410 W 10th Ave
Columbus, OH 43210
Phone: (614) 366-8403
Associate Professor - Practice, Anesthesiology
Business Impact on Clinical Medicine
After my internship and Anesthesiology residency at The Ohio State University Medical Center from 1988 through 1992, I remained at OSU as an Assistant Professor of Anesthesiology until July 1998. During my CA-3 year I was chosen as Chief Resident, and I was selected as Teacher-of-the-Year by the residents in the Department of Anesthesiology in 1995. I was a co-author on six abstracts published in peer-reviewed journals, and I had several poster presentations at national and regional meetings including the American Society of Anesthesiologists Annual Meeting and the Midwest Anesthesiology Residents Conference. I also had numerous invited speaker presentations including the Ohio State Association of Nurse Anesthetists Annual Meeting and the Ohio Society of Anesthesiologists Annual Meeting. Finally, I was a member of the Committee on Awards of the Society of Ambulatory Anesthesia (SAMBA) for three years.
In 1998, I left OSU to become a partner in the start-up of the Ohio Surgery Center, the first entirely physician-owned ambulatory surgery center in Columbus, Ohio. We specialized in ENT surgery for adult and pediatric patients and grew to over 7,000 cases per year in five ORs. I cared for both adult and pediatric (age > 6 months) outpatient ENT patients, and our anesthesiology group also provided services for a physician-owned adult urology surgery center start-up for several years. During my time in private practice, I served as a member of the Board of Directors of the Ohio Surgery Center and later as its Medical Director for three years in addition to leading a successful JCAHO survey in which we received a score of 100. I also implemented several successful physician engagement and leadership programs during my tenure as Medical Director. At the surgery center I participated in the successful management of a profound case of Malignant Hyperthermia and was subsequently invited as a guest speaker on that topic for the Ohio Department of Health as well as the Columbus and Worthington Fire Departments to provide education and training about MH.
In September 2011, I entered the MBA program at The Fisher College of Business of The Ohio State University. During my time at Fisher, I was selected to the Beta Gamma Sigma International Business Honor Society and a Fisher College of Business Weidler Scholar, graduating with a 4.0 GPA in May 2015. My affiliation with Fisher continues as I have been invited as a guest speaker in healthcare operations courses. Additionally, I collaborated with Dr. Ken Boyer, Chair of the Management Sciences Department, in developing a case study entitled “Gowdy Outpatient Surgery Center.” This case study, which is used in the MBA program, developed from the work that I did at Fisher which centered on process improvement and patient satisfaction at OSU. I am currently a member of the 4th cohort of the Lean/Six Sigma training program of the Medical Center & Fisher College of Business and I expect to obtain my Yellow Belt in August 2016. Finally, I am working with a multi-disciplinary team to create a Physician Leadership Development Program for all resident physicians at The Ohio State University Wexner Medical Center.
In December 2013 I left private practice and returned to OSU on the Auxiliary track as Associate Professor of Anesthesiology and the Medical Director for Ambulatory Surgery where I practice clinical anesthesia in the OR on a 30-40% FTE basis. I am the Medical Director and Chair of the Executive Committee of the Outpatient Surgery Center at the Eye & Ear Institute where we do over 6,000 cases per year in Ophthalmology, ENT, Urology, Plastic & Hand Surgery. At that time, Press Ganey (PG) patient satisfaction scores were in the 91st percentile. However, a project that I completed at Fisher using actual patient comments from the survey identified several key areas of possible improvement, and I initiated two projects that brought patient families into the Preop Holding Area and standardized IV placement including the use of buffered lidocaine before insertion. These changes have reduced negative patient comments on the survey from over 30% to under 10% and helped to increase our PG score to the 95th percentile (including several months at the 99th percentile). Furthermore, we have exceeded target parameters in quality, efficiency, patient satisfaction and financial margin for the first time since the surgery center opened 7 years ago and we lead the Medical Center in OR Turnover Time and First Case On-Time Starts. When I arrived at OSU, I also identified our preop process, which consisted of a nurse call to the patient 24-48 hours prior to surgery, as inadequate. I assembled a multidisciplinary team that includes IT, nursing and administration and started a two year project that has culminated in development of our Preanesthesia Questionnaire (PAQ) center. This process allows us to evaluate patients for surgery on the same day that they visit their surgeon, either in-person or by video chat. We can also determine, in advance, if the patient is adequately prepared for surgery, direct ‘unprepared’ patients to our preoperative clinic, and designate the most appropriate OR site for each patient. Our new process has already reduced cancellations within 48 hours of surgery by over 70%. Other improvements that have come from this initiative include automated preop calls and texts to inform patients of arrival times (with concomitant decreased FTE usage for this task), and development of comprehensive preop information and instructions for patients and their families. We are currently working on a website and handout materials to simplify preop instructions and give patients all of the information that they need and want. As a result of these efforts, I was asked to lead a multi-disciplinary team implementing a new Epic product called “Procedure Pass” that will serve as a ‘scorecard’ for patient readiness and prevent delays and cancellations due to incomplete patient preparation for surgery.
In the last 18 months I have actively participated in the development of a new Ambulatory Surgery unit on the main medical campus. I now serve as Co-Chair of the Executive Committee and Co-Medical Director of this very successful unit. I have also been thoroughly involved with the design and future operation of the new Sports Medicine Institute that is being built within the Athletic District at OSU. I will serve as Medical Director and Chair of the Executive Committee of the surgery center when that facility opens in September 2016.
In August 2015 my first Fellow started in a fellowship that I created to develop business leadership in anesthesiology. This “Ambulatory Business Fellowship” is the first of its kind and includes clinical and management training in ambulatory anesthesia along with completion of an Executive MBA from the Fisher College of Business (ranked in the Top 10 nationally by Businessweek). My fellow and I have recently been approached to write an article for the American Society of Anesthesiologists (ASA) monthly magazine describing the early progress of this new program. Additionally, we have had four resident poster presentations at each of the last two Society of Ambulatory Anesthesia (SAMBA) Annual Meetings and one of our residents won a travel award for her work this year. Finally, along with my Clinical Coordinator, I have hosted an annual Ambulatory Anesthesia Journal Club in the Department of Anesthesiology for the last two years.
I serve on several institutional committees that I have not already mentioned, including the Health System OR Coordinating Committee, the Surgical Executive Committee and the Health System Perioperative Quality Committee. As part of the Surgical Executive Committee, I lead a sub-committee that is charged with improving OR turnover time in the entire Medical Center. I am a member of the Governmental Affairs Committee of the Ohio Association of Ambulatory Surgery Centers, and I have lobbied in Washington, D.C. as part of that organization. Nationally, I have been a member of the ASA Perioperative Surgical Home Learning Collaborative since it began in 2014. This has allowed me to play a key role in organizing our own multi-disciplinary PSH/ERAS project. This initiative, combined with the other perioperative projects that I have undertaken, has been named OSUWMC2 (Optimal Surgical Utilization with Minimal Complications and Cancellations). I am working to ‘brand’ all of these processes as our unique way to improve operative outcomes at OSU. I am also a member of the SAMBA Committee on Clinical Outcomes and Performance Measures and I have been asked to serve as Vice-Chair for that committee starting at the Annual Meeting in May 2016.
I have several clinical research projects in various stages of completion. These include a retrospective analysis of Obstructive Sleep Apnea (OSA) patients undergoing ENT surgery, a prospective study of OSA patients undergoing Outpatient Surgery and use of multimodal analgesia including IV Tylenol and gabapentin for ENT Surgery in OSA patients.
|1988 - present||Medical Doctor: State Medical Board of Ohio|
|1989 - present||Diplomate: National Board of Medical Examiners|
|1993 - present||Diplomate: American Board of Anesthesiology|
|2016 - present||Certified Provider: Advanced Cardiac Life Support|
A Comparison of Clinical Experiences and Outcomes in Patients Undergoing Elective Surgery Under General Anesthesia with Ultiva vs. Hypnotic/Inhalation-based Anesthesia
A Retrospective Chart Review of Patients with Obstructive Sleep Apnea
|1987||B.A., Wayne State University|
|1988||M.D., Wayne State University School of Medicine|
|2015||M.B.A., Ohio State University Fisher College of Business, The|
|1991 - present||Resident Scholar. Foundation for Anesthesia Education & Research.|
|1992||Chief Resident. The Ohio State University Medical Center Department of Anesthesiology.|
|1995 - present||Teacher-of-the-Year. The Ohio State University Department of Anesthesiology.|
|2012 - present||Beta Gamma Sigma International Honor Society. The Ohio State University Fisher College of Business.|
|2015 - present||Fisher College of Business Weidler Scholar. The Ohio State University Fisher College of Business.|
|January 1990||Rypel GD, Guertin MG, Cartabuke R, Nouri A, Howie MB."Preoperative Concerns of Parents Whose Children Are Admitted Through the Ambulatory Surgical Unit" .|
|January 1990||Rypel GD, Guertin MG, Cartabuke R, Noir A, Howie MB."Preoperative Concerns of Parents Whose Children Are Admitted Through the Ambulatory Surgical Unit" .|
|January 1991||Howie MB, Galbraith TA, Romanelli VA, Rypel GD, Guertin MG, McSweeney TD."Titration of Barbituate Cerebral Protection to an Isoelectric EEG Prior to Circulatory Arrest" .|
|January 1991||Howie MB, Galbraith TA, Romanelli VA, Rypel GD, Guertin MG, McSweeney TD."Titration of Barbiturate Cerebral Protection to an Isoelectric EEG Prior to Circulatory Arrest" .|
|January 1992||Romanelli VA, Howie MB, Jopling MW, Liu AY, Hiestand DC, Guertin MG, DenBesten KE, McSweeney TD."Correlation of Myocardial Tissue Impedance to Sonomicrometry Length and Myocardial Function Analysis in an ischemic canine model" .|
|January 1993||Hiestand DC. Howie MC, Jopling MW, Kelly WB, Guertin MG, Ganjianpour R, Hazelbaker MT."Shunt Fraction and Pulmonary Vascular Resistance in Patients Undergoing Single-Lung Ventilation for Thoracotomy: Desflurance vs, Isoflurane" .|
Titration of Barbiturate Prior to Circulatory Arrest
Effect of Anesthesia in Patients with Elevated PA Pressures
Preoperative Concerns of Parents
Titration of Barbiturate Prior to Circulatory Arrest
Preoperative Concerns of Parents
Effect of Oral Clonidine Premedication on Stress Hormone Response and Anesthetic Requirements in CABG Surgery Presentation
Correlation of Myocardial Tissue Impedance to Sonomicrometry Length and Myocardial Function Analysis in an Ischemic Canine Model
Shunt Fraction and Pulmonary Vascular Resistance in Patients Undergoing Single-Lung Ventilation for Thoracotomy: Desflurane vs Isoflurane
Pathogenesis of Postoperative Nausea and Vomiting
Anesthesia for Abdominal Aortic Aneurysm Repair
Pathogenesis of Postoperative Nausea and Vomiting
Management of the Difficult Airway
Malignant Hyperthermia and Succinylcholine
Healthcare Operations; Application at OSU’s Eye & Ear Institute Outpatient Surgery Center
Non-obstructive Apnea Following Elective Excision of an Epidermal Inclusion Cyst
Improving Patient Satisfaction by Listening to Their Comments
Prolonged PACU Stay Secondary to Atypical Presentation of Increased Intraocular Pressure
Live Case Debut: Gowdy Outpatient Surgical Center, OSU Wexner Medical Center
Body Mass Index Effects on Time to Discharge from Ambulatory Surgery Center
Routine Pregnancy Screening for All Elective Outpatient Surgery: How Far Have We Come?
Healthcare: A Uniquely Complex & Interactive Service
Physician Financial Preparedness
Physician Employment & Compensation Models
OPTIMAL SURGICAL UTILIZATION WITH MINIMAL CANCELLATIONS AND COMPLICATIONS (OSUWMC2): AN INITIATIVE TO IMPROVE RECOVERY AFTER MICROVASCULAR BREAST RECONSTRUCTION
A Retrospective Chart Review of Patients with Obstructive Sleep Apnea undergoing ENT Procedures that Required Hospital Admission
Effect of oral clonidine premedication on anesthetic requirement, hormonal response, hemodynamics, and recovery in coronary artery bypass graft surgery patients.