SPRING 2010

Member Spotlight

Richard J. Rivers MD
Wilmer Eye Institute
The Johns Hopkins University
Baltimore, Maryland
OAS Member since 2001

Robert H. & Clarice Smith Building
Wilmer Eye Institute

I have been specializing in ambulatory anesthesia for 15 years and became chief of ophthalmic anesthesia in 2002 at the Wilmer Eye Institute. We recently moved into a new building that was designed from the ground up for ophthalmic cases. We have six operating rooms and perform all types of ophthalmic cases and only ophthalmic cases. We average around 6,000 cases per year. We perform all types of ophthalmic surgical cases with about 10% requiring general anesthesia and the balance needing only MAC.

We recently had our initial JCAHO visit and we passed with flying colors except for the occasional omission of a time and date on some signatures. Our reviewer was especially complimentary of our patient tracker system that shows the daily OR schedule with each case identified by color as to the stage of passage through the OR suite. The tracker also features icons that will disappear as elements of the pre-op care such as consent, anesthesia preparation, and OR room ready are completed. This communication tool allows all members of the care team to know when items are completed and to identify which items have the potential to delay a case.

Our new OR suite, called the Bendann Pavilion, is on the first floor of the Smith building. We have our own free patient parking just outside our door, which makes us very unique from the rest of the Hopkins medical campus. We have sixteen pre-op/post-op bays and eight PACU beds. We are utilizing the Transmotion chair/tables so the patient stays in their bed from pre-op through post-op. In-room survey cameras and video monitors of all the microscopes are displayed at the control desk. Some of the physiological monitors were updated with Patient Data Modules from GE. These modules are used in rooms with many cases requiring rapid turnover. They stay attached to the beds so all the monitors are attached and removed by the pre-op nurses. The anesthesiologist starts monitoring by attaching a single plug to the monitor so anesthesia ready time is potentially only one minute long.

Ric Rivers with GE Patient Data Module

When I first arrived about 8 years ago, our anesthesia group was made up of 3-4 attendings with mostly residents and a few CRNA’s. Since that time many more of the Johns Hopkins anesthesia attendings have rotated through our OR’s with the requisite loss of specialty experiences. More recently, however, we have been able to consolidated back down to around six attendings with each one working about two days per week in our OR. We are now using almost exclusively CRNA’s although residents do come through occasionally for the pediatric cases.

OAS has been a critical part of my ophthalmic anesthesia training. I have learned how to safely perform retrobulbar and subtenon blocks and I always enjoy the camaraderie of the group and the lively discussion at the annual meetings. Through this group I met new colleagues who gave me the opportunity to visit and learn how they do things. I incorporated a lot of what I learned into the design of our new OR suite.