Pulmonary, Critical Care and Sleep Medicine |
CLINICAL PROGRAMS
|
INPATIENT SERVICES
1) Critical Care
UHC: The Division of Pulmonary, Critical Care and Sleep Medicine is responsible for the
overall direction and care of patients in the Medical Intensive
Care Units (MICU) of both UHC and the VAMC. The UHC MICU is
a 20 bed ICU, staffed by 4 physicians (Hejal, Kern, Petrozzi,
Schilz). Due to nurse staffing, over the past few years maximal
beds available in the MICU are ~14. Admissions above this census
are boarded in the adjacent CICU, NSICU or SICU. In 2003 there
were 1141 admissions to the MICU, with an average LOS of 3.2
days. The severity of illness in this population is very high
with an average APACHE III score of 73 (2004 data). The critical
care team consists of a Pulmonary, Critical Care and Sleep Medicine Attending
(2 week rotation), a Pulmonary, Critical Care and Sleep Medicine Fellow (1 month
rotation), 3 second or third year residents, first year residents
or off-service residents (Family Practice, Neurology, Anesthesiology,
Medical Students) as available. Resident in house call is every
third night. Attendings and Fellows area available 24 hours/day
and round 7 days/week.
VAMC: The VAMC MICU is a 12 bed ICU, shared with Cardiovascular Medicine. Patient census varies between 2-8. The severity of illness is lower in the VAMC ICU population than at UHC. The critical care team consists of a Pulmonary, Critical Care and Sleep Medicine Attending, a Pulmonary, Critical Care and Sleep Medicine Fellow, and three teams of two residents (second or third year resident teamed with a first year resident). Resident call is taken as a team every third night. Attendings and Fellows area available 24 hours/day and round 7 days/week. During FY 2003 there were 232 admissions to the VAMC MICU.
2) Pulmonary Consult Service - The Pulmonary Consult service provides inpatient consultation expertise to the UHC and VAMC patient population and inpatient pulmonary procedures as needed.
UHC: The consult team consists of a Pulmonary Attending, a Pulmonary Fellow, and residents and medical students that enroll in the consult service elective. Over the academic years of 2001-2003 the consult team saw an average of 672 inpatient consults per year at UHC. Attendings and Fellows are available 24hours/day and round 7 days/week when needed.
VAMC: Inpatient Pulmonary Consult service responsibilities at the VA are combined with the responsibilities of the Pulmonary Critical Care Attending and Fellow at the VA. Attendings and Fellows are available 24hours/day and round 7 days/week when needed.
OUTPATIENT SERVICES
1) General Pulmonary Clinic. General Pulmonary services are provide to outpatients at both the VAMC and UHC
UHC: Outpatients are seen in the Respiratory Diagnostic Center in the Mather Pavilion. The Division has a total of 12 half day faculty clinics in the outpatient area seeing patients referred for evaluation of general pulmonary problems - asthma, emphysema, pneumonia, interstitial lung disease, hemoptysis, etc. Last year there were 3947 patient visits to these clinics. In addition, Faculty staff the weekly fellows General Pulmonary continuity of care clinics, scheduled on Thursday morning. Last year a total of 382 patient visits were recorded for these clinics.
VAMC: Outpatients are seen in the General Pulmonary outpatient clinics at the VAMC. Currently there are two half day clinics at the VAMC staffed by a faculty attending and a fellow. In addition, the faculty staff four Fellows General Pulmonary continuity of care clinic that meets weekly for half day each. This year there will be 2,222 outpatient visits (FY 2004 annualized data) to these clinics.
2) Thoracic Oncology - The Pulmonary Thoracic Oncology service was established in 2000 under the direction of Dr. Kern. This is primarily an outpatient service working out of the Ireland Cancer Center. The Thoracic Oncology Group consists of Pulmonary, Thoracic Surgery, Medical Oncology, Radiation Oncology, Pathology, and Radiology. This group meets weekly for evaluation of all new and problem patients at Tumor Board. Outpatient services are provided throughout the week. The entire team is together for a Monday clinic, as well as individually seeing patients in separate clinics at hours convenient to the faculty. 170 patient visits (Dr. Kern only) were recorded in this new clinic for AY 2003-04).
3) Sleep Clinic - the Division of Pulmonary,
Critical Care and Sleep Medicine is responsible for sleep services
at both UHC and VAMC. In addition, the Division directs the
Sleep Diagnostic Laboratory at the VAMC.
UHC: The VA and UHC Sleep Clinic meets weekly. At UHC, Dr. Reena
Mehra is the clinic director (established 2004). Support is
also provided by Respiratory Therapy for evaluation of patient
CPAP and BiPAP. The Division is responsible for reading ~ 40%
of the sleep studies performed at UHC through the Neurology
Sleep Laboratory. No visit data is available for this new clinic.
VAMC: The VAMC clinic also meets weekly, directed by Dr Kingman
Strohl, with Fellows involved in the Sleep Research Fellowship
program. Support is provided by Respiratory Therapy for evaluation
of patient CPAP and BiPAP. All sleep studied performed at the
VAMC are read within the Division. Last year (FY 2003), 286
sleep studies were performed and interpreted at the VAMC. This
year, 967 patients (FY 2004 annualized data) will be seen in
the VAMC Sleep Clinic.
4) Bariatric Service - the Bariatric Service
was established in 2000. Currently the program is under the
Directorship of Dr. Thomas Stellato, Professor of Surgery. Due
to the high incidence of obstructive sleep apnea in this population,
Dr. Stellato requested Pulmonary, Critical Care and Sleep Medicine
support in the evaluation and post-operative follow-up of these
patients. Dr. Mariana Petrozzi directs this clinic.
5) Lung Transplant Service - University Hospitals
of Cleveland provides lung transplantation to patients with
pulmonary diseases that can not be effectively treated by any
other means. Dr. Robert J. Schilz is the medical director of
the lung transplantation program and follows patients as they
prepare for and after lung transplantation. This pioneering
technology technology improves outcomes and enhances quality
of life for patients with end-stage lung disease. University
Hospitals Lung Transplant Program is a member of the Ohio Solid
Organ Transplantation Consortium (OSOTC) and the United Network
for Organ Sharing (UNOS).
The comprehensive program is designed to successfully assist
individuals with advanced lung disease through highly specialized,
technologically advanced medical and surgical care. The program
embraces a multidisciplinary team approach in treating patients
with disease and disorders including:
· Alph-1 Antitrypsin Deficiency
· Bronchiectasis
· Congenital Abnormalities
· Cystic Fibrosis
· Eisenmenger’s Syndrome
· Idiopathic Pulmonary Fibrosis
· Lymphangioleiomyomatosis (LAM)
· Obliterative Bronchiolitis
· Occupational Lung Disease
· Primary Pulmonary Hypertension
· Pulmonary Firbrosis
· Pulmonary Vascular Disease
· Sarcoidosis
Adults who are severely limited by end-stage pulmonary disease
without other significant medical problems may be potential
candidates for lung transplantation.
Lung Transplantation Services
Robert J. Schilz, D.O., Ph.D., - Division of Pulmonary, Critical
Care and Sleep Medicine
216-844-2707
6) Pulmonary Vascular Disease Service - The Pulmonary Vascular Disease service was established under Dr Robert Schilz's direction in 2001. This service has developed an integrated team of Pulmonary physicians and cardiologists (adult and pediatric) to address the problems of pulmonary artery hypertension. Lian Latham, RN, is the program coordinator. Currently 119 patients are followed with PAH, with 84 on vasodilator therapy.
7) Bronchoscopy and other procedures. Bronchoscopic service are provided at both the VAMC and UHC
UHC: Services at UHC are provided in our outpatient procedure area in the Mather Pavilion. This is a dedicated suite for bronchoscopy and other pulmonary procedures (thoracentesis, chest tubes, fluoroscopic guided fine needle aspirates). The suite is under the medical direction of Dr Rana Hejal, and is assisted by a nurse dedicated to the suite, Caroline Radyk. Instrumentation for bronchoscopy is state-of-the art with new digital Olympus instruments. The Olympus report generator is also used with direct upload of bronchoscopy reports to the hospital mainframe upon procedure completion. Images are archived on a server within the endoscopy area. Between 2001-2003, 1928 bronchoscopies were performed in the bronchoscopy suite or in the hospital using mobile equipment.
VAMC: Services at VAMC are provided in a 4 room endoscopy suite, shared with gastroenterology. A team of 4 nurses for both bronchoscopy and endoscopy provides support. Equipment is also stat-of-the-art Olympus equipment. Reports are currently generated directly in the VAMC CPRS data base immediately upon completion of the procedure. The Olympus system is now in the endoscopy suite, and is being linked to CPRS. When this is accomplished, the reporting structure will be identical across both institutions. Last year (FY 2003), 136 bronchoscopies were performed at the VAMC
