of others’- An unhurried examination- Physicans personal responsibility forpatient care- Comprehensive evaluation- Availability of advanced diagnostic andtherapeutic technology
  33. 33. Research- Clinical Research Units – inpatients,outpatients, mobile facility (research vehicle)- cca 400 projects/year- 2800 publications a year in biomedicaljournals- Research training – clinical and laboratory....Optional - Clinician-Investigator Program
  34. 34. ResearchSome of projects...- Genetic markers for intracranial aneurysms among family members-The influence of tobacco on the extent and likelihood of proximalprogression of ulcerative colitis-Supplemental method of controlling pain in pancreatic cancer patients-Left ventricular-based cardiac stimulation postAV node ablation evaluation (PAVE)-Effectiveness of sildenafil to placebo in patientswith diastolic heart failure-Comparison of Tacrolimus and Sirolmius immunosuppression in kidney transplant patients-Memory support system for patients with amnesticmild cognitive impairment .......... Impact factor 4,81
  35. 35. Similarities and differencies Drugs- phenylephrine vs. efedrine- glycopirolate vs. atropin- sucynilcoline vs. rocuronium- Isoflurane® vs. Sevoflurane® STUDIJA .....propofol, fentanyl...Drug delivery in induction by Consultant- bupivacaine vs. levobupivacaine
  36. 36. Similarities and differencies Ventilation in OR- anesthesia machine BLEASE®- protective lung ventilation: 6 ml/kg x f of breathing, etCO2 4.7-6.0 kPa, PEEP 5 kPa, recruitment every 1.5 hour
  37. 37. Similarities and differencies Regional anesthesia- 2 month rotation – recovery days, OR days- US (Sonosite® Micromax) guided blocks- Neurostimulator guided continous blocks- aseptic conditions- premedication with midazolam, monitoring (SpO2,BP cuff, ECG, temperature probe)
  38. 38. Similarities and differencies Regional anesthesiaExamples:1. Knee replacement – sciatic block (30 ml 0,25%bupivacaine) + femoral cont. block (test 5 ml xylo.,bolus 20 ml 0,25% bupivacaine).......+ SAB2. Hip replacement – psoas cont. Block (test 5 mlxylo, bolus 25 ml 0,25% bupivacaine) + femoral cont.block (test 5 ml xylo., bolus 20 ml 0,25%bupivacaine).......+ SAB
  39. 39. Mayo Clinic Model of Care....Obama’s Model of Care Sept. 2009., ABC News‘.....best quality and the lowest cost........because of the minimized patient tests, fixed doctors salaries, electronic records and team work....’
  40. 40. Referring patient to Mayo Clinic.......Anyone can request an appointment atMayo ClinicMayo Clinic’s Referring Physician Offices (24hours a day) – tel: 800-533-1564.....Online serviceswww.mayoclinic.org/medicalprofs
  41. 41. Collaboration with: J. Sprung, MD, Ph.D., prof. anesthesiologyO. Gajić, MD, Ph.D., anesthesiologist (head medical ICU)R. Flick, MD, pediatrician, anesthesiologist (head PICU)H. Smith, MD, anesthesiologist, regional ansthesiaB. Hoelzer, anesthesiologist , invasive pain proceduresM. Huntoon, MD, anesthesiologist, cancer painT. Harrison, MD, anesthesiologist (pediatric), pain clinicJ. Munis, MD, neuroanesthesiologistE. Wijdicks, MD, Ph.D., neurologist (head ICU)W. Nicholson, MD, clinical pharmacologistR. White, MD, anesthesiologist, reanimatology
  42. 42. Art&Healing.....since 1955. Ivan Meštrović, ‘Man and Freedom’ Lobby of Gonda building
  43. 43. Art&Healing.....since 1955. Dale Chihuly’s Chandeliers, Lobby of Gonda building
  44. 44. Art&Healing.....since 1955. Auguste Rodin, ‘Jaine d’Aire’ Siebens building
  45. 45. Art&Healing.....since 1955. Andy Warhol, ‘Flowers’
  46. 46. Art&Healing.....since 1955. Joan Miro
  47. 47. H Komen U, RD Miller, J Sprung Plummer house Miller RD, Hyatt RE. Evaluation of obstructing lesions of the trachea and larynx by flow-volume loops. Am Rev Respir Dis. 1973 Sep;108(3):475–481.
  48. 48. HVALA !

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