Department of Anesthesiology and Critical Care

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Caroline A. Pasquariello, MD, FAAP

Associate Professor of Clinical Anesthesiology and Critical Care
Attending Anesthesiologist, Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia
Associate Clinical Director of Perioperative Services, The Children's Hospital of Philadelphia
Director of General Anesthesia Faculty and Staff Scheduling and Coordination, The Children's Hospital of Philadelphia
Department: Anesthesiology and Critical Care

Contact information
The Children's Hospital of Philadelphia
Department of Anesthesiology and Critical Care Medicine
34th and Civic Center Blvd
Philadelphia, PA 19104
Office: 2155904755
Fax: 2155901415
Education:
BA (Psychology)
The University of Pennsylvania, 1978.
MD (Medicine)
University of Pennsylvania School of Medicine, 1982.
Post-Graduate Training
Pediatric Intern, The Children's Hospital of Philadelphia, 1982-1983.
Pediatric Resident, The Children's Hospital of Philadelphia, 1983-1985.
Anesthesia Resident, The Hospital of the University of Pennsylvania, 1985-1987.
Fellow in Pediatric Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, 1987-1988.
Certifications
American Board of Pediatrics, 1987.
American Board of Anesthesiology, 1988.
Special Competence in Critical Care- American Board of Anesthesiology, 1989.
Pediatric Critical Care Medicine- American Board of Pediatrics, 1990.
Recertification: Pediatric Critical Care Medicine- American Board of Pediatrics, 1997.
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Description of Research Expertise

OR Management
Perioperative Efficiency
Six Sigma (green belt course)

Description of Clinical Expertise

My main professional interests include: Pediatric Anesthesia, specifically Liver Transplant, Orthopedic and Neonatal Anesthesia. In addition, I have a special interest in Non-Operating Room Anesthesia.

My specific teaching interest is in the thorough preoperative evaluation of the pediatric patient. I work with the residents and fellows on a daily basis,specifically morning sign out with the on call residents. We choose one or two cases that represent either a classic pediatric disease or surgical procedure, or a complicated medical history. We develop problem lists ("anesthetic issues") and attempt to reduce a very complex medical situations into several bullet item problems from which we can deduce an anesthetic plan. I also include at least one "Pasquariello Pearl" per case presented, one point that they can bring to their clinical practice.

Description of Other Expertise

I am involved in a hospital wide initiative to smooth out hospital surgical admissions throughout the week/month. I am a member of both the Steering Team and Project Team of this Surgical Patient Flow Project. A natural extension of this project is a series of surgical patient flow projects. I have been trained in the Kaizen process for Rapid Improvement and have been an active team in all three of the Rapid Improvement Events:Pre-procedure Patient Readiness (team memeber); Patient Readiness (Process Owner) and Operating Room Efficiency (Process Owner).

The two committees to which I currenly belong are the Perioperative Throughput Commitee and the Surgical Flow Committee. Both groups are looking at ways to improve OR efficiency and to maximize OR utilization by concentrating on surgical release and surgical utilzation. In order to maximize my understanding and expertise in these areas, I have completed training in Green Belt Six Sigma (lean process) through Villanova University.

Summary of improvements:
- dramatically improve on time starts from 3% to 50-60%
- identified case specific appropriate start times
- improved communication between the three groups (surgery/anesthesia/nursing)
- identified preventable delays, and now starting to dig deeper into solving them. Working specifically with ENT and UROL to identify the issues that prevent on time starts.
- encourage surgical services to release unused block time in time frame so that time can be used by another service. We showed that there was significant loss of utilization and monetary reimburesment with these periods of unreleased time. We are working specifically with ORTHO and ENT to relase unused block time in a time fashion, and meaure metrics with improved utilization and financial reimbursement.
- used simulation to show that additional postop surgical beds were required at certain times of the year, and this resulted in the expansion of the 4E/S unit.
- continue to find ways to smooth surgical census.

Selected Publications

Tyler DC, Pasquariello CA, Chen CH: Operating Room utilization: Determination of Optimum Utilization. Anesth Analg 96(4): 1114, April 2003.

Rajchert DM, Pasquariello CA, Watcha MF, Schreiner MS: Rapacuronium and the risk of bronchospasm in pediatric patients. Anesth Analg 94(3): 488, 2002.

Choudry DK, Stayer SA, Schwartz RE, Pasquariello CA: Early intravenous cannulation in children during inhalational induction of anesthesia. Paediatric Anaesthesia 8(2): 123, 1998.

Pasquariello CA: Book Review. Pain Handbook. The American Journal of Anesthesia March-April 1997.

Stayer SA, Schwartz RE, Pasquariello CA, Dunn SP: Pediatric orthotopic liver transplantation: potential predictors of intraoperative blood loss and coagulation status monitoring. Pediatric Surgery International 10: 317, 1995.

Stayer SA, Pasquariello CA, Schwartz RE, Balsara RK, Lear BR: The safety of continuous pleural lignocaine after thoracotomy in children and adolescents. Pediatric Anaesthesia 5(5): 307, 1995.

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Last updated: 05/07/2014
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