Care and Feeding of Chest Tubes

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Care and Feeding of Chest Tubes

  1. 1. Pulmonary/Critical Care Fellowship Program Phoenix VA/BGSMC
  2. 2. History  Fellowship started in 1980  Three Year Fellowship Program  Leads to certification in : – Pulmonary Disease – Critical Care
  3. 3. History  As of June 2008, ALL graduated fellows: Board Certified  Graduated Fellows: primarily in Private Practice
  4. 4. Staff Members VAMC  Richard A. Robbins – Program Director, Chief Pulmonary/Critical Care VAMC  Owen Austrheim – Associate Section Chief & Director, Sleep Medicine VAMC  Lillibeth Pineda  Patricia Rocha  John Roehrs  Clement Singarajah – Director Critical Care VAMC  Allen Thomas – Director Pulmonary VAMC
  5. 5. Staff Members (BGSMC)  Pulmonary Associates – David Baratz (Director Pulmonary BGSMC) – Mark Gottfried – Manny Mathew – Da-Wei Liao  SAFA (Critical Care BGSMC) – Robert Rashke (Director Critical Care BGSMC) – Huw Owen-Reece – Thomas Bajo  Arizona Center Chest Diseases – Arcot Premkuar – Cameron Dick
  6. 6. Other Affiliated Hospitals  Mayo Clinic – Pulmonary Pathology  St. Josephs Medical Center – Pulmonary transplant – SICU/Trauma  Scottsdale Shea – Pulmonary radiology  JC Lincoln – Trauma  Maricopa Medical Center – Pulmonary – MICU
  7. 7. Current Fellows  Kevin Park (Third Year Fellow)  Evan Schmitz (Third Year Fellow)  Roxanne Garcia-Orr (Second Year Fellow)  Jessica Hurley (Second Year Fellow)  Christian Jivcu (First Year Fellow)  Henry Leudy (First Year Fellow)  Emad Wissa (First Year Fellow)
  8. 8. Pulmonary Fellows (2011)  Tonya Whiting (Good Samaritan)  Joshua Jewell (University of Nevada)
  9. 9. Current Fellow Demographics (includes 2011 fellows)  4 /9 are from the Good Samaritan residency program  Other institutions include University of Massachusetts, Rutgers, St. Joseph’s in Phoenix, Maricopa in Phoenix.  3 / 9 are international graduates.
  10. 10. VA Staff  Fellowship coordinator (Nancy Brown)  1 research PhD  1 physician assistant  1 research coordinator  Multiple respiratory therapists including – Bronchoscopy – Oxygen/CPAP  2 section secretaries
  11. 11. VA Pulmonary Critical Care Section  Endoscopy suite (flouro, Super Dimension)  Sleep Lab (3 beds)  MICU (10 beds)  3 pulmonary function labs (>1000 PFTs per year)
  12. 12. Fellowship Program Structure  3 year Program (Clinical) – 6 months research – 30 months clinical (below is approximate and can be varied)  10 months VA – Half pulmonary/half ICU  10 months BGSMC – Half pulmonary/half ICU  10 months electives
  13. 13. Fellowship Program Structure - VA  Consultations (in-patients)  Pulmonary Clinic (1/2 day once a week at VAMC and 1/2 day once a week at private office).  MICU (closed unit with primary care responsibility).
  14. 14. Fellowship Program Structure - BGSMC  Pulmonary –Consultation and primary care  ICU –Primary care
  15. 15. Fellowship Program Structure Most Popular Electives  Pathology Mayo Clinic  Sleep (both VA and BGSMC)  Infectious disease (BGSMC)  Toxicology (BGSMC)  Pulmonary transplant (St. Josephs)  Pulmonary radiology (Shea)
  16. 16. Clinical and Basic Research  Biostatitics/Epidemiology (Dr Gerkin BGSMC)  Areas of interest: – COPD – Pulmonary inflammation – Nitric oxide and oxidants – Clinical research
  17. 17. Fellowship Program Structure – Most fellows present at national meetings (ATS or ACCP). – Case presentations at both Arizona ATS and National ATS
  18. 18. Pulmonary/Critical Care Conferences  Wednesdays (2-4 hours) – Journal Club – Pulmonary presentation – Critical care presentations  Monthly-Arizona ATS multidisciplinary conference  Every 2 weeks-tumor board
  19. 19. Fellowship Weekend Call  2 fellows BGSMC – One in ICU – One in Pulmonary  1 fellow at VA (AM only)  BGSMC pulmonary fellow covers nights at VA.
  20. 20. Fellowship Governance  Fellowship Committee – 5 faculty  Robbins, Baratz, Rashke, Singarajah, Thomas – 3 fellows  one from each year – Meets monthly
  21. 21. VA Pulmonary Fellowship Consults & Procedures  Consultations: >3000  Bronchoscopies: >200  Sleep studies: >500  Other frequent procedures – Needle biopsies ─ Chest tubes – Thoracentesis ─ Central lines – Pleural biopsies ─ Pleurex cathers
  22. 22.  Average ICU census ~ 7  Critical Care Consults: ~50  Procedures in ICU per year – Percutaneous tracheostomies: ~50 – Bronchoscopies: ~120 – Intubations: ~120 – Variety of other ICU procedures (lines, thoracentesis, paracentesis, etc) done mostly by residents with fellow supervision VA Critical Care Fellowship Census & Procedures
  23. 23. Banner GSMC Pulmonary Rotation  Average Daily Census - 25 7 ICU patients 18 ward patients  Average Consults / Day – 5  Supervision of Residents / Medical Students that are on service
  24. 24. Banner GSMC Pulmonary Rotation  Procedures per year – Percutaneous tracheostomies: ~50 – Bronchoscopies: ~200 – Intubations: ~ 100 – Variety of other ICU procedures (lines, thoracentesis, paracentesis, etc)
  25. 25. Pulmonary Associates Continuity Clinic  Each fellow works a half day per week in the Pulmonary Associates office seeing private practice patients with a wide variety of pulmonary diseases.  Fellows will have direct responsibility for patients on an ongoing basis over 3 years.  An opportunity to interact with private practice pulmonary medicine
  26. 26. GOALS  Board Certification  Consultant in Pulmonary and Critical Care  Clinical Research  Provide direct patient care especially in ICU  Competence in bronchoscopy and other procedures  Teaching
  27. 27. Ultimate Goal LEADER IN PULMONARY and CRITICAL CARE !!!

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