Anesthesiology link set between MGH and Martha’s Vineyard Hospital


The Martha’s Vineyard Hospital has signed an agreement under which the Massachusetts General Hospital (MGH) Department of Anesthesia, Critical Care and Pain Medicine (DACCPM) will provide anesthesia coverage for its Island affiliate.

Island hospital officials said the agreement, which will take effect in June, is part of a continuing evolution linking the Island to the Boston hospital’s medical services and technology. Major changes in the hospital service model will include the addition of certified registered nurse anesthetists (CRNAs) who will be available 24/7 year-round to assist MGH anesthesiologists, and the adoption of MGH electronic scheduling and anesthesia record-keeping systems.

The change will mean the replacement of the hospital’s two staff anesthesiologists with MGH physicians. Tim Walsh, Martha’s Vineyard Hospital chief executive officer, told The Times the hospital has told Drs. Stephen London and Stacie Nobel-Shriver that it will end their contracts effective this spring.

Under the old service model, the hospital relied on one doctor who would be in the hospital when needed, or on call if there were no scheduled procedures that day that required anesthesia services. Dr. London’s longstanding contract also provided him with 10 weeks’ paid vacation in the winter, a gap the hospital needed to fill annually with temporary help.

Mr. Walsh said it is always problematic for a small hospital to fill gaps in physician coverage, but that MGH, with its pool of resources, will now, under the new arrangement, be responsible for scheduling coverage.

Mr. Walsh said Dr. London and Dr. Nobel-Shriver have the opportunity to apply to become a part of the DACCPM staff that will rotate through the hospital.

There is little difference between the approximate cost of the current hospital staff model and the cost of the MGH contract, Mr. Walsh said. The real advantage is the scheduling flexibility and expansion of medical services it provides, he said.

Mr. Walsh said nothing would change in terms of the physician schedule. One anesthesiologist would continue to be on-site or on-call.

The major change, he said, is the addition of nurse anesthetists on a 24-hour, 7-day-a-week basis.

“It is a much safer model,” Mr. Walsh said, explaining that it would allow the hospital to manage two surgical emergencies at the same time.

Greater flexibility added

In a telephone conversation with The Times Wednesday morning, Dr. Peter F. Dunn, MGH executive medical director of perioperative services administration, said the expanded scope of anesthesia services will mean greater flexibility for Martha’s Vineyard Hospital and allow for growth in elective procedures.

“For example,” he said, “just a simple hernia repair. People need not go off-Island to have that done. Pieter Pil and his surgical teams can do it, and we will make sure that there is the amount of anesthesia services available for those kinds of elective procedures. With limited resources on the Island, it’s a challenge to be doing elective cases in case an emergency comes in. But we will make sure there is that type of flexibility.”

Dr. Dunn said the use of nurse anesthetists is common at MGH and hospitals around the country. “Rather than having the physician practice solo in the room, having the physician oversee and medically direct the care as a team with the nurse anesthetist provides greater flexibility.”

Dr. Dunn, who oversees all operating rooms, said MGH is currently expanding from 52 to 70 operating rooms. He said MGH consulted with Martha’s Vineyard on the design of its two operating rooms in the new building, and the two hospitals share many similarities.

Dr. Dunn described the goal for Martha’s Vineyard Hospital. “We are going to be creating an entire team that will be a core group of anesthiologists that are members of our department that will be working as a team down there as well,” he said.

Other benefits of the collaboration, according to a press release, will include pre-operative testing for elective patients, assistance with newborn resuscitation during deliveries, post-operative recovery, and ventilator management, as well as support for endoscopic procedures.

For example, a patient scheduled for major surgery at MGH would normally need to make a trip to Boston prior to the operation for evaluation and clearance by the anesthesia department. Now that pre-operative clearance may be done on the Vineyard.

Anesthesia co-pilots

“What this new contract allows us to do is really expand the anesthesia coverage,” said Dr. Pieter Pil, hospital chief of staff and one of two staff surgeons.

Dr. Pil said the in-house CRNAs would augment physician coverage and furnish resources not now available on the Island.

“The real expansion is in the 24/7 CRNA coverage. I think that is where people will notice the benefit,” Dr. Pil said. As examples, he said they would be able to start epidurals for pregnant women and sedation procedures in the emergency room.

He added, “It should expedite taking emergency cases into the operating room after hours, because they will be able to walk over to the emergency room and prep the patient for the anesthetic.”

For example, if a patient arrived with a severe case of appendicitis, the CRNA could prepare the patient and get everything ready while waiting for the attending anesthesiologist, he said.

“It really deepens the team,” Dr. Pil said. “It is just one more person with expertise after hours who can be helpful in various scenarios.”

Dr. Pil said that under the current model, when the attending anesthesiologist is in the operating room during surgery, he cannot leave the operating room, even if there is an emergency requiremen that he assess another patient.

“Having a nurse anesthetist is sort of like having a co-pilot,” Dr. Pil said. “The anesthesiologist can sign over the case to the anesthetist and go over to the emergency room and determine if they need a breathing tube or whatever, so it is an extra set of hands.”

The goal Dr. Pil said is to run both hospital operating rooms simultaneously, something the hospital cannot do with only one anesthetist.

Another advantage is that MGH uses a computer system for monitoring and recording anesthesia. “They are going to help us simplify and streamline our OR (operating room) scheduling,” he said.

Noting that MGH pioneered inhalation anesthesiology 163 years ago, Dr. Pil said the new arrangement allows the hospital to tap into world experts. That includes systems that would normally be out of reach of a small, rural hospital.

In March 2007, Martha’s Vineyard Hospital became an affiliate of Massachusetts General Hospital and a member of Partners HealthCare.

Drawing a comparison between the Boston hospital’s scores of operating rooms and Martha’s Vineyard Hospital’s two, Dr. Pil said, “This is small fry for MGH, so I think if we were not affiliated with them we would not be on their radar.”