Inside the operating room, surgeons and anesthesiologists work side by side to improve and save the lives of patients. But outside of it, especially in the scholarly arena, there’s room for more interaction between the two specialties. Both groups already perform cutting edge research to find ways to improve patient care. However, it would be beneficial to find more ways to form surgeon-anesthesiologist teams to design and execute various research projects that are of importance to both departments and to the hospital, say BWH’s Richard Urman, MD, and Edward Whang, MD.
Urman, an attending physician in the BWH Department of Anesthesiology, Perioperative and Pain Medicine, and Whang, an associate surgeon in the BWH Department of Surgery, want to build some formal infrastructure to encourage this. With support from the leadership of both departments, they have launched the Center for Perioperative Research (CPR) at BWH, a new model for promoting Surgery-Anesthesia collaboration.
Describing the new center, Bhavani Kodali, MD, clinical director of Brigham and Women’s Department of Anesthesiology, said, “The results of the projects of this kind are vital to provide safe, effective, efficient, and value based medical care.”
Urman and Whang recently spoke to Clinical & Research News about the new center and its mission.
How did the idea for the Center for Perioperative Research take shape?
EW: I remember one day Dr. Urman and I crossed paths in the hallway – we’d both just finished our cases in separate rooms in the OR that day. We started chatting informally about the research projects each of us was working on. Both of us wanted to see if there was some common interest, so we continued the conversation over the course of about a month, with weekly meetings. That’s when we came up with the idea of a center that could bring together surgeons and anesthesiologists around research problems that both groups work on and care about.
RU: We want to give both groups an organized way of collaborating. Surgeons and anesthesiologists at BWH do research together sometimes, but it happens randomly – there isn’t a formal way to share ideas and look for the necessary resources. What we wanted to establish was an infrastructure of support and a portfolio of projects for both groups to tackle.
How did CPR go from an idea hatched in the hallway to an established center?
EW: Once we had the initial idea, we met with the department heads of Surgery and Anesthesiology, Michael Zinner, MD, and Bhavani Kodali, MD, respectively.
RU: Both were very supportive of the idea. They encouraged us and gave us the initial support and resources we needed to get this off the ground.
You two have been colleagues for a long time, and your friendship seems like it helped you build this center. How did you meet?
RU: When I was a third-year medical student at Harvard Medical School, I did my clerkship in Surgery at BWH, and Dr. Whang was my preceptor. That was about 14 years ago. I came back to BWH about eight years ago as a member of the faculty, and we’ve worked together as colleagues since then. We’re sometimes in the same Operating Room – Dr. Whang on the Surgery side of the curtain, and me on the Anesthesia side.
EW: When we met during his clerkship, I remember I thought Dr. Urman was a great student – I encouraged him to pursue a career in surgery, and he initially went into a surgery residency. What makes our relationship so easy is that in many ways, I can communicate with him as a fellow surgeon. He bridges that gap. Traditionally, the training paths of surgeons and anesthesiologists have been completely separate. But there are now some programs where anesthesiology residents work side-by-side with surgery residents during their first year of training. In the future, surgeons and anesthesiologists will be more accustomed to working together both inside and outside of the OR.
How does the CPR model work? What does the future of the center look like?
EW: We have an advisory board and seed funding for some initial projects. The next phase is to expand our portfolio of collaborative projects and do some serious fundraising. Project ideas can come from the investigators themselves. We’ll provide the resources they need in terms of administrative and research support.
RU: We have several IRB-approved projects and funding from both donations and industry to support these initial projects. CPR will provide the infrastructure to support research projects, and that includes personnel: research assistants from both departments, statisticians, support staff, trainees and others. All projects will involve staff from both Surgery and Anesthesia.
Can you give us an example of one of the initial projects?
RU: One of the projects will look at the causes of readmission of surgical patients. This is of interest to the hospital, surgeons and insurance companies, but it’s ultimately about improving the quality of care for patients.
EW: We’d like to develop a post-surgery readmission risk calculator based on the Brigham data so that we can identify patients at high risk of complications when they leave the hospital that would cause them to be readmitted. We’ll develop targeted interventions to prevent those complications and therefore the need for readmission. We think this will improve quality of care and reduce costs at the same time.
Any last thoughts?
RU: There’s the potential for a lot of benefit from collaboration. Other institutions have active research programs on perioperative issues, but we’re not aware of a setup like this that formally puts surgeons and anesthesiologists together on a research team. We hope that this can serve as a national model.
EW: As far as we can see, this is a relatively unique concept. And it’s time for this concept. There’s great interest in improving care, lowering costs and improving patient safety. CPR represents a unique way of addressing these unmet needs.
Learn more about the Center for Perioperative Research on its website.