TopMedTalk

ANESTHESIOLOGY® 2025. The TopMedTalk team were there and this piece sees Mike Grocott speaking with Sheena Scott, Founder of Scott Healthcare Consulting and Jason Greenberg, Strategic Advisor, Anesthesia, Ventra Health.

They discuss common governance mistakes in anesthesiology groups, the importance of effective governance structures, and strategies for improvement. The conversation highlights the challenges of democratic decision-making in larger groups, the need for emotional intelligence in leadership, and methods to address detractors and conflicts. They also emphasize the importance of bylaws, outside consultation, and continued professional development through resources like the ASA's Advance meeting.

ANESTHESIOLOGY® 2025, Desiree Chappell and Sol Aronson discuss the evolving economics of anesthesiology with guests Jonathan Gal, MD, Professor of Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, System Medical Director- Facility Revenue Integrity & Optimization; System Medical Director- Offsite ASC Anesthesia; ASA Director from New York for the Board of Directors and Chair of the Committee on Economics and Gordon Morewood, MD, Anesthesiologist-in-Chief of Temple University Health System, Chair and Professor of Clinical Anesthesiology at Lewis Katz School of Medicine at Temple University and Chief of Anesthesia at Piedmont Health (Piedmont Healthcare System, Georgia).

The conversation spans various models of payment, including CPT codes, fee-for-service, and alternative payment models. They delve into the nuances of navigating different payer systems like Medicare, Medicaid, and private insurers, highlighting recent trends and challenges. Specific topics include the erosion of physician payments, the impact of the No Surprises Act, and the ASA's ongoing advocacy efforts. The episode underscores the importance of proper economic strategies to ensure the sustainability and optimization of anesthesiology practices.

Presented by Desiree Chappell and Sol Aronson with their guests, Mary Dale Peterson, Executive VP and COO, Driscoll Children's Health System, serving as chair of the ASA's Workforce Summits, chair of the Ad Hoc Taskforce on Physician Workforce and chair of the Ad Hoc Committee on Anesthesia Workforce Research and a member of the ASA Charitable Foundation's board of directors, and Thomas Miller, Director of Analytics and Research Services (ARS) and the Center for Anesthesia Workforce Studies (CAWS).

The conversation covers topics such as the increasing supply of anesthesiology professionals, the impact of COVID-19, and the growing demand for non-operating room anesthesia services. Dr. Peterson shares insights from her experience managing pediatric anesthesiology and suggests innovative solutions for workforce management. The panel also addresses the challenges of maintaining efficient operations amidst changing practice patterns and the importance of adapting to the new workforce's needs and preferences.

More on the ASA's CAWS here: https://www.asahq.org/research-and-publications/center-for-anesthesia-workforce-studies

As we mention Mary has appeared previously on TopMedTalk here: https://topmedtalk.libsyn.com/the-asas-immediate-past-president-topmedtalk-at-the-asa

Our coverage of ANESTHESIOLOGY® 2025 begins, presented by Desiree Chappell and Andy Cumpstey with their guest Annery Garcia-Marcinkiewicz MD MSCE, Care Medicine at the Children's Hospital of Philadelphia, University of Pennsylvania.

The discussion highlights the unique challenges and anatomical differences in pediatric patients, elaborates on the evolution of airway management tools and the impact of the Pediatric Difficult Intubation Registry. We underscore the benefits of video laryngoscopy over direct laryngoscopy in improving first-attempt success rates and reducing complications, especially in small, vulnerable infants. The episode concludes with practical advice for clinicians and the importance of advanced equipment in enhancing patient safety and efficiency in pediatric anesthesiology.

https://www.pediregistry.org/

The full team gather together to reflect on the last 12 months of TopMedTalk at this year's Evidence Based Perioperative Medicine (EBPOM) Dingle conference.

Desiree Chappell, Sol Aronson, Andy Cumpstey, Mike Grocott, Kate Leslie and Monty Mythen select highlights from the archives for our new listeners.

Here are the podcasts they mention, start your TopMedTalk journey with any of these.

The PREPARE Trial

"some great insights in the frailty, rehabilitation field and .. some really smart work … probably the top of my list"

Mike Grocott.

This excellent podcast:

TopMedTalk: The PREPARE trial with Daniel McIsaac | IARS

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Gender Disparities in Surgical Efficiency and Outcomes

"We had a great meeting with a medical student of Professor Matthias Eikermann in New York who talked about the different experiences of male and female practitioners. And that was really very powerful … she spoke really well…someone to watch out for, for the future."

Kate Leslie

TopMedTalk: Gender Disparities in Surgical Efficiency and Outcomes | IARS --

Perioperative medicine, the challenges, the rewards and the future

"We had Ramani Moonesinghe visiting Australia from the uk, who obviously great friend of TopMedTalk and we know well, which she did a really, really fascinating conversation with us."

Andy Cumpstey

TopMedTalk: Perioperative medicine, the challenges, the rewards and the future

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Improving sustainability and reducing operating room waste

"She says the same thing every time and, and every time I feel I'm a little bit closer to being a good citizen with respect to sustainability.

And, you know, we all sort of focus on things like recycling and disposables and things like that, but she, she sort of focuses on a much bigger picture of the supply chain and, um, how we really need to reinvent all the processes"

Kate Leslie

TopMedTalk: Improving sustainability and reducing operating room waste

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Exploring cerebral autoregulation

"Her research, which is published in the public domain, recognizing the fact that there isn't a magic number of, for blood pressure. It's very individual and so it's a great podcast.

Please do listen to it. There's a scary bit towards the end, which recognized that, in critical critically ill patients, you know, they quite often, we let their blood pressures drop. They have high right sided pressures and we often sit them up 'cause we think it's good for them. So listen to that bit because, you know, scary."

Monty Mythen

TopMedTalk: Exploring Cerebral Autoregulation

"He just crystallized so well, it was like a sort of a primary exam. A capsule of information about this new idea, which I don't think I can actually properly explain either, but it's got to do with blood pressure, diabetes, and hypercholesterolemia, and how a combination of things can put you in this metabolic risk category."

Kate Leslie

TopMedTalk: Metabolic flexibility

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Periperative Profiles, Paul Myles

"A really interesting conversation with Professor Paul Myles, which started off a new series for us, which I'm really enjoying. We've called that the Perioperative Profile series and, I guess the aim of that series, if you like, is to speak to some of the key thought leaders in our space"

Andy Cumpstey

At this year's Evidence Based Perioperative Medicine (EBPOM) World Congress we sat down with Ramani Moonesinghe OBE, and had a conversation about her remarkable journey from her immigrant roots to her influential roles in perioperative and critical care. Hear about her contributions to Britain's National Health Service, her groundbreaking research, and her personal life balancing a demanding career with family. Gain insights into the future of perioperative care, health inequalities, and her thoughts on the nation's COVID-19 preparedness.

Presented by Andy Cumpstey with Ramani Moonesinghe OBE, Professor of Perioperative Medicine, UCL, and Honorary Consultant in Anaesthesia and Perioperative Medicine, UCLH, London, UK.

Recorded at this year's Evidence Based Perioperative Medicine (EBPOM) World Congress held in London, this episode of TopMedTalk features Andy Cumpstey with his guests TJ Gan, Professor and Division Head, Anesthesiology, Critical Care and Pain Medicine, UT Texas MD Anderson Cancer Center, Houston, TX, USA, and Tim Miller, Professor of Anesthesiology at Duke University Medical Center, Durham, NC, USA.

The conversation provides insights on the key themes and developments from the conference. They discuss the critical importance of postoperative monitoring and interventions, including haemodynamic management, advanced monitoring systems, and the integration of new technologies such as AI and wearables. They emphasize evolution in surgical practices, particularly the shift towards outpatient procedures facilitated by robotic surgery. The conversation then highlights the global need for enhanced postoperative care standards and the potential future directions in perioperative medicine.

Andy Cumpstey is joined by three experts from NHS England; Mindy Dawes, Deputy Divisional Director of Nursing for Surgery at Walsall Healthcare NHS Trust; Maria Oyston, Head of Nursing Service Transformation & Resilience at NHS England; and Jane Murkin, Deputy Director for Safety & Improvement - Nursing at NHS England, to discuss the Dreaming Project and Toolkit.

The conversation delves into the origins and implementation of the Dreaming Collaborative, which aims to prevent patient deconditioning post-surgery by promoting early drinking, eating, and mobilizing. They discuss the contributions of various stakeholders, the importance of a multi-disciplinary approach, and the toolkit which was designed to help healthcare providers implement these strategies effectively. The episode highlights the significant improvements in patient outcomes and reduced length of stay achieved through this project, as well as the importance of engaging patients and healthcare staff at all levels.

Further reading:

We mention this paper: https://www.bjanaesthesia.org/article/S0007-0912(22)00146-5/fulltext

Our guest, Mindy Dawes, provides this paper: https://www.bjanaesthesia.org.uk/article/S0007-0912(25)00162-X/abstract

Recorded at the Evidence Based Perioperative Medicine (EBPOM) World Congress in London this piece sees Andy Cumpstey speaking with Imogen Fecher-Jones, Lead Nurse Perioperative Services, University Hospital Southampton, and Andrew Davies, Consultant in upper gastro-intestinal surgery at Guy's and St Thomas' NHS Hospital Trust, in the UK.

We discuss the concept and benefits of surgery schools, their development in the UK, and a newly created toolkit aimed at standardizing and implementing these programs more effectively. Discover how surgery schools are impacting patient outcomes and the importance of evidence-based approaches in modern medicine.

This episode also delves into the multidisciplinary efforts and various stakeholders involved in creating the surgery school toolkit, with insights on its applicability both nationally and internationally. Tune in to learn more about this pivotal initiative from leading experts in the field.

We mention our previous podcast on the topic of The Perioperative Quality Initiative (POQI), which you can hear here:

https://topmedtalk.libsyn.com/an-update-on-the-perioperative-quality-initiative-ebpom24

Recorded at the Evidence Based Perioperative Medicine (EBPOM) World Congress in London, Andy Cumpstey is joined by Simon Davies, Consultant Anaesthetist York Teaching Hospitals NHS Foundation Trust.

We discuss Simon's work at the intersection of university research, NHS practice, and industry consulting. Hear about his recent experiences and insights from a meeting on Capitol Hill where a bipartisan group is pushing for increased continuous blood pressure monitoring.

Key topics include technological advancements, patient safety, and the significant implications for maternal and general surgical care. The episode also touches upon the global and future impact of these initiatives as well as upcoming research projects in the field.