Anesthesia-Guided Palliative Care in the Perioperative Surgical Home Model.
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Cobert, Julien, Jennifer Hauck, Ellen Flanagan, Nancy Knudsen and Anthony Galanos (2018). Anesthesia-Guided Palliative Care in the Perioperative Surgical Home Model. Anesthesia and analgesia, 127(1). pp. 284–288. 10.1213/ane.0000000000002775 Retrieved from https://hdl.handle.net/10161/26110.
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Healthcare costs in the United States are at an all time high. In 1997, 13.5% of the Gross Domestic Product was spent on healthcare. Ten percent or 1.3% was spent in the intensive care unit (ICU). Over 500,000 patients/year die in an ICU setting. ICU mortality rates average 10-20%. Intensivists are now widely recognized as one of the keys to improving outcome in the length of stay and cost/case. My research interests lie in utilizing our scarce resources for the most appropriate patients, those who will derive the most benefit from ICU care. Through analyzing the transfers to our ICU, we have found that those patients on a ventilator and with renal failure have a higher mortality than other patients. Scoring systems have been routinely used as well, but can be difficult to apply in the small hospital setting. We have also documented that over half of the trauma and floor emergencies appear at night when most institutions do not have attendings available. The Duke ICU has had in-house attending coverage since 1998 and has a mortality rate of 4% for the year 2001. It is not enough to just improve care, but to improve the experience for the family during this very stressful time. We have shown that the presence of intensivists 24/7 has improved family communication and satisfaction as well. My goals are to continue to improve outcomes for patients and their families by streamlining care yet keeping an eye on the individual patient and their family's emotional needs.
I am also interested in mechanical ventilation and ways to improve morbidity/mortality in this group of patients. I am a member of the Duke ARDSnet and Duke ARDSnet2 research teams.
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