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Leader Profile: Trevor Sutton, MD, MBA, CPE

Posted on Mon, Feb 01, 2016
Leader Profile: Trevor Sutton, MD, MBA, CPE

When you speak with Trevor Sutton, MD, MBA, CPE, his passion for the field of anesthesiology and patient safety is instantly evident. As Regional Medical Director for anesthesia services for EmCare’s North Division, Dr. Sutton’s role continues to evolve, but one thing’s for certain: he loves what he does.

“My job is to provide clinical and administrative leadership support that bridges the gap between patient care and the business side of anesthesia,” he explains. “Although the responsibilities can be challenging, it’s feasible to wear both hats because patient care goals in clinical medicine and business strategies in medicine are increasingly aligned. Both considerations require transparency, reliable information and consistent focus on efficiency, experience, safety and perceived value.”

Dr. Sutton earned his undergraduate degree from Harvard University and his medical degree from the University of California at San Francisco School of Medicine. He selected anesthesiology because he enjoyed acute care medicine, and its application to the broad population of patients who undergo complex elective and emergency surgical procedures in the operating room. He completed an internship in medicine, a residency in anesthesia and critical care, and a fellowship in cardiothoracic and vascular anesthesia, all at Massachusetts General Hospital.

“I enjoy working as a consultant in medicine during an important aspect of a patient’s surgical experience. I also enjoy the problem-solving nature of our field, and how it applies advances in medicine in the domains of the physiology and clinical pharmacology with operations management science,” said Dr. Sutton, who returned to academia in 2005 to earn an MBA from the Isenberg School of Management at the University of Massachusetts, Amherst.

A typical day for Dr. Sutton starts early. He is credentialed at several hospitals and surgery centers in Connecticut, where he provides anesthesia care to patients undergoing cardiac surgery, neurosurgery, robotic surgery, obstetrical surgery, pediatric surgery and a variety of less invasive outpatient surgical procedures, usually beginning at 7 a.m. His administrative work often begins at the end of his clinical day, but sometimes on dedicated weekdays and weekends. For Dr. Sutton, it’s important that he continue to work clinically, even if that means burning the midnight oil at times.

“I provide support to current physician leaders, and also help identify, recruit and mentor emerging physician leaders,” he explained. “The best way to inspire and be credible is to work in the same clinical arena and lead by example.”

Dr. Sutton’s administrative oversight includes activities that support knowledge sharing between medical directors and divisional management teams that promote best practices, reliable and efficient delivery of anesthesia services, and the development and implementation of strategic initiatives that might support performance and growth within the anesthesia division. He’s involved with local, state and national anesthesia organizations, including the Connecticut Surgical Quality Collaborative, which seeks to identify and communicate evidence-based best practices in surgery and anesthesiology. His voice quickens as he explains enhanced recovery (ERAS) protocols, evidence-based practices, perioperative surgical homes and “pre-habilitation” patient education initiatives.

Perhaps even more exhilarating to Dr. Sutton, however, is spending quality time with his family. It remains a challenge with his busy schedule, but Dr. Sutton works to balance his professional commitments with spending time with his wife, daughter and mother. Watching equestrian competitions has become a shared enjoyment for his family, as Dr. Sutton’s daughter has progressed in state and regional competition as a hunter jumper equestrian.

“I like to travel, cook, read and play a variety of sports, but really, my wife and I are “horse barn parents’,” he said with a laugh. “We love watching our daughter enjoy and pursue her extracurricular passions.”

When asked how his colleagues would describe him, Dr. Sutton said, “I hope they’d say that I’m hardworking, that I balance being fun and being serious, that I’m a good doctor, that I care about my patients and my colleagues, and that I try to do the right thing.


Best Practices for Preventing Post-Op Nerve Injuries

Posted on Tue, Aug 25, 2015
Best Practices for Preventing Post-Op Nerve Injuries

Harry H. Jung III, M.D., Regional Anesthesia Medical Director of EmCare Anesthesia Services, responds to a recent article in Anesthesiology News.

By Harry H. Jung III, M.D.

After reading an interesting and informative article by Dr. Hardman addressing post-op nerve injuries in patients who had received peripheral nerve blocks, I think there may be a much higher probability of these patients running out of gas or having a flat tire on their trip home from the OR than actually sustaining a nerve injury!

"A 2009 prospective case series involving more than 7,000 PNBs, conducted in Australia and New Zealand, demonstrated that when a postoperative neurologic symptom was diagnosed, it was 9 times more likely to be due to a non-anesthesia-related cause than a nerve block–related cause." Hardman; Barrington MJ, Watts SA, Gledhill SR, et al.

Although these complications rarely occur, I suggest my ultrasound-guided regional anesthesia colleagues and protégés maintain 100% compliance with these two hard and fast rules of the field. Note: these two rules apply to IN PLANE techniques only.

  • Advance needle ONLY when visualizing needle tip with ultrasound
  • NEVER inject anything through needle without visualizing needle tip with ultrasound

These two rules are obviously difficult to adhere to in OUT OF PLANE techniques, which should be performed by those with extensive ultrasound-guided regional anesthesia experience.

And lastly, using a peripheral nerve stimulator (0.5 mA) is a good idea when ultrasound-guided interscalene, adductor canal, and other blocks are performed. My colleagues and I have been doing this for a while now to help us be aware of where we DON'T want the needle to go.

For example, we want to avoid the long thoracic nerve and dorsal scapular nerve in the belly of the middle scalene muscle during an interscalene block, and we want to avoid the nerve to the vastus medialis muscle during an adductor canal block.

Dr. Harry Jung

Harry H. Jung III, M.D., is Regional Anesthesia Medical Director of EmCare Anesthesia Services.


Physician of the Year: Anesthesiology

Posted on Thu, Apr 16, 2015
Physician of the Year: Anesthesiology

2015 Ace Award Presented to California Anesthesiologist
EmCare Honors Dr. Ali Manoochehrian with National Recognition

ORLANDO, FLA. (April 7, 2015) – The medical director for five hospitals in the Victorville, Calif. area has been selected for the 2015 Ace Award.  Ali Manoochehrian, M.D., was chosen for the honor. The award is presented by EmCare, a leading national physician practice management company, and singles out a sole anesthesiologist for the honor each year.

“I was very surprised that I won the Ace Award this year,” said Dr. Manoochehrian. “I am so honored.”
“Dr. Manoochehrian is a very valued member of the EmCare Anesthesia Services Team,” says Michael Hicks, M.D., CEO of EmCare Anesthesia Services. “His patient care is exceptional, his clinical skills and leadership are all spectacular.”

The anesthesia departments led by Dr. Manoochehrian include Victorville Valley Global Medical Center in Victorville, Calif.; Palmdale Regional Medical Center in Palmdale, Calif.; Barstow Community Hospital in Barstow, Calif.; Valley Presbyterian Hospital in Van Nuys, Calif. and Physicians Surgery Center in Victorville, Calif.

Dr. Manoochehrian is lauded for his anesthesia skills, especially nerve blocks for orthopedic surgeries, as well as attentive patient care. Colleagues describe him as an effective leader with a collaborative spirit. He earned his medical degree from Ross University School of Medicine in Dominica, West Indies. His residency in anesthesia was completed at the University of Southern California Medical Center.

Dr. Manoochehrian was honored with the Ace Award during EmCare’s annual Leadership Conference. The 2015 convention was held at Coronado Springs Resort in Orlando, Fla. March 30 – April 1. While the Ace Award recognizes a single anesthesiologist from across the United States, EmCare also annually honors individuals from emergency medicine, radiology and hospital medicine as its Physicians of the Year.


Complication Rate Low for CNRA Lumbar Epidural Injections

Posted on Sun, Feb 22, 2015
 Complication Rate Low for CNRA Lumbar Epidural Injections

Rates similar to physician rates for fluoroscopic-guided LESI

THURSDAY, Feb. 5, 2015 (HealthDay News) --  Complication rates for fluoroscopic-guided lumbar epidural steroid injections (LESIs) performed by certified registered nurse anesthetists (CRNAs) are similar to physician rates cited in the literature, according to a study published online Jan. 27 in the Journal for Healthcare Quality.

Donald E. Beissel, D.N.P., from Southwest Interventional Pain Specialists in Albuquerque, N.M., conducted a survey of CRNA pain practitioners. He collected data on the number of fluoroscopic-guided LESIs performed and each of 20 complications for a six-month period.

Beissel found that participants practiced in urban (23 percent) and rural (77 percent) settings in office/clinic (31 percent), hospital (62 percent), and mixed (7 percent) practices. CRNAs had both master's (62 percent) and doctoral (38 percent) degrees. Experience in performing fluoroscopic-guided LESIs ranged from one to 17 years and 50 to 12,000 procedures. For each complication, the rate of occurrence was below 1 percent, with the highest rates for bruising and vasovagal reactions. There were no cases of paralysis or death. There was no association between either practice setting or experience level and complication rates.

"CRNAs were able to safely and effectively perform fluoroscopic-guided LESIs with complication rates similar to physician rates cited in the literature," the authors write.

The author has a financial stake in a pain-related services enterprise.

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Patients Tend to Prefer Formal Physician Attire

Posted on Mon, Feb 16, 2015
Patients Tend to Prefer Formal Physician Attire

Patient preferences influenced by age, geographic location, context of care

FRIDAY, Feb. 13, 2015 (HealthDay News) -- Patients often prefer physicians with formal attire and white coats, according to a systematic review published online Jan. 19 in BMJ Open.

Christopher Michael Petrilli, M.D., from the University of Michigan in Ann Arbor, and colleagues conducted a systematic review to examine the influence of physician attire on patient perceptions. Data were included from 30 studies involving 11,533 patients from 14 countries.

The researchers found that in 70 percent of studies, there were reports of preferences or positive influence of physician attire on patient perceptions. In 60 percent of studies, formal attire and white coats with other attire not specified were preferred. Among older patients and in studies conducted in Europe and Asia, the preference for formal attire and white coats was more prevalent. No preference was reported for attire or a preference for scrubs was reported in four of seven studies involving procedural specialties. No attire preference was reported in four of five studies in intensive care and emergency settings. Of the 12 studies that surveyed patients after a clinical encounter, only three concluded that attire influences patient perceptions.

"Although patients often prefer formal physician attire, perceptions of attire are influenced by age, locale, setting, and context of care," the authors write. "Policy-based interventions that target such factors appear necessary."

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