Bio

Bio


Dr. Thomas Caruso specializes in the treatment of pediatric anesthesiology. He has practiced in pediatric anesthesiology for more than 4 years. Dr. Caruso has a special interest in regional anesthesia, quality and safety, and medical education.

Clinical Focus


  • Anesthesia
  • Pediatric Anesthesia
  • Pediatric Regional Anesthesia

Academic Appointments


Administrative Appointments


  • Graduate Medical Education Faculty Adviser, Stanford University Department of Graduate Medical Education (2014 - Present)
  • Physician Lead for Perioperative Improvement, Lucile Packard Center for Quality and Clinical Effectiveness (2013 - Present)

Honors & Awards


  • Alan M. Krensky Endowed Clinical Fellow, Lucile Packard Children's Hospital Stanford (2012-2013)

Professional Education


  • M.Ed., Johns Hopkins School of Education, Masters Degree in Education for the Health Professional (2015)
  • Board Certification: Anesthesia, American Board of Anesthesiology (2013)
  • Board Certification: Pediatric Anesthesia, American Board of Anesthesiology (2013)
  • Fellowship:Lucile Packard Children's Hospital (2013) CA
  • Residency:Massachusetts General Hospital (2012) MA
  • Internship:Kaiser Permanente at Santa Clara (2009) CA
  • Medical Education:Stanford University School of Medicine (2008) CA

Research & Scholarship

Current Research and Scholarly Interests


My research pursuits are focused on system based improvement projects. At Lucile Packard Children's Hospital Stanford, I use system based approaches to improve the quality of care patients receive in the perioperative area and in the ICUs, with a focus on safe transitions of care. Through the Department of Graduate Medical Education at Stanford School of Medicine, I advise residency and fellowship programs on evidence based methods to improve their programs, with a focus on mentorship.

Teaching

Publications

All Publications


  • A quality improvement initiative to optimize dosing of surgical antimicrobial prophylaxis. Paediatric anaesthesia Caruso, T. J., Wang, E., Schwenk, H. T., Scheinker, D., Yeverino, C., Tweedy, M., Maheru, M., Sharek, P. J. 2017

    Abstract

    The risk of surgical site infections is reduced with appropriate timing and dosing of preoperative antimicrobials. Based on evolving national guidelines, we increased the preoperative dose of cefazolin from 25 to 30 mg·kg(-1) . This quality improvement project describes an improvement initiative to develop standard work processes to ensure appropriate dosing.The primary aim was to deliver cefazolin 30 mg·kg(-1) to at least 90% of indicated patients. The secondary aim was to determine differences between accuracy of cefazolin doses when given as an electronic order compared to a verbal order.Data were collected from January 1, 2012 to May 31, 2016. A quality improvement team of perioperative physicians, nurses, and pharmacists implemented a series of interventions including new electronic medical record order sets, personal provider antibiotic dose badges, and utilization of pharmacists to prepare antibiotics to increase compliance with the recommended dose. Process compliance was measured using a statistical process control chart, and dose compliance was measured through electronic analysis of the electronic medical record. Secondary aim data were displayed as percentage of dose compliance. An unpaired t-test was used to determine differences between groups.Between January 1, 2012 and May 31, 2016, cefazolin was administered to 9086 patients. The mean compliance of cefazolin at 30 mg·kg(-1) from May 2013 to March 2014 was 40%, which prompted initiation of this project. From April 2014 to May 2016, a series of interventions were deployed. The mean compliance from September 2015 to May 2016 was 93% with significantly reduced variation and no special cause variation, indicating that the process was in control at the target primary aim. There were 649 cefazolin administrations given verbally and 1929 given with an electronic order between October 1, 2014 and May 31, 2016. During this time period, the rate of compliance of administering cefazolin at 30 mg·kg(-1) was significantly higher when given after an electronic order than when given verbally, 94% vs 76%.This comprehensive quality improvement project improved practitioner compliance with evidence-based preoperative antimicrobial dosing recommendations to reduce the risk of surgical site infections.

    View details for DOI 10.1111/pan.13137

    View details for PubMedID 28321988

  • Pediatric Postoperative Pulse Oximetry Monitoring During Transport to the Postanesthesia Care Unit Reduces Frequency of Hypoxemia. Joint Commission journal on quality and patient safety Caruso, T. J., Mokhtari, T. E., Coughlan, M. J., Wu, D. S., Marquez, J. L., Duan, M., Freeman, H., Giustini, A., Tweedy, M., Sharek, P. J. 2017; 43 (3): 146–50

    Abstract

    The standard use of pulse oximetry during the transport of postoperative patients from the operating room (OR) to the postanesthesia care unit (PACU) is not routinely practiced. A study was conducted to determine if the frequency of hypoxemia on admission to the PACU decreased after implementation of routine use of transport pulse oximeters for postoperative patients being transferred to the PACU.In this prospective cohort study, which was conducted at an academic pediatric hospital, the primary outcome measure was the frequency of hypoxemic events on arrival to the PACU.A total of 506 patients in the preintervention phase and 597 in the postintervention phase met the inclusion criteria. Six hypoxemic events on arrival to the PACU were identified in preintervention phase versus zero in the postintervention period, p = 0.009. Use of oxygen monitors during transport from the OR to the PACU increased from 0% to 100%, p < 0.0001, in the postintervention phase. The median duration of unmonitored time during transport decreased from 272 seconds to 13 seconds, p < 0.0001. Of the 605 patients who met the inclusion criteria for sustainment audits-conducted 18 months after the postimplementation evaluation-99.8% were transported to the PACU with a pulse oximeter, and there were zero reported hypoxemic patients on PACU admission.The routine use of portable oxygen monitoring when transferring patients from the OR to the PACU is a low-cost, noninvasive safety measure that should be considered at any institution performing pediatric general anesthesia.

    View details for DOI 10.1016/j.jcjq.2016.12.001

    View details for PubMedID 28334593

  • A Strategic Approach to Implementation of Medical Mentorship Programs. Journal of graduate medical education Caruso, T. J., Steinberg, D. H., Piro, N., Walker, K., Blankenburg, R., Rassbach, C., Marquez, J. L., Katznelson, L., Dohn, A. 2016; 8 (1): 68-73

    Abstract

    Mentors influence medical trainees' experiences through career enhancement and psychosocial support, yet some trainees never receive benefits from involved mentors.Our goals were to examine the effectiveness of 2 interventions aimed at increasing the number of mentors in training programs, and to assess group differences in mentor effectiveness, the relationship between trainees' satisfaction with their programs given the presence of mentors, and the relationship between the number of trainees with mentors and postgraduate year (PGY).In group 1, a physician adviser funded by the graduate medical education department implemented mentorships in 6 residency programs, while group 2 involved a training program with funded physician mentoring time. The remaining 89 training programs served as controls. Chi-square tests were used to determine differences.Survey responses from group 1, group 2, and controls were 47 of 84 (56%), 34 of 78 (44%), and 471 of 981 (48%, P = .38), respectively. The percentages of trainees reporting a mentor in group 1, group 2, and the control group were 89%, 97%, and 79%, respectively (P = .01). There were no differences in mentor effectiveness between groups. Mentored trainees were more likely to be satisfied with their programs (P = .01) and to report that faculty supported their professional aspirations (P = .001). Across all programs, fewer first-year trainees (59%) identified a mentor compared to PGY-2 through PGY-8 trainees (84%, P < .001).A supported mentorship program is an effective way to create an educational environment that maximizes trainees' perceptions of mentorship and satisfaction with their training programs.

    View details for DOI 10.4300/JGME-D-15-00335.1

    View details for PubMedID 26913106

  • Implementation of a standardized postanesthesia care handoff increases information transfer without increasing handoff duration. Joint Commission journal on quality and patient safety / Joint Commission Resources Caruso, T. J., Marquez, J. L., Wu, D. S., Shaffer, J. A., Balise, R. R., Groom, M., Leong, K., Mariano, K., Honkanen, A., Sharek, P. J. 2015; 41 (1): 35-42

    Abstract

    In the transition of a patient from the operating room (OR) to the postanesthesia care unit (PACU), it was hypothesized that (1) standardizing the members of sending and receiving teams and (2) requiring a structured handoff process would increase the overall amount of patient information transferred in the OR-to-PACU handoff process.A prospective cohort study was conducted at a 311-bed freestanding academic pediatric hospital in Northern California. The intervention, which was conducted in February-March 2013, consisted of (1) requiring the sending team to include a surgeon, an anesthesiologist, and a circulating nurse, and the receiving team to include the PACU nurse; (2) standardizing the content of the handoff on the basis of literature-guided recommendations; and (3) presenting the handoff verbally in the I-PASS format. Data included amount of patient information transferred, duration of handoff, provider presence, and nurse satisfaction.Forty-one audits during the preimplementation phase and 45 audits during the postimplementation phase were analyzed. Overall information transfer scores increased significantly from a mean score of 49% to 83% (p < .0001). Twenty-two PACU nurse satisfaction surveys were completed after the preimplementation phase and 14 surveys were completed in the postimplementation phase. Paired mean total satisfaction scores increased from 36 to 44 (p =. 004). The duration of the handoffs trended downward from 4.1 min to 3.5 min (p = 0.10).A standardized, team-based approach to OR-to-PACU handoffs increased the quantity of patient information transferred, increased PACU nurse satisfaction, and did not increase the handoff duration.

    View details for PubMedID 25976722

  • Images in clinical medicine. Severe vitamin D deficiency--rickets. New England journal of medicine Caruso, T. J., Fuzaylov, G. 2013; 369 (9)

    View details for DOI 10.1056/NEJMicm1205540

    View details for PubMedID 23984751

  • Airway management of recovered pediatric patients with severe head and neck burns: a review PEDIATRIC ANESTHESIA Caruso, T. J., Janik, L. S., Fuzaylov, G. 2012; 22 (5): 462-468

    Abstract

    There are approximately 10,000 pediatric burn survivors in the United States each year, many of whom will present for reconstructive surgery after severe burns in the head and neck (1). These recovered burn victims, who are beyond the acute phase of injury, often have significant scarring and contractures in the face, mouth, nares, neck, and chest, which can make airway management challenging and potentially lead to a 'cannot intubate, cannot ventilate' scenario (2). Although numerous cases have been presented in the literature on this topic (3-17), there are no comprehensive review articles on the unique challenges of airway management in the recovered pediatric burn patient with distorted airway anatomy. This article aims to provide a comprehensive review of airway management in such patients, focusing on challenges encountered during mask ventilation and tracheal intubation, as well as the role of surgical release of neck contractures to facilitate tracheal intubation. Lessons learned from all reported cases identified in a thorough literature search are incorporated into this review.

    View details for DOI 10.1111/j.1460-9592.2012.03795.x

    View details for Web of Science ID 000302540900009

    View details for PubMedID 22260458

  • Complementary and Alternative Medicine for Pain: An Evidence-based Review CURRENT PAIN AND HEADACHE REPORTS Dhanani, N. M., Caruso, T. J., Carinci, A. J. 2011; 15 (1): 39-46

    Abstract

    Pain is one of the most prevalent conditions for which patients seek medical attention. Additionally, the number of patients who utilize complementary and alternative medicine as a treatment of pain either in lieu of, or concurrent with, standard conventional treatments continues to grow. While research into the mechanisms, side effect profiles, and efficacies of these alternative therapies has increased in recent years, much more remains unknown and untested. Herein, we review the literature on complementary and alternative medicine for pain, with particular emphasis on evidence-based assessments pertinent to the most common alternative therapies, including acupuncture, herbal therapy, massage therapy, hypnosis, tai chi, and biofeedback.

    View details for DOI 10.1007/s11916-010-0158-y

    View details for Web of Science ID 000286230400007

    View details for PubMedID 21063917

  • Magnetic resonance Imaging detected renal volume reduction in refluxing and nonrefluxing kidneys JOURNAL OF UROLOGY Chang, S. L., Caruso, T. J., Shortliffe, L. D. 2007; 178 (6): 2550-2554

    Abstract

    Renal parenchymal damage is a well recognized sequela of urinary tract infection in the setting of vesicoureteral reflux. We investigated renal magnetic resonance imaging as a quantitative modality to detect renal parenchymal damage in children with primary vesicoureteral reflux and urinary tract infection.We retrospectively reviewed the medical records of children with primary vesicoureteral reflux and urinary tract infection who underwent renal magnetic resonance imaging evaluation. Those with other genitourinary pathology were excluded. Controls underwent magnetic resonance imaging for nongenitourinary pathologies. Kidneys were segregated among control, nonrefluxing, and low grade (I to III) and high grade (IV to V) reflux. Size plots (magnetic resonance imaging volume vs age) were drawn for comparison. Gross imaging abnormalities observed were renal scarring and small size.Magnetic resonance imaging was performed in 114 patients with vesicoureteral reflux (228 kidneys, patient age 0.5 to 17.8 years) and 21 controls (42, 0.5 to 12). Higher grades of reflux were associated with smaller volume, and smaller volume was noted in the refluxing and nonrefluxing kidneys of children with vesicoureteral reflux. Kidneys from patients with unilateral or bilateral reflux had significantly decreased renal volume compared to controls (p <0.0001). Kidneys in which vesicoureteral reflux spontaneously resolved had renal volumes similar to control kidneys (p = 0.23).Use of magnetic resonance imaging derived renal volume allows renal comparison and is helpful in evaluating patients with vesicoureteral reflux. In patients with a history of a febrile urinary tract infection and reflux the finding of measurably smaller kidneys appears to be more common than scarring. Whether these findings represent renal atrophy or hypoplasia needs further investigation.

    View details for Web of Science ID 000250847900082

    View details for PubMedID 17937957

  • Treatment of naturally acquired common colds with zinc: A structured review CLINICAL INFECTIOUS DISEASES Caruso, T. J., Prober, C. G., Gwaltney, J. M. 2007; 45 (5): 569-574

    Abstract

    Over the past 20 years, the use of zinc as an over-the-counter alternative therapy for the common cold has vastly grown in popularity. Recent reports of potentially permanent anosmia caused by intranasal zinc therapy warrant careful analysis of the therapeutic effects of zinc.A search of the Medline database (including articles published during 1966-2006) for studies of zinc and the common cold produced 105 published reports. Fourteen were randomized, placebo-controlled studies that examined the effect of zinc lozenges, nasal sprays, or nasal gels on naturally acquired common colds. Eleven features of experimental design affecting signal quality, chance, bias, and blinding were used to evaluate the 14 placebo-controlled studies. These criteria were validated case definition, quantifiable hypothesis, sample size calculation, randomized assignment, double blinding, proof of blinding, measurement of compliance, measurement of dropout rate, analysis by intent to treat, description of methods of analysis, and measurements of probability. Equal weight was given to each criterion, because failure to meet any one could potentially invalidate the findings of a clinical trial.Four studies met all 11 criteria. Three of these studies reported no therapeutic effect from zinc lozenge or nasal spray. One study reported positive results from zinc nasal gel. Of the remaining 10 studies, 6 reported a positive effect and 4 reported no effect. Intent-to-treat analysis was the most common criterion not met.This structured review suggests that the therapeutic effectiveness of zinc lozenges has yet to be established. One well-designed study did report a positive effect of zinc nasal gel.

    View details for DOI 10.1086/520031

    View details for Web of Science ID 000248557000016

    View details for PubMedID 17682990

  • Treatment of the common cold with echinacea: A structured review CLINICAL INFECTIOUS DISEASES Caruso, T. J., Gwaltney, J. M. 2005; 40 (6): 807-810

    Abstract

    Echinacea is a herbal preparation that is frequently used to treat the common cold. Spending on echinacea in the United States has risen to >300 million dollars annually.A total of 322 articles related to echinacea and colds, including 9 placebo-controlled clinical trials, were identified using the Medline and PubMed databases. Eleven features of experimental design that affect the accuracy of the measurement of features of interest, the probability of a chance relationship, bias, and blinding were used to evaluate the 9 placebo-controlled studies. The criteria were validated case definition, quantifiable hypothesis, sample-size calculation, randomized assignment, double blinding, proof of blinding, measurement of compliance, measurement of drop-out rate, analysis by intention to treat, description of the methods of analysis, and measurement of probability. Equal weight was given to each criterion, since failure to meet any one of them could potentially invalidate the findings of a clinical trial.Of the 9 studies, 2 met all 11 criteria. The results of both studies were judged to be negative by the people who performed the studies. Of the remaining 7 studies, 6 were judged to have positive results, and 1 was judged to have negative results. The criterion most commonly not met was proof of blinding.This structured review suggests that the possible therapeutic effectiveness of echinacea in the treatment of colds has not been established.

    View details for Web of Science ID 000227492800005

    View details for PubMedID 15736012