Chair's Welcome

 

Roberta Hines, MD

 

Nicholas M. Greene Professor and Chair

 

Department of Anesthesiology

 

Yale University School of Medicine

 

 


Welcome to the Department of Anesthesiology at the Yale School of Medicine! The Department’s rich history combined with its current focus on advancing the practice of anesthesiology and the science of medicine informs all we do. The Department is recognized for its focus on providing exemplary clinical care, as well as its innovations in anesthesiology education and research. Since achieving Departmental status in 1968, the Department has experienced dramatic clinical, scientific and academic growth. Currently, clinical services are provided in the inpatient and ambulatory operating rooms of all campuses of Yale-New Haven Hospital (YNHH), the West Haven VA hospital, and the Temple Surgery Center. Yale-New Haven Hospital is now the third largest hospital in the nation, providing care to a diverse array of patients. With over 1500 patient beds, YNHH focuses on general and specialty specific care at its campuses which include: Yale New Haven Hospital’s York and Chapel Street campuses, Yale-New Haven Children's Hospital, and The Smilow Cancer Center. Each of these sites is located within the diverse geography of Southern Connecticut, in close vicinity to New England coastal towns, urban cityscapes, vibrant suburbs, and the rural farmland of inland Connecticut. Our patients are a product of this diversity and offer boundless opportunities for the expert, patient-centered anesthesia services that are the foundation of everything we do.
 
Demographics
The Department attracts faculty who have trained at top tier programs in the United States and abroad. Over 90 percent of our faculty have advanced subspecialty fellowship training in a particular clinical area of focus. Currently, the Department is comprised of 110 faculty members, 76 residents, 90 CRNAs and 12 clinical fellows, as well as postdoctoral research fellows. The Department provides clinical care in a care team model wherein we deliver care in conjunction with a variety of clinical practitioners including CRNAs, APRNs, PAs, RNs and anesthesia technicians.
 
Clinical Practice
For the 2016-2017 academic year, the Department provided anesthetic care for over 60,000 patients. Our clinical anesthesia practice is composed of divisions and sections which provide clinical service in a specialty specific manner. This approach assures that our patients receive the most contemporary and evidenced based care. These clinical divisions include: Ambulatory, Cardiac, Adult Perioperative, OB/Gyn, Pediatrics, Pain Medicine, Non-OR anesthesia (NORA), intensive care medicine and the VA facility. The section of perioperative adult anesthesia is the largest division and is further divided into the following sections: bariatrics, regional, thoracic and vascular, neuro, ENT, preadmission testing and intensive care medicine. All divisions and sections incorporate faculty with fellowship expertise to assure in depth educational experience for all trainees and provide our patients with the most contemporary and highly specialized clinical care.

Our pain medicine practice includes both acute and chronic pain management. The outpatient practice is located within the musculoskeletal center at Long Wharf in New Haven, which focuses specifically on the interdisciplinary treatment of musculoskeletal diseases. Cancer pain treatment is provided in conjunction with faculty from the palliative care program at Smilow Cancer Hospital. The acute pain services care for in patients with a focus on the management of postoperative pain and the treatment of sickle cell disease in both adults and children.

The Department is strongly committed to providing perioperative care across the entire clinical care continuum. This is demonstrated our active presence in all the Post Anesthesia Care Units (PACU's) as well as the multiple intensive care units (ICU’s) The Department has 15 board certified intensive care anesthesiologists, who practice in the Medical Intensive Care Unit (MICU), Surgical Intensive Care Unit (SICU), and the Cardio-thoracic Intensive Care Unit (CTICU).

A dedicated pediatric anesthesia section provides specialized care for our pediatric patients, with faculty who all have added expertise in pediatric anesthesia. This pediatric anesthesia practice is responsible for the care of all children <16 years of age. The pediatric anesthesia service provides both intra-operative care, as well as anesthesia services in the MRI and catheterization laboratory, as well as in the interventional radiology and oncology areas. The division of pediatric anesthesia is comprised of 12 faculty, all board-certified subspecialists.

The Department is continually assessing its quality and clinical performance via a robust quality assurance process. In addition, as our institutional needs expand, the Department is adding new and innovative clinical programs to address these demands. Examples of such programs include: a rapid response airway call team for emergency care, extended use of transesophageal echocardiography for management of patients undergoing cardiac surgery, management of high risk obstetrical patients (including a pre-assessment clinic) and a highly skilled regional anesthesia service providing regional analgesia for patients requiring orthopedic, oncological, urologic or general surgery. The Department is an active participant in the solid organ transplantation program, which provides transplantation in the following areas: renal, intestinal, cardiac, and liver. A specialized anesthesia transplant team (for both pediatric and adult patients) is available 24/7 to assure state of the art care.
 
Education
The primary focus of our educational initiatives is our resident and fellow training program. Our core residency training program is comprised of 57 PGY II – PGY IV residents with an additional 17 PGY I residents. Our educational mission focuses on preparing our residents to become leaders in our field, as demonstrated by the emphasis on their scholarly and clinical activities. The pursuit of academic activities during the residency is strongly encouraged and protected time is available to pursue such endeavors. Residents with a strong interest in research are encouraged to enroll in the Resident Scholars Program (please see link for future details). In addition to this formal program, during the CA-III year, residents may receive up to 6 months of protected time for research related activities.

Our educational program incorporates innovative and novel educational methods, as well as simulation, board review course preparation, PBLD and lecture presentations. We have recently introduced the concept of the “flipped” classroom into our didactic program. Workshops aimed at providing experience in techniques for vascular access, regional anesthesia and airway techniques/devices are given annually. Our grand rounds programs highlight faculty from within the Department as well as the extended Yale community. We host numerous visiting professors (from national and international institutions) as part of our Grand Rounds program, which covers the broad range of topics from clinical advances to science and health policy. Clinical fellowship opportunities are offered in the following areas: ambulatory, cardiothoracic (ACGME), pediatrics (ACGME), regional, OB, quality and safety, neuro-anesthesia and thoracic anesthesia. Over the next year, we are planning to add ACGME fellowships in pain medicine and critical care medicine. Research fellowships are available via an NIH supported T-32 program and via the National Clinical Scholars Program. These may be pursued as a primary fellow or in combination with any of the above clinical fellowships. (See associated links for details).
 
Research
The Yale School of Medicine and Yale-New Haven Medical Center are among the premier research and training institutions in the country. As part of this rich tradition, the areas of research interest in the Department of Anesthesiology encompass both traditional areas of anesthesia research, as well as new areas of science and medicine. Expanding and enhancing the research mission of the Department is one of our top priorities.

Our Research Program is under the directorship of Dr. Laura Niklason, Vice Chair for Research. Dr. Niklason’ s lab is focused on cutting edge research in the areas of vascular biology, tissue engineering and regenerative medicine. Her group was one of the first to achieve the culture and successful implantation of tissue engineered lungs in a rat model, work that was published in Science and that has continued to expand in subsequent years. 

Other faculty members in collaboration with Dr. Laura Niklason are studying topics in vascular biology, as it pertains to peri-operative outcomes and sepsis, as well as stroke and the regeneration of blood vessels that are damaged by injury or disease. This work is performed in collaboration with numerous investigators in the Interdisciplinary Vascular Biology program at the Yale School of Medicine.  In addition, the Department is working on pioneering new strategies for regeneration of entire segments of functional lung for the treatment of end-stage lung diseases such as emphysema and cystic fibrosis.

Another strength of our Departmental research is in the basic neurobiology of the perception of pain, touch and itch. Research in this area spans the entire gamut from whole animal studies (including human) to fundamental molecular approaches looking at the gene expression patterns of single neurons that are involved in sensation. Dr. Robert LaMotte’s lab is renowned for its work in identifying the neural mechanisms of pain and itch. This research program complements a variety of other research programs in the world-renowned Neurobiology laboratories at Yale University and the neuroimaging facilities of the Yale School of Medicine.

Dr. Helene Benveniste recently joined the Department. Dr. Benveniste is an internationally recognized expert in anesthesia imaging and brain metabolic systems. Her work incorporates imaging (MRI) into the study of various metabolic pathways of the brain and has been instrumental in defining the glymphatic pathway and its implication to a host of neuro-degenerative diseases such as Alzheimer’s.

Clinical research ongoing in the Department of Anesthesiology includes: industry-funded clinical trials, NIH-funded research of new care delivery models, and foundation grants that range from patient safety and outcomes research, to environmental impact assessments, to research into the history of Anesthesiology. Clinical studies of several novel agents that are active in the cardiovascular arena and coagulation systems are underway in the operating rooms and intensive care units. Dr. Manny Fontes, Director of Clinical Research, leads our efforts in this area in collaboration with Dr. Robert Schonberger, Associate Director of Clinical Research. Large scale database research studies are ongoing, looking at peri-operative and post-operative outcomes, the impact of preoperative beta blockade, and the impact of aging on anesthetic dosing requirements. The Department is a participant in the national multi-center perioperative outcomes group (MPOG).

Looking at the practice of anesthesia holistically, faculty members are studying the environmental impact of disposable items and exhausted gasses that are used in anesthetic practice, with the goal of mitigating environmental effects of these agents.  These exciting areas of research, in addition to many others, are part of the Yale training and clinical experience. Working together, we are breaking new ground and forging new links in science and medicine.
 
Research Fellowships
The Department is fortunate to be able to provide advanced research training opportunities to both residents and fellows, via an NIH T-32 grant. This is a two-year NIH sponsored program under the direction of Dr. Laura Niklason, MD, PhD. The T-32 program provides an opportunity to train the next generation of physician scientists. T-32 trainees can choose from a variety of research venues and opportunities. Please visit this link on the site to learn about this exciting program.

National Clinical Scholars Program
The Department is delighted to offer fellowships within the National Clinical Scholars Program, formerly known as The Robert Wood Johnson Clinical Scholars Program. This is an inter-professional fellowship program, designed for future clinician leaders to improve healthcare in the US through scholarships and activities at the national, state and local levels.
 
Conclusion
It is clear that we are in the midst of a rapidly evolving health care environment. The Department remains committed to delivering exemplary clinical care while training the next generation of leaders in anesthesiology. Our clinical education and research programs are designed to advance clinical care and scientific knowledge across the entire spectrum of modern anesthesiology.

It has been an honor and privilege to serve as the chair of the Department since 1995. I am delighted that I have been able to share a brief overview of the many innovative and exciting opportunities that the Department is currently engaged in. I encourage you to explore the many links provided on this site to learn more about your specific areas of interest.