Jonathan Siner, MD, rolled up the left sleeve of his button-down shirt and leaned slightly away from the needle as he received his COVID-19 vaccination in mid-December. Siner, an associate professor (pulmonary, critical care, and sleep medicine), was among the first five Yale New Haven Health (YNHHS) employees to be vaccinated. He received his first vaccine dose after nearly a year spent caring for patients during the pandemic as the director of the medical intensive care unit (MICU) at Yale School of Medicine’s (YSM) Section of Pulmonary, Critical Care, and Sleep Medicine (Yale-PCCSM).
“It’s been a long and challenging year for a lot of people,” Siner said that day. “Everybody’s worked together -- administrators, physicians, nurses, respiratory therapists, advanced practice providers, pharmacists. There are a lot of different ways of helping people, caring for them, both in the hospital and public health. This pandemic, because of the limited knowledge, lack of proven therapies, and rapid spread of the virus, demonstrated that we all had to work together to get the best possible outcomes.”
After many successes as MICU director, including integrating the MICU with Saint Raphael’s Campus and the launch of the tele-ICU program, on the day that he received his vaccination Siner was in the process of handing over the reins of his frontline leadership role in the MICU to his colleague, Shyoko Honiden, MD, MS, associate professor (pulmonary, critical care, and sleep medicine) at YSM.
Honiden, fellowship program director for Yale-PCCSM, said she looked forward to bringing her leadership skills to her new role as MICU director, where she will focus on continuing the growth and the success of the MICU. She hopes to advance all dimensions of its mission: patient care, research, and medical education.
“This is an exciting moment for us,” said Naftali Kaminski, MD, chief of Yale-PCCSM. “Dr. Siner led the MICU through an unprecedented period of growth from 24 beds to close to 60, expansion of the step-down unit, and creation of first Tele-ICU unit in the EPIC environment that allows remote treatment of critically ill patients,” Kaminski said. “But when he took over as the chief for clinical affairs for Yale-PCCSM and director critical care for the health care system, we needed somebody to fill his big shoes. We ran a national search, but the ideal candidate was here.”
Honiden, he said, not only has been successful as fellowship director, but has played an important role alongside Siner, Margaret Pisani, MD, MPH, and Lynn Tanoue, MD, MBA, in orchestrating the critical care redeployment during the first phase of the COVID-19 pandemic in the spring of 2020.
“We needed to quadruple the number of teams taking care of critically ill patients, which meant that some teams required additional support because physicians were not necessarily experts in medical intensive care,” Kaminski explained. “They came up with an amazing plan. Dr. Honiden worked on this day and night, while managing the fellowship program, so I had no doubt that she was the person to fill Dr. Siner’s huge shoes.”
Approximately 4,700 patients are admitted to the MICU each year, making it one of the most active medical ICUs in the country. Honiden has witnessed that growth since joining YSM’s faculty in 2007, three years before Smilow Cancer Center, where the MICU is located, opened in the hospital’s North Pavilion.
“I fondly remember our 'move day' as I helped transport patients from South Pavilion to North Pavilion during my third trimester with my first child.” As fellowship director, Honiden oversaw the expansion of both the traditional pulmonary critical care and one-year critical care fellowship training programs. “We have come a long way in terms of education, quality and safety, research, and patient care,” she said.
Even so, Honiden sees room for additional growth, specifically for enhancing education and career development for junior faculty, as well as advancing patient care and research. She plans to tap into the relationships she has formed with colleagues throughout YSM and YNHHS to help move the MICU forward. “As we've learned throughout the COVID crisis, we can do more if we work together,” she said. “Even seemingly insurmountable challenges can be tackled and solved.”
One of her top priorities will be focusing on frontline health care workers who are at risk for burnout and a lack of well-being after a year of intense clinical work during the global pandemic. “I appreciate the thoughtful attention that has been paid by the university and hospital leadership in that regard,” Honiden said. “Threats to physician well-being are ever present, even beyond the pandemic, and I believe there are lessons that we can carry forward.”
Another of her goals is to create a MICU database to more fully understand the unit’s patient population, patient outcomes, and practice variations. Having access to granular data will help Honiden and her team better evaluate programs and design policies, she said.
Honiden also plans to facilitate and integrate research in the MICU. In recent years, MICU research has grown through the work of nationally recognized researchers such as Melissa Knauert, MD, PhD, and Lauren Ferrante, MD, MHS, and more recently, the proliferation of COVID-19 research. “The size of our units and the excellence of Yale’s research programs should put us in a unique position to make substantial contributions to critical-care research,” Honiden said.
She is committed to making the leadership transitions in Yale-PCCSM as seamless as possible while a national search for her replacement as fellowship director takes place. “I feel that it is vital that this transitional phase be smooth, and executed with clarity, planning and transparency,” she said. “Change can feel scary, but it doesn't have to be.”
The Section of Pulmonary, Critical Care, and Sleep Medicine is one of the 11 sections within YSM’s Department of Internal Medicine. To learn more about Yale-PCCSM, visit PCCSM’s website, or follow them on Facebook and Twitter.