I am an Associate Professor in the department of Anesthesiology at Stanford University and a Staff Physician at the Palo Alto Veterans Affairs Hospital. My main academic focus is on improving the performance and delivery of medical care to critically ill patients. For me this involves establishing better definitions of critical illness and creating means to better identify patients that benefit from ICU admission. In the past, this has led to studies on the prognostic value of vital signs in ward patients, creation of a medical emergency team, and establishment of better systems to examine the origin and outcomes of critical events such as codes, emergency team calls, and ICU admissions. To improve the delivery of key resources to critically ill patients, the VA Palo Alto has been one of the earliest users of diagnostic modalities such as portable echo, and point-or care blood gas analysis outside of the ICU. I have also worked closely with a number of other departments and services to better identify, triage and provide early care of septic patients, and develop massive transfusion procedures.
While my goal for establishment of the medical emergency team was to put our code team out of business, this effort also led me to becoming in charge of the code team! In this capacity, we have redesigned our approach to cardiac arrest management and have developed a number of training programs for code team participants; the latter have been propagated throughout the US Veterans affairs hospitals as part of the “Sim Learn” program. Interestingly, the principles and concepts for arrest management we implemented were derived and applied concurrently and completely independently at UCSD by Dr. Dan Davis, another Kritikus board member. I have done some small-scale research in the area of cardiac arrests, and hope to establish reporting standards for arrests within the VA system.
It is also important to understand ways of improving the care of patients once in the ICU, and toward that end, have been an avid user of simulation systems to introduce the concepts of teamwork to the ICU staff and trainees. Our group was one of the first to deploy inter-professional simulation in critical care in the late 1990s. We have also developed simulation-based metrics of performance in managing septic shock and have used such to evaluate the impact of educational programs.