Joshua Bloomstone, M.D., MS, Southwest Medical Director of Anesthesia Quality and Reliability for Envision Physician Services, won the 2018 Dean’s Prize from University College London (UCL) for work on his master’s thesis involving goal-directed fluid therapy administered in post-surgical patients.
Intravenous fluid administration currently serves as part of enhanced recovery after surgery (ERAS) protocols. However, Dr. Bloomstone’s findings suggest the process may not provide better outcomes.
A large-scale clinical research study helped Dr. Bloomstone achieve his thesis findings, which showed neither improvements nor negative outcomes when using post-surgical, goal-directed fluid therapy. He and his colleagues applied fluid therapy to more than 500 patients and matched them with a controlled group, which did not receive the treatment. They found that using fluid therapy did not increase or reduce complications, readmissions or cost per patient.
Findings from the research trial helped Dr. Bloomstone contribute to TEMPO, Envision Physician Services’ proprietary ERAS program by influencing post-surgery fluid administration protocol. TEMPO, which stands for transition and action, evaluation and significant history, medications, procedure and condition, and overall plan, was implemented companywide in 2017 to help Envision anesthesiologists standardize clinical quality and efficiency.
Dr. Bloomstone believes all ERAS protocols should be regularly re-examined to determine effectiveness. “Surgery has changed so much since the time where a lot of fluids were given. Most surgery today is laparoscopic, so medical management is different,” he said. “It’s not a surprise that in today’s surgical patients, we don’t see the outcomes we once did with fluid therapy.”
Dr. Bloomstone continues to advocate for the anesthesiologist’s involvement in perioperative medicine – a specialty title now known as “perioperatist.” As the first American recipient of a master of science degree in perioperative medicine from UCL, he hopes to represent the emerging field of perioperative medicine in the U.S.
“Anesthesiologists have to accept a broader scope of the definition of our specialty,” Dr. Bloomstone said. “We can enhance the scope of patient experience and outcome, from the time they enter to the time they leave.”
The Dean’s Prize is awarded to overseas students to recognize and fund research excellence in engineering or mathematical and physical sciences.