The Nutrition Support service at the University of Virginia for surgical patients has a long history of managing very complicated patients. The physicians working on this service include Robert Sawyer and Bruce Schirmer. The nutrition support specialists include a very experienced group of dedicated Registered Dietitians, including Kate Willcutts, Kelly O’Donnell, Amy Berry, Theresa Fessler, and Christie Moulder. The most common patients that we see include patients with gastrointestinal failure, fistulae, and critical illness. Unique strengths of the program include the nutritional management of patients in the intensive care unit with highly specialized needs, as well as those with complicated gastrointestinal tract disease. The service is also very involved with the bariatric/weight loss surgery program that is headed by Dr. Bruce Schirmer. New efforts from this group include more efficient ways to deliver appropriate nutrition to all patients on the surgical services.
This is an exciting period for efforts designed to keep the patient safe during their hospital stay. If there was always an attending surgical intensivist available to be at the bedside of every patient at all times then no such technology would be necessary. Acknowledging that expert computer systems can possibly watch for dangerous patters of physiologic decompensation may make it possible to alert clinicians when things go awry. Algorithms are designed with specific clinical decompensation scenarios in mind and are capable of determining which patients will have respiratory decompensation, hemorrhage, or sepsis over the following 24 hour period. Our group has the most experience and capability of any center in the world in this area. This is likely due to the successful collaboration of mathematician, physicists, architects, surgeons, intensivists, and data specialists. The era of big data has arrived and it will be used to save the lives of inpatients at the University of Virginia using this technology for years to come.
In general surgery, the University of Virginia is the only hospital to provide robotic-assisted abdominal operations in central, western and southern Virginia. The EGS Division offers robotic-assisted laparoscopic operations to treat hiatal hernia and severe gastric reflux disease (Nissen operation), gallbladder surgery, ventral hernia and inguinal hernia repairs. The single port surgery for cholecystectomy reduces 4 small incisions to one small incision. Robotic-assisted laparoscopic hernia repair benefits patients by reducing postoperative pain and shortened recovery time. The robotic system provides surgeons with 3D views and makes difficult procedures less complicated.
We have embarked on a new era of remote access for patients to the specialty care at the University of Virginia. We have established relations over time with clinics at great distance who refer patients to our division and are now very excited to offer them the ability to interact with a UVA surgeon without having to travel. Patients will be able to see their surgeon, meet their surgeon, and ask any question they would as if they were in a face-to-face encounter. Patients who live at great distance however will not be faced with as many as four trips to the Medical Center or Grounds. In the new system, the patients will go to their local primary care provider and undergo an exam by clinicians at that site while being viewed and interacting with faculty within our division. Faculty members will be able to solicit physical exam findings and other data in a high fidelity, high resolution audio-visual format. It is expected that we will save patients hours of travel time as well as many, many miles.
The Division of Acute Care Surgery and Outcomes Research is engaged in a 7 year initiative to train the next generation of educators in Sub-Saharan Africa. We have three surgeons that work overseas full time in dedicated positions that serve to support residencies and partnership with local surgeons. To date the number of residents in Rwanda has doubled and we are on track for a successful accomplishment of program goals. Never before has a program like this been carried out with local leaders in control of the budgetary process. Likewise there has never been any similar program that focuses on long term mentorship rather than short term relief. Stay tuned for details as monitoring and evaluation efforts continue to assess what we are accomplishing.
System Engineering and Communications
The trauma service has worked with the Department of System Engineering for several years examining the flow of information during critical events. This has resulted in several presentations and manuscripts at scientific meetings.
This has also led to the development of a secure radio communication system for the trauma service, which is currently being piloted.
The program has also sponsored 2-3 medical students each summer in the Medical Student Summer Research Program to work on research projects related to trauma, critical care, system engineering, and critical communications.
We also have collaborated with emergency medical services, and emergency management in these projects, and hope to develop processes that will allow us to become aware of critical patients in our geographic area earlier so we can optimize their treatment.