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Capital Health Systems, Hopewell Physician Assistant Fellowship in Acute Care Surgery

PHYSICIAN ASSISTANT FELLOWSHIP IN ACUTE CARE SURGERY AT CAPITAL HEALTH

1. Name of Program:   Surgical Trauma and Acute Resuscitative Service (STARS)

2. Specialty:    Acute Care Surgery

3. Program Address:   Capital Health Systems, Hopewell 2 Capital Way, Suite 356 Pennington, New Jersey 08534

4. Program Phone Number:  (609) 537-6000

5. Program Fax Number:  (609) 537-6002

6. Program Site URL:   Not Applicable

7. Program Medical Director:  Michael Kalina, DO, FACOS, FACS

8. Program Co-Director:  Rachel Kirkpatrick, PA

9. Program Co-Director Email: rkirkpatrick@capitalhealth.org

10. Program Co-Director:  Shaun Foley, PA

11. Program Co-Director Email: sfoley@capitalhealth.org

12. Primary Contact Name:  Michael Kalina, DO, FACOS, FACS

13. Primary Contact Title:  Medical Director of Acute Care Surgery

14. Primary Contact Phone:  (609) 537-6000

15. Primary Contact Email:  mkalina@capitalhealth.org

16. Program Coordinator:  Leslie Goldsmith, RN

17. Program Coordinator Email: lgoldsmith@capitalhealth.org

18. Program History and Description:

History: The Surgical Trauma and Acute Resuscitative Service (STARS) was created by Dr. Michael Kalina, DO, FACOS, FACS.  As the Medical Director of Acute Care Surgery at Capital Health in Pennington, New Jersey, Dr. Kalina integrated the STARS into the Section of Acute Care Surgery, within the Department of Surgery at Capital Health.  The STARS was designed by Dr. Kalina to implement the principles of Acute Care Surgery into the daily care of critically ill surgical, emergency general surgery, elective general surgery, trauma, and acute resuscitative patients.  The STARS integrates physician assistants, advanced nurse practitioners, allied health practitioners, and Acute Care Surgeons into a multidisciplinary Acute Care Surgery model of patient care.

Description: The Surgical Trauma and Acute Resuscitative Service (STARS) is a multidisciplinary team with specific membership criteria that provides coverage of emergency general surgery, trauma, surgical critical care, and acute resuscitative patients with acute surgical disease at Capital Health Systems, Hopewell.  As the Medical Director of Acute Care Surgery, Dr. Michael Kalina, DO, FACOS, FACS, has direct oversight and approval of its membership and enforces its policies.  To obtain membership in STARS, there are specific criteria, responsibilities, and requirements that must be met and maintained.  Membership will be held or revoked based upon non-compliance and in accordance with the professional practice guidelines at Capital Health Systems.   STARS membership can include Allied Health Practitioners, Nurses, Advanced Practice Nurses, MidLevel Practitioners, Physician Assistants, STARS Acute Care Surgeons and STARS General Surgeons.  STARS Mid-Level Practitioners, Physician Assistants, and Nurses include but are not limited to nurses of all accreditations, physician assistants, and mid-level practitioners of all accreditations who dedicate a significant portion of their practice to managing emergency general surgery, trauma, surgical critical care, and acute resuscitative patients with acute surgical disease at Capital Health.   

 

STARS Mid-Level practitioners, Physician Assistants, and Nurse Practitioners must:

-Possess and maintain the requisite and current specialty expertise and competence in clinical patient care

-Possess and maintain eligibility and/or certification in their respective discipline

– Possess and maintain appropriate qualifications for the practice of Acute Care Surgery including but not limited to certifications in BLS (required), ACLS (required), PALS (preferred), and ATLS (preferred).

-Promote an environment of education and scholarship -Promote a multidisciplinary approach to patient care

-Maintain a presence within local, regional, and national committees and societies related to clinical practice

– Possess and maintain a position in good standing at Capital Health

– Possess and maintain an active membership at Capital Health

-Adhere to the code of conduct in accordance with Capital Health policy

-Adhere to the policies set forth by the Section of Acute Care Surgery

-Adhere to the code of conduct for STARS members

– Possess and maintain practice privileges in accordance with Capital Health policy

– Possess and maintain proper licensure and professional competence in accordance with Capital Health policy and the state of New Jersey 

 

  • The acute surgical diseases managed by the STARS are those most commonly associated with emergency general surgery, trauma, surgical critical care, and acute resuscitation patients, which include but are not limited to:

-Appendicitis

-Acute biliary disease

-Acute pancreatitis

-Acute diverticulitis

– Airway emergencies

-Acute uncontrolled hemorrhage (all sources)

– Colitis caused by Clostridium dificile

-Gastrointestinal hemorrhage

-Perforated peptic ulcer disease

-Intestinal obstruction (adhesive disease)

-Intra-abdominal sepsis

-Mesenteric ischemia

-Surgical Site Infection (SSI)

-Necrotizing skin and soft tissue infections

-Acute incarcerated hernias (all)

-Open abdomen

-Critically ill trauma patients (all types)

-Critically ill surgical patients (all types)
The STARS will:

-Assess and manage all patients consulted or admitted to STARS Acute Care Surgeons or STARS General Surgeons expeditiously.

-Abide by all STARS consultative and tertiary referral guidelines.

-Abide by policies and procedures set forth by the Section of Acute Care Surgery, Department of Surgery, their respective departments, and the Medical Staff of Capital Health

-Be knowledgeable of all patients on the service.

-Promote efficient and precise communication between members, consultants, and staff at Capital Health.

-Promote a collegial relationship with all services, departments, and staff at Capital Health. – Promote a multidisciplinary, patient safety, best practice, and evidenced based approach to patient care.

-Promote scholarship in the form of poster and abstract formation and manuscript submission as well as conference attendance

-Promote administrative policy and curriculum formation in Acute Care Surgery and their disciplines

-Maintain the STARS database, procedural logs, performance improvement and outcomes data

-Maintain proper certification, eligibility, and good standing within their respective organizations, boards, and at Capital Health.

19. Curriculum Outline

Title:  Surgical Trauma and Acute Resuscitation Service (STARS) Physician Assistant Certification

I. Principle

Capital Health has an increasing requirement for the early and expedient care of emergency general surgery, trauma, surgical critical care, and acute resuscitation patients with acute surgical disease.

II. Purpose

The purpose is to define and detail the Surgical Trauma and Acute Resuscitation Service (STARS) Physician Assistant (PA) process for initial certification and maintenance of certification at Capital Health.

III. Scope

The Surgical Trauma and Acute Resuscitation Service (STARS) PA will provide a service for the coverage and care of emergency general surgery, trauma, surgical critical care, and acute resuscitative patients with acute surgical disease at Capital Health.   The PA’s will also provide coverage as operative first assists.  The PA’s initial certification and maintenance of certification will include educational and procedural requirements as detailed below.  STARS PA certification will:

-Improve patient care

-Improve patient outcomes

-Improve provider knowledge

-Improve provider skills

-Maintain a standard of patient care

-Maintain a standard of provider knowledge and skill

IV. Certification

-The STARS PA must meet the initial requirements for membership into STARS.

-The STARS PA must meet the initial requirements for membership of the medical staff at Capital Health.

-Direct supervision and indirect supervision for procedures will be provided by and will be at the discretion of the STARS Acute Care Surgeons, credentialed General Surgeons, certified/credentialed STARS PA’s, or credentialed medical providers available to the STARS PA at the time of procedure.

Requirements:

1. Educational

The STARS PA must complete:

A. The American College of Surgeons Fundamentals of Surgery Curriculum (FSC)

-The STARS PA will be enrolled and must complete the curriculum within the allotted time (usually 1 year)

-The STARS PA must obtain a passing grade for each scenario within the FSC curriculum

-The STARS PA must obtain a passing grade for the entire FSC curriculum

B. The New England Journal of  Medicine Videos in Clinical Medicine Curriculum

-The STARS PA must watch the following videos, especially prior to performance of bedside procedures for:

Central Line Catheter Placement – Subclavian Vein

Arterial Line Placement

Chest Tube Insertion

Ultrasound Guided Peripheral IV placement

Intraosseus Catheter Placement in Children

Ultrasound Guided Internal Jugular Central Line placement

Placement of a Femoral Venous Catheter

Central Venous Catheterization

Paracentesis

Thoracentesis

Arthrocentesis

Lumbar Puncture

Swan-Ganz Catheter placement (non-NEJM video)

Peripherally Inserted Central Catheter (PICC)placement (non-NEJM video)

2. Procedural

A.  The STARS PA must complete:

Central Line Placement Certification*

Observation of 5 Central Line placements

Placement of 5 Central Lines under direct supervision

Placement of 5 Central Lines under indirect supervision

Arterial Line Placement Certification*

Observation of 5 Arterial Line placements

Placement of 5 Arterial Lines under direct supervision

Placement of 5 Arterial Lines under indirect supervision

Chest Tube Insertion Certification*

Observation of 2 Chest Tube Insertions

Placement of 2 Chest Tubes under direct supervision

Placement of 2 Chest Tubes under indirect supervision

Swan-Ganz Catheter Placement Certification**

Observation of 1 Swan-Ganz Catheter placement

Placement of 1 Swan-Ganz Catheter placements under direct supervision

Placement of 1 Swan-Ganz Catheter placements under indirect supervision

Paracentesis Certification**

Observation of 2 Paracentesis

Performance of 2 Paracentesis under direct supervision

Performance of 2 Paracentesis under indirect supervision

Thoracentesis Certification**

Observation of 2 Thoracentesis

Performance of 2 Thoracentesis under direct supervision

Performance of 2 Thoracentesis under indirect supervision

Arthrocentesis Certification**

Observation of 2 Arthrocentesis

Performance of 2 Arthrocentesis under direct supervision

Performance of 2 Arthrocentesis under indirect supervision

Lumbar Puncture Certification**

Observation of 2 Lumbar Puncture

Performance of 2Lumbar Puncture under direct supervision

Performance of 2 Lumbar Puncture under indirect supervision

Peripherally Inserted Central Catheter Certification**

Observation of 5 Peripherally Inserted Central Catheter placements

Performance of 5 Peripherally Inserted Central Catheter placements under direct supervision

Performance of 5 Peripherally Inserted Central Catheter placements under indirect supervision

*Required

**Preferred but not required

The STARS PA must operatively assist with:

Elective General Surgery, open

Assistance with 10 cases

Elective General Surgery, laparoscopic

Assistance with 10 cases

Elective Vascular Surgery

Assistance with 10 cases

Elective Specialty Surgery (Eg. Orthopedics, ENT, OB/GYN, Urology, Spine, etc.)

Assistance with 10 cases

Emergent General Surgery, open

Assistance with 10 cases

Emergent General Surgery, laparoscopic

Assistance with 10 cases

Emergent Vascular

Assistance with 10 cases

Emergent Specialty Surgery

Assistance with 10 cases

Research

The STARS PA will be responsible to contribute to ongoing research projects and presentations. The STARS PA will be encouraged to present research at regional and national conferences and meetings

V. Documentation

The STARS PA must keep logs of all procedures and operative assistance performed.* The STARS PA must provide documentation of completion of educational requirements. The STARS PA must document the direct and indirect supervisor for each procedure, within the logs. The STARS PA will undergo quarterly (4x/year) evaluations by the Section Chief of Acute Care Surgery to:

-Assess progress for educational requirements

-Assess progress for procedural requirements, bedside and operative

-Assess performance for procedural and educational requirements

-Assess the need for remediation or FPPE (see below)

_Assess for completion of certification.

VI. Process for Certification

Upon Completion of the above requirements:

-The STARS PA will submit completed documents to the Medical Director of Acute Care Surgery for approval.

-The STARS PA will receive a “Certification in Acute Care Surgery” at Capital Health Systems, as granted by the Medical Director of Acute Care Surgery and countersigned by the Chairperson of Surgery, CMO and CEO.

VII. Maintenance of Certification

STARS PA’s must meet maintenance of certification requirements including but not limited to: 

-Submission of procedural logs  

-Submission of relevant CME’s, CE’s All submissions will occur annually.

All submissions must be provided to the Section Chief of Acute Care Surgery for approval.

VIII. Failure to Complete Certification

STARS PA’s who do not complete the educational and/or procedural certification will be subject to a Focused Professional Practice Evaluation (FPPE) according to Capital Health policy.  Failure to complete certification may also result in further action from the Medical Director of Acute Care Surgery, according to Capital Health and STARS policy.

20. University and Institutional Affiliations

a) Salus University,  8360 Old York Road Elkins Park, PA 19027

b) Arcadia University, 450 South Easton Road Glenside, PA 19038

c) Drexel University, 3141 Chestnut Street Philadelphia, PA 19104

21. Admissions Process and Timetable

The length of the program is 12 months with an estimated enrollment of 1 Physician Assistant every 12 months.  The program will commence upon date of hire, with a rolling admission.

22. Application Components and Selection Criteria:

The application for privileges within the Medical Staff of Capital Health will serve as the application for the STARS.  Prior to hire, the physician assistant will be selected based upon their desire to meet membership criteria for STARS and to complete the certification requirements as described above.  Upon hire, the physician assistant will begin the certification/fellowship.

23. Credentials Awarded

Upon completion of the educational and procedural requirements, the physician assistant will be “Certified in Acute Care Surgery”.  All the rights and responsibilities of that status will be conferred at the time of certification by the Medical Director of Acute Care Surgery at Capital Health.  The Physician Assistant will receive a formal certificate with a seal of approval and the signatures of the Medical Director of Acute Care Surgery, Chairman of Surgery, and the Hospital CMO/CEO.

24. Financial Information

There is no tuition or housing fees associated with the program.  A salary commensurate with the experience of the physician assistant will be provided upon hire.  All program members must have graduated an accredited physician assistant program and have obtained New Jersey State Licensure.  All program members must be hired into a STARS position and meet the initial requirement for employment within STARS, Capital Health, and the state of New Jersey.  Each member, once employed, is provided an educational fund to cover expenses such as, professional membership dues, professional certifications, medical textbooks, and continuing medical education expenses.

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