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Anesthesiology Patient Care at
Harborview Medical Center

To quote a former Chief of Anesthesia, Dr. Bruce Cullen: "HMC prides itself on a special esprit-de-corps and positive attitude. We enjoy what we do, we enjoy each other, and we work together toward a common goal." The teaching component is considered vital, and many faculty regard it as one of their main aims. Harborview Medical Center is a very busy place, and one that is sometimes described as "controlled chaos". Residents do work hard here, but they also learn a lot and gain a wealth of experience.

Overview

Harborview Medical Center is a major health-care facility for the Pacific Northwest and Alaska. HMC is unique in that it is the only Level 1 trauma center in 4 states: Washington, Idaho, Montana, and Alaska. HMC receives tertiary transfers by helicopter, airlift Northwest fixed wings aircrafts, and ground transports. A helipad in front of the hospital lands referral patients continually. Internationally, HMC has achieved recognition for trauma management, orthopedics, burn surgery, neurotrauma surgery, neurovascular surgery, and paramedic services. With the recent expansion and completion of the Maleng Building, HMC now has 411 beds, of which 100 beds are intensive care unit beds, distributed among the Neuro Intensive Care Unit, the Trauma/Surgical Intensive Care Unit, the Burn Intensive Care Unit, the Pediatric Intensive Care Unit, the Medical intensive Care Unit, and the Coronary Care Unit. A new 14 floor building (Ninth and Jefferson Building or NJB) is due to be complete early 2009. This building will house the Neurologic Institute, the Eye Institute, the Spine Center and the Hand Center. The State of Washington regularly reviews HMC and its mission and operation, and provides substantial support. The hospital is owned by King County, but run by the University of Washington. All attending physicians are full time faculty at University of Washington.

The anesthesia services provided at HMC offer a wealth of training experience in an atmosphere of high morale and genuine friendship. At the completion of their time at HMC, residents are experienced at difficult cases of all kinds: seriously ill trauma victims; neuroanesthesia for head injuries, aneurysms, and AVMs; anesthesia for open and endovascular procedures; anesthesia for burns (HMC has one of the busiest burn centers in the world); complex orthopedic procedures; and in particular, patients with airway problems. We also have a very active neurointerventional service, and there are daily procedures for coiling of aneurysm or angioplasty for vasospasm, in addition to "brain attack" thrombolysis procedures. Our residency graduates are experts at fiberoptic intubations and related techniques, due in part to exposure to difficult airways at HMC. We attend all emergency airways in the Emergency Department and Intensive Care units. All residents are backed up by attendings who are present at all airway emergencies.

Skills gained include extensive exposure in limb-block techniques, neuraxial blockade, and invasive vascular monitoring. There are many opportunities to learn placement of internal jugular central venous catheters under ultrasound guidance. In addition, members of the neuroanesthesia division routinely places retrograde jugular bulb catheters for intraoperative monitoring of cerebral venous oxygen saturation. They also maintain an active clinical research program. The Pain Relief Service is a busy teaching and working unit that has won awards of excellence. The pain relief service typically sees 1000 patients in more than 5000 visits and performs many procedures; a large percentage of the patients are critically ill. Increasingly all peripheral nerve blocks are performed under ultrasound guidance. An active regional anesthesia group complements the Pain Relief Service. An outpatient pain service including implantation of spinal cord stimulators is in the planning stage. The other subspecialty division is pediatric anesthesia. Although there is no elective pediatric surgery, we provide anesthetic care for all trauma and burn pediatric patients, many of whom provide unique challenges.

The anesthetizing locations in the hospital include 14 O.R.s in the main building, and 8 O.R.s in the Maleng Building (opened August 2008). The main building and the Maleng Building are connected by architecturally impressive sky bridges as well as two tunnels underground. All operating rooms are in the basement. Other anesthetizing locations include the post-anesthesia care unit (PACU), a burn O.R. for debridement and minor procedures in the Burn Center, and out-of-OR anesthetics in the Gamma Knife suite, angiography, MRI, or CT-scanner. During the 2007-8 academic year, anesthesiology attendings and residents performed approximately 12,000 anesthetics, and this number is expected to increase. (About 30-40 percent of the surgical cases are unscheduled.)

We currently have 32 attending anesthesiologists, 24 CRNAs, and on average 20 residents rotating through HMC. Many of our faculty are experienced anesthesiologists from other countries and bring unique wealth of clinical expertise and perspectives to our training program. We are all full time faculty members of University of Washington and value education and training of residents. Nurse anesthetists are integral members of the anesthesia care team and are full participants in the anesthetic care of the patients under the supervision of the attending anesthesiologists.

HMC is a special place where we work hard to accomplish our mission, to provide quality care to all citizens of King County and the State of Washington. The teaching component is considered vital, and many faculty regard it as one their main aims. In addition to bedside OR teaching, there are weekly scheduled seminars/conferences on Thursday mornings. Residents work hard but, in the process, they see a lot, do a lot, and develop self-confidence.


Image of HMC Chief

Dr. Michael J. Souter, MB BS, FRCA
Professor, Anesthesiology & Pain Medicine;
Chief, HMC Anesthesiology Clinical Services;
Adjunct Professor, Neurosurgery;
Medical Co-Director, NeuroCritical Care Service,
Harborview Medical Center

Box 359724
Harborview Medical Center
325 Ninth Avenue
Seattle, WA 98104

Phone: 206 744-3059
FAX: 206 744-8090
E-mail: msouter@uw.edu