410 W 10th Ave
Columbus, OH 43210
Phone: (614) 293-8487
Assistant Professor-Clinical, Anesthesiology
Anesthesia for Electrophysiology Procedures
Anesthesia for Structural Heart Disease Procedures
I have supported several youth athletic teams, including assistant coaching (formally or informally) for baseball and basketball. I have supported Columbus City Ballet. I have supported and been a member of St Patrick Parish in Columbus
I am a board certified anesthesiologist with subspecialty expertise in cardiovascular and thoracic anesthesia.
Having been in private practice for 16 years, I moved to Columbus in 2007 to complete a fellowship in cardiothoracic and vascular anesthesia here at Ohio State. Upon completion of the fellowship, and now American Board of Echocardiography certified in transesophageal echocardiography, I was persuaded to stay on as faculty at Ohio State. I was recruited because of my clinical skills, reliability, personal approach to patients, and my gift and love for teaching.
Shortly after beginning my tenure here at OSU, I was named the Director of Perioperative Echocardiography. As such, in cooperation with my CT Anesthesiology colleagues, I have implemented major change in the perioperative echo service here at OSU. To wit:
1. I took the initiative to transform a failed archiving system for our intraoperative studies into a consistent, reliable system. The situation in 2008 was such that the necessary wired ports to upload the studies were literally pulled out of the walls in all of our CV operating rooms. Very few studies were being successfully archived for future reference or comparison. On my initiative, we partnered with our IT and PACS departments to design wireless transfer of all of our images from all of our echo machines into the archives, simply and automatically. This has made studies accessible after the fact which were unavailable to clinicians before my intervention. We thus went from a clinical (and possibly medico-legal) liability to a strength.
2. At my urging, and in response to a clear clinical need, we began providing intra-procedure TEE monitoring and guidance in the EP and Cath Labs. This had never been done before and required discreet dialogue in order to respect the legitimate domain of the cardiology echo service. Under my directorship over the last several years, it has now become commonplace, indeed routine for some procedures, for CT anesthesiologists to provide TEE services in the EP lab. We also provide TEE guidance for transcatheter aortic valve replacements (TAVRs), Mitra-Clips, and other interventional cardiology procedures when a cardiologist is not available. This provides direct patient and institutional benefit. In some cases, the patients previously underwent the procedures without echo guidance. In others, there were substantial delays or cancellations due to the inability to coordinate schedules with the very busy echo lab. Because our entire team of CT anesthesiologists is now accepted as competent to provide the needed expertise, these delays and cancellations are a thing of the past.
3. Together with Mike Andritsos (CT Anesthesiology Director), I worked to move us from a paper intraoperative TEE record to an electronic one. Prior to this, the paper copy was frequently “lost” or not properly linked to a case. Even after the medical center EMR “go live”, we were left with paper records until we undertook this initiative ourselves. As a direct result of this effort, departmental billing for our studies went from 48 in 2008 to over 900 in 2015. We are on track to bill for over 1000 studies in 2016.
4. When I took over the directorship, there was no formal training in TEE being given to our faculty here at OSU. With the exception of CV Conference presentations and individual efforts, there was no avenue for keeping the staff’s abilities at the top of the field. Taking advantage of “tuitions” made available to me with the purchase of new machines, I was able to negotiate with Philips and provide state of the art training, including in 3D echo, to our entire faculty. I joined with the Philips staff, and trained our faculty (and fellows) on multiple occasions. In 2014, I was able to “trade in” some of my “tuitions” for a comprehensive two day workshop on the new 3D machines and most recent software. As a result, our entire faculty is now adept at image acquisition, optimization, and quantification, in both 2D and 3D. We thus provide critical data to our surgeons and cardiologists at a level never seen before at this institution. The benefit to patients is self evident.
5. Having identified the lack of any Continuous Quality Improvement initiative for Perioperative Echo, Dr. Andritsos assigned me the task of designing one. I submitted this to Dr. Andritsos in January, 2016. My CQI program, based on American Society of Echo recommendations, sets standards for our department in the areas of:
a) Faculty training, certification, and maintenance of skills
b) Exam content, timeliness of study, interpretation and
c) Supervision of trainees
d) Periodic peer review of faculty exams
e) Equipment maintenance
f) Utilization Review
g) Required Documentation of the above
6. I worked with my entire department to standardize our perioperative exams. We’ve moved from a situation of highly variable exams (e.g., from 3 to 75 or more images, depending on the individual and/or the case) to a consistent, unified effort at obtaining comprehensive exams in the great majority of cases, along with directed post-intervention exams. The change in comprehensiveness and quality of our TEE exams has been dramatic, and is testimony to the dedication and excellence of our entire CT Anesthesiology team. The reaction of our surgeons, cardiologists, sonographers, and others, has been extremely positive and gratifying. Barring contraindications or other rare impediments, clinicians can count on finding complete TEE exams for all heart surgeries and many other cases. This results in more and better information available for patient care, including a significant incidence of the discovery of occult pathology and/or the changing of the surgical/interventional plan as a result of our studies.
7. Prior to my directorship, an OSU sponsored Perioperative TEE Conference had never been contemplated, let alone brought to fruition. I conceived, and in conjunction with Drs. Essandoh, Stein, and Flores, designed two such conferences.
-In 2011, we held the Inaugural Ohio State TEE Conference. This was a local conference with primarily (but not exclusively) OSU attendees. It centered on evaluation and repair of the mitral valve. Four CT anesthesiologists and one CT surgeon presented.
-In 2016, I teamed with our CT surgeons and cardiologists, and for the first time we had a CT Anesthesia and TEE track in the Fourth Annual OSU Structural Heart Disease Conference. This was a huge success, bringing in over 200 participants, most from outside of OSU. This is detailed below, but I will say here that we dramatically improved our image as a center of perioperative TEE excellence by not only bringing in nationally prominent speakers, but also providing several of our own faculty a chance to shine at the podium. As a direct result our participation in this conference, attendance increased by over 33%, we received fantastic evaluations, and generated new outreach for SHD referrals in the state of Ohio (see below). Further, I directly received a request to set up a mentorship program in perioperative TEE for outside physicians here at OSU.
-In addition, Dr. Flores and I teamed up for a workshop on Basic Transthoracic Echo for the Anesthesiologist, presented at the Ohio Society of Anesthesiologists Annual meeting in 2014.
- We look forward to continuing these efforts, as it definitely enhances the image of Ohio State as a comprehensive cardiovascular center of excellence, as well as improving working relations with our surgery and cardiology colleagues and providing a forum for our faculty to gain regional and national prominence.
8. I’ve enhanced the reputation of our section by two personal achievements. First, I applied for and was awarded designation as a Fellow of the American Society of Echocardiography. This designation is given to approximately 10% of all ASE members, and requires the demonstration of significant achievement in echo based education, research, and service. I am the first and only anesthesiologist at Ohio State to achieve FASE status. Indeed, at the time of my FASE designation, there were only three cardiologists from Ohio State listed as FASE on the ASE website. Secondly, I have been selected for, and am now a member of the (national) Committee on Education for the ASE. Both of these will undoubtedly lead to further opportunity for myself and my colleagues — not the least of which is I am recruiting other members of our team to meet the criteria and apply for the FASE designation themselves.
9. Working with Dr. Andritsos, I have lobbied for, evaluated vendors for, negotiated, and secured the purchase of an entire fleet (four, soon to be 5) of state of the art, 3D capable, echo machines. When I became Echo Director, we had three antiquated 2D machines with VCR technology. The images were poor and quantification functions limited. We now have the very best imaging, including real time 3D capability, allowing us to make diagnoses and communicate with surgeons and interventionalists at a level heretofore unseen at Ohio State. Furthermore, I negotiated a contract with Philips such that we are perpetually upgraded with the latest software and given training on any new or improved functions or capabilities.
10. In 2008, echo based scholarship was almost non-existent in our department. There was only one faculty member publishing at all, and this was based on proprietary technology unavailable to the rest of the faculty and primarily a continuation of work done at a previous institution. As a result of our equipment and software upgrades, as well as the extensive training provided to our faculty, we have now provided opportunity for scholarly efforts in echo which simply did not exist previously. Our faculty and fellows have responded enthusiastically, as we now have an ever increasing production of published papers, posters, conference presentations (local, regional, national) and lectures on the topic of TEE — many of them based on 3D imaging and/or new capabilities of the machines (e.g., speckle tracking based strain measurements). Indeed, the majority of our CT Anesthesiology faculty now have TEE based publications to their credit. We are making a name for Ohio State in echo based scholarship.
11. In 2008 we had no resident TEE rotation. We have instituted one, and on two occasions, working with Drs. Andritsos and Iyer, I have improved, and now completely renovated and restructured this rotation. The residents currently rotating through are getting a thorough, structured rotation complete with pre and post-testing, simulator training, individualized lectures, guided exam interpretation, and many opportunities to do their own echoes. This has been a major boon to the residents, especially those required to have these skills as they move on in their careers. We have even had a few residents become certified in Basic Perioperative Echo by the ABE on the basis of our rotation. All of this ultimately benefits patient care, here at OSU and wherever our residents end up practicing.
12. We began an ACGME accredited fellowship in Cardiothoracic and Vascular Anesthesia in Fall 2008. Under the capable direction of Dr. Dimitrova, we have successfully trained 15 fellows. A major part of this training is perioperative echo; all 15 of our fellows have passed the exam for Advanced Certification in Perioperative Echocardiography on the first attempt. This is a testament to the dedication and ability of our faculty, as well as the resources provided to them. In particular, I have personally given individualized lectures and training to all the fellows, and successfully organized wet labs (heart dissection) in cooperation with Dr. Gerhardt, and later, with the CT surgeons. Three of these fellows were eventually hired as faculty here.
13. I have endeavored to improve what were initially admittedly tenuous relationships with our cardiology echo colleagues, as well as the CT surgeons. This has borne fruit in many ways, not all of them readily quantifiable. The most obvious is the cooperation in the Structural Heart Disease Conference this year, but it is also evident in our inclusion in other conferences, the mutual teaching of each others’ fellows, and the palpably increased sense of cooperation between the specialties. I provide further details in the narratives below.
In addition to my efforts as Echo Director, I have been a leader in clinical care in the Section of CT Anesthesiology at Ohio State.
As detailed below, I make a conscious effort to treat my patients with compassion, respect and dignity regardless of circumstance. As a result, I have been a departmental leader in patient satisfaction as evidenced by a medical center award in this category as well as consistent comments, Bravos, etc., from nursing staff, surgical techs, and surgeons (detailed below).
I give excellent clinical care to my patients despite the fact that they are often among the sickest of the sick. I have had a remarkably low complication rate and done very well on our departmental quality metrics over the years. It is a privilege to see the results when people whose very lives hung by a thread go home from the hospital.
I have also been productive, especially when considering my clinical load against my FTE, my unfortunate illnesses, and our subspecialty. This is evident in data provided in my annual reviews, as I have generated above average RVUs on a proportional basis, thus financially supporting all of our missions.
I have been one of the most efficient clinicians in our department (detailed below), regularly ranking at or near the top in first case on-time starts as well as turnover times vs my peers. On several occasions, I have received thanks from numerous surgeons for getting their urgent, emergent, or add-on cases into the operating room expeditiously.
Despite serious illness, I have been exceptionally reliable, even garnering credit in my review letters for working entire years without taking any sick days. I am prompt and dependable, and I go out of my way to help my colleagues whenever possible.
I have a positive attitude in the preop and postop areas, operating rooms and ICU. I take pride in cultivating a positive culture and creating an atmosphere of professionalism and respect in all circumstances. I value every staff member, from the Chair of CT Surgery to the receptionist at the desk. As a result, I have earned the respect of my coworkers.
I am committed to patient safety, having been on multiple patient safety committees for the Ross Heart Hospital. I was instrumental in implementing Crew Resource Management when we installed it as a norm here, and I continue to champion its methodology. I am personally aware of many miscommunications that have been avoided as a result.
Finally, I have made it known to the general anesthesiology staff that they can call me for advice freely. On a fairly routine basis, several of my colleagues on the general side call me with questions about patients and/or cases with difficult or complex cardiovascular histories. In many cases, all that is required is a conversation about the physiology and goals. Occasionally, I’ll change their management or even join them on the case if possible. Finally, in some cases, I recommend having myself or another one of the CT anesthesiologists provide that anesthetic for that patient. These efforts are very much appreciated and I am happy to help.
I have contributed to our educational mission in a substantive way:
A. Developing Core Modules and quizzes for the resident CV rotation
B. Director of CV Resident Education (2010-2013)
C. Co-Director of the Resident TEE Rotation
D. Renovating and restructuring the resident TEE rotation
E. Teaching the residents many new techniques and approaches
so they benefit from my private practice experience
F. Giving high quality, often interactive didactic presentations
to residents, fellows, medical students, and faculty. At this
point these number nearly 400 since I became CT Faculty.
G. I have mentored dozens of students, residents and fellows
over a broad spectrum of topics, but particularly in the area
of TEE instruction.
H. I have guided several residents through their job hunting
process as they neared graduation.
All of these efforts are detailed below, including the resulting awards and accolades I have received as a result.
I have gradually grown in the area of research and scholarship: First by simply supporting the work of others, later by participating directly and even becoming primary investigator and first author on some projects, I have begun to have success in this area as well.
As detailed below, in my time at OSU I have been first author twice (including one clinical trial) and contributing author twice for papers already published and have a paper in submission as last author. I have participated in four IRBs and have at least two papers forthcoming from work already in progress. In addition, I have presented or mentored for presentation (as detailed below) on many, many occasions at the local, state and national level.
My involvement with the Catholic Medical Association at the university, local, and national levels has been extensive and is also detailed below. As a result, I have recently been honored to be named Co-Chair of the CME Committee of the CMA, with oversight over several subcommittees. This is a national organization of over 2000 members with a peer reviewed journal as well as annual and mid-year meetings with Category I CMEs, etc. My committee will oversee all of these meetings, plus online education, our Medical Student Boot Camp, etc. (see below).
I am also an active member of several other professional societies.
Despite four hospitalizations (2009-12) and dealing with critical, and then chronic illness which required me to decrease my FTE, I have rebounded and reached a greater level of achievement with each passing year.
In short, I have given everything I have in the areas of patient care, clinical and extracurricular service, and education. I am happy to say I have had recent success with posters and publications, with more “in the pipeline”.
I have summarized my accomplishments to this point in my career to the best of my ability. My efforts and results have been substantial, but I will always strive to improve.
Ultimately, my greatest impact is found in the many patients I have cared for and the graduates of our program . Their well being and success is my personal metric. I am honored to say that they have spoken well of me.
|2011 - present||, Ohio State University College of Medicine.|
|2014 - present||, The Ohio State University.|
|2013||Elisabeth Matheson, The Ohio State University. Graduated 0.|
|2016||Andrea Fuller, The Ohio State University. Graduated 0.|
|2016||Ibrahim Warsame, The Ohio State University. Graduated 0.|
|2016||Stephen Miller, The Ohio State University. Graduated 0.|
|2016||Nakia Hunter, The Ohio State University. Graduated 0.|
|2008||Alok Moharir, The Ohio State University. Graduated 2009.|
|2008 - 2009||Lucas Mitchel, The Ohio State University. Graduated 2009.|
|2008 - 2009||Ben Morris, The Ohio State University. Graduated 2009.|
|2008 - 2009||Muhammad abd, The Ohio State University. Graduated 2009.|
|2009||Heather Gensel, The Ohio State University. Graduated 2009.|
|2009||Christopher Annis, The Ohio State University. Graduated 2010.|
|2009||Demicha Rankin, The Ohio State University. Graduated 2010.|
|2009 - 2010||Jacob Bettesworth, The Ohio State University. Graduated 2010.|
|2009 - 2010||Steve Beckley, The Ohio State University. Graduated 2010.|
|2009 - 2010||Dwight Mosley, The Ohio State University. Graduated 2010.|
|2009 - 2010||Samuel King, The Ohio State University. Graduated 2010.|
|2010||Nick Franklin, The Ohio State University. Graduated 2010.|
|2010||Brian Kelly, The Ohio State University. Graduated 2010.|
|2010||Gurneet Sandhu, The Ohio State University. Graduated 2011.|
|2010||Mara Grossman, The Ohio State University. Graduated 2011.|
|2010||Tinu Thomas, The Ohio State University. Graduated 2010.|
|2010||Feyce Peralta, The Ohio State University. Graduated 2010.|
|2008 - 2011||Derek Foerschler, The Ohio State University. Graduated 2011.|
|2009 - 2011||Brett Goy, The Ohio State University. Graduated 2011.|
|2010 - 2011||Hokuto Nishioka, The Ohio State University. Graduated 2011.|
|2010 - 2011||Tom Harris, The Ohio State University. Graduated 2011.|
|2011||Yasdet Maldonado, The Ohio State University. Graduated 2011.|
|2011||Alex Porter, The Ohio State University. Graduated 2011.|
|2011||Dane Yuratich, The Ohio State University. Graduated 2012.|
|2011||Lance Shilliam, The Ohio State University. Graduated 2012.|
|2010 - 2012||Jennifer Perrone, The Ohio State University. Graduated 2012.|
|2011 - 2012||Michelle Santiago, The Ohio State University. Graduated 2012.|
|2011 - 2012||Abram Elsenraat, The Ohio State University. Graduated 2012.|
|2011 - 2012||Brian Kelly, The Ohio State University. Graduated 2012.|
|2011 - 2012||Brenda Christopher, The Ohio State University. Graduated 2012.|
|2011 - 2012||Andrew Springer, The Ohio State University. Graduated 2012.|
|2012||Lance Shilliam, The Ohio State University. Graduated 2012.|
|2012||Barry Marks, The Ohio State University. Graduated 2012.|
|2012||Sarah Wendling, The Ohio State University. Graduated 2013.|
|2012||Todd Sleeper, The Ohio State University. Graduated 2012.|
|2012||Brian Schloss, The Ohio State University. Graduated 2012.|
|2012||Michael Hays, The Ohio State University. Graduated 2012.|
|2012||Richard Bryant, The Ohio State University. Graduated 2012.|
|2010 - 2013||Jane Lee, The Ohio State University. Graduated 2013.|
|2013||Jeff Fujii, The Ohio State University. Graduated 2014.|
|2013||Kyle Macaluso, The Ohio State University. Graduated 2014.|
|2013||Eric Egeler, The Ohio State University. Graduated 2014.|
|2013||Jon Godzanovic, The Ohio State University. Graduated 2013.|
|2013||Moumen Asbahi, The Ohio State University. Graduated 2013.|
|2011 - 2014||Jay Duncan, The Ohio State University. Graduated 2014.|
|2011 - 2014||Christopher Dukatz, The Ohio State University. Graduated 2014.|
|2012 - 2014||Amber Beery, The Ohio State University. Graduated 2014.|
|2013 - 2014||Kasey Fiorini, The Ohio State University. Graduated 2014.|
|2013 - 2014||Kiran Chandrashekarappa, The Ohio State University. Graduated 2014.|
|2013 - 2014||Amar Bhatt, The Ohio State University. Graduated 2014.|
|2014||Jesse Richards, The Ohio State University. Graduated 2014.|
|2014||Matthew McConnell, The Ohio State University. Graduated 2014.|
|2014||Alec Lawrence, The Ohio State University. Graduated 2014.|
|2014||Michelle Humeidan, The Ohio State University. Graduated 2015.|
|2014||Peter Dienhart, The Ohio State University. Graduated 2014.|
|2014||Jonathan Lipps, The Ohio State University. Graduated 2014.|
|2014 - 2015||Leonid Gorelik, The Ohio State University. Graduated 2015.|
|2014 - 2015||Jacob Uhler, The Ohio State University. Graduated 2015.|
|2014 - 2015||Matthew Jaruwannakorn, The Ohio State University. Graduated 2015.|
|2015||Michael Powell, The Ohio State University. Graduated 2015.|
|2015||Colleen Wirtz, The Ohio State University. Graduated 2015.|
|2014 - 2016||Meghan Cook, The Ohio State University. Graduated 2016.|
|2015 - 2016||Amar Bhatt, The Ohio State University. Graduated 2016.|
|2015 - 2016||Greg Yerington, The Ohio State University. Graduated 2016.|
|2015 - 2016||Dominic Robinson, The Ohio State University. Graduated 2016.|
|2015 - 2016||Adam Dalia, The Ohio State University. Graduated 2016.|
|1987 - present||Advanced Cardiac Life Support: American Heart Association|
|1988 - present||Diplomate: National Board of Medical Examiners|
|1991 - present||Doctor of Medicine: State Medical Board of Washington|
|1992 - present||Diplomate: American Board of Anesthesiology|
|1996 - present||Doctor of Medicine: State Medical Board of Ohio|
|1998 - present||Doctor of Medicine: State Medical Board of West Virginia|
|2008 - present||Certification in Perioperative Transesophageal Echocardiography: National Board of Echocardiography|
|2008 - present||Fellowship in Cardiothoracic Anesthesiology: Ohio State University College of Medicine|
|2016 - present||Fellow of the American Society of Echocardiography: American Society of Echocardiography|
|07/01/2009||Director of Perioperative Echocardiography (Ross Heart Hospital)|
|1982||B.S., University of Puget Sound|
|1987||M.D., University of Washington Seattle|
|1999||M.A., Franciscan University|
|2010 - present||Certificate of Excellence: Outstanding Achievement in Patient Service. OSUMC.|
|2014 - present||Faculty Invitee to Alpha Omega Alpha Banquet. Alpha Omega Alpha Honor Society.|
|February 2011||William Perez."Cardiovascular Anesthesiology Core Modules"|
3D Mitral Valve Changes during OPCAB Surgery
Automated Quantification of Aortic Root Remodeling in Aortic Stenosis Using Volumetric 3-D Transesophageal Echocardiography: Implications for Trans-Catheter Aortic Valve Replacement (TAVR)
Perioperative Evaluation of the Mitral Valve
EEG Level-of-Consciousness Monitor and Cerebral Oximeter Response in Patients Undergoing Carotid Endarterectomy
Clinical Perspectives on Dealing with requests for Physician Assisted Suicide: The Oregon Experience
Basic Transthoracic Echocardiography
Acute Mitral Regurgitation Secondary to Libman Sacks Endocarditis Requiring Emergent Mitral Valve Replacement
Euthanasia and Assisted Suicide: Catholic Moral Tradition and the Current Debate
Bivalirudin During Cardiopulmonary Bypass for a Patient with a Complex Hematologic History
Euthanasia and Assisted Suicide: Catholic Moral Tradition and the Current Debate
|present||Vocation, Virtue and the Sacraments. Ohio State University Catholic Medical Student Group. Columbus, OH.|
|present||Q & A Session on Catholic Beliefs regarding the Virgin Mary. Ohio State University Catholic Medical Students. Columbus, OH.|
|present||Vocation, Virtue and the Sacraments. John Paul II Guild, Catholic Medical Association. Columbus, OH.|
Anticoagulation Dilemma for a Patient with a Complex Hematologic History