Volume 24 • No. 5 • MAY 2000
A
Novel Thought?
Hospital turns toward service
Response prepared to national medical errors report
1. Anesthesia at Stanford Hospital and Clinics is provided by three services: the university departmental group, Associated Anesthesiologist Medical Group Inc., and the Palo Alto Medical Foundation. All three groups share block time to provide clinical care in the SHC main operating rooms, the ambulatory surgery unit, the cardiac catheterization laboratory and radiology. The university group also provides services in the obstetrical suite, the Pain Management Clinic (directed by medical staff vice president Ray Gaeta, associate professor of anesthesiology), the Intensive Care Unit (where attending services are shared with the Division of Pulmonary Medicine), the Complementary Medicine Clinic, the Gynecology Clinic (oocyte retrieval) and in Packard Children's Hospital.
2. Fiscal year 1999 saw a 9 percent increase in cases and a 12 percent rise in surgical hours for all anesthesia groups in the main OR and the Ambulatory Surgery Center. In the main OR, 15,468 cases accounted for 43,888 hours. In the ASC, 13,401 cases tallied 17,602 hours.
3. Significant growth in 1999 was logged in pediatric anesthesia, including expansions in the areas of inpatient acute pain management, outpatient chronic pain management, pediatric cardiac surgery and general pediatric surgery. Also showing increases in volume were obstetrical anesthesia, the Acute Pain Service, including the Pain Management Clinic (which recruited two faculty members in 1999), MRI, CT, endoscopy, interventional radiology, pediatric outpatient procedures, egg retrieval and ECT procedures.
4. The university anesthesia faculty totals 45 anesthesiologists plus three Ph.D. researchers, including eight faculty pediatric anesthesiologists. Eight to 10 faculty members are assigned to the Palo Alto Veterans Affairs Health Care System. Faculty time spent in clinical vs. research duties is individually negotiated and ranges from approximately 40 to 100 percent time. Ten physicians comprise the Palo Alto-based Associated Anesthesiologist Medical Group Inc., headed by Lynn Rosenstock. The Palo Alto Medical Foundation's anesthesia group includes 10 anesthesiologists and is headed by Thomas L. Gaston.
5. Residents rotate among SHC, the PAVAHCS and Santa Clara Valley Medical Center (SCVMC). At SCVMC, resident supervision is provided by voluntary clinical faculty members on the staff of that institution.
6. Training at Stanford is available in pediatric, obstetric, cardiovascular, thoracic surgery, pain management, critical care medicine, neuroanesthesia and ENT anesthesia. Subspecialty training is also offered in transesophageal echocardiography and pediatric cardiac anesthesia.
7. Ronald G. Pearl came to Stanford in 1977 after receiving his M.D. from the University of Chicago, where in 1975 he completed a Ph.D. in pharmacological and physiological sciences. At Stanford, Pearl finished an internal medicine residency in 1980 and a fellowship in critical care medicine in 1981. He served in several staff physician capacities, including associate medical director of the intensive care units, before completing an anesthesia residency here in 1985. He joined the faculty and in 1986 became associate director of the intensive care units- a post he continues to hold along with associate medical director of the Medical Transport Program. He was appointed associate professor in 1992, associate chair for clinical affairs and finance in 1997, chair in 1999 and full professor in February this year.
8. Elliot J. Krane received his M.D. from the University of Arizona in 1977 and served his residency in pediatrics and anesthesia at Massachusetts General Hospital, Boston. After serving a fellowship in anesthesia and intensive care at Children's Hospital and Medical Center, Boston, in 1982-83, Krane joined the University of Washington School of Medicine faculty. He came to Stanford in 1994 as a professor in anesthesia and, a year later, was appointed to the faculty in pediatrics. He serves on many editorial boards, has authored numerous clinical studies and is a medical advisor to several international organizations, including Project Hope.
9. Lynn L.B. Rosenstock, received her M.D. from Washington University, St. Louis, in 1963. She served a surgical residency, 1964-65, at Bellevue Hospital, New York University Division and then completed an anesthesiology residency in 1969 at Columbia University's Presbyterian Hospital program. Rosenstock served on the faculties at Einstein Medical School, New York and from 1970 to 1972 at Stanford. She joined Associated Anesthesiologists and the Stanford voluntary clinical faculty in 1975 after five years in practice at San Mateo County General Hospital (Chope). Since 1988, Rosenstock has been president of Associated Anesthesiologists. She has been active in departmental and hospital affairs at Stanford, including seven years, 1985-92, as deputy chief of the Department of Anesthesia. Rosenstock is active in Santa Clara County Medical Association affairs and as a mentor for women entering the medical profession.
10. The Department of Anesthesia and Pearl may be reached at (650) 723-5024 (RGP@leland.stanford.edu), Krane at 723-5728 (Krane@stanford.edu) and Rosenstock at (650) 323-0617 (LBRNROSEN@aol.com).
