David E. Skarda, MD

Languages Spoken: English, Spanish

David E. Skarda, M.D. has specialized training and experience in minimally invasive surgical treatment for babies, children and teenagers. He is a board certified pediatric surgeon and attending physician in the Division of Pediatric Surgery at Primary Children’s Hospital and Utah Valley Hospital. His passion is providing leading edge compassionate surgical care promptly and he ensures that you understand the procedures, options, risks and benefits. He is currently seeing new patients in his clinic at Utah Valley Hospital as well as in the Emergency Department, Newborn ICU, PICU, and general patient care units at Primary Children’s Hospital.

He speaks Spanish.

He is happy to talk to you and/or your child’s doctor.

Dr. Skarda specializes in the following conditions: Inguinal hernia, Umbilical hernia, Undescended testicle, Hydrocele, Cholecystectomy (removal of the gallbladder), GT (placement of a stomach tube), Appendectomy (removal of the appendix), Vascular access (ports and central lines), Ulcerative colitis, Crohn’s disease, Gastroesophageal reflux disease, Chest wall deformities (pectus excavatum and pectus carinatum), Pediatric endocrine surgery (thyroid and adrenal tumors/pancreas surgery), and the surgical treatment of inflammatory bowel disease (Crohn’s disease and Ulcerative colitis).

07.09.2018

Dr. David Skarda’s career focus is improving care for patients. His areas of administrative accomplishment and clinical research focus on quality and value improvement in patient care. He is currently the Senior Medical Director of Intermountain Healthcare’s Center for Surgical Value. He is clinically active at Utah Valley Hospital (UVH) and Primary Children’s Hospital (PCH). At both facilities he evaluates and managed the broad range of emergent and elective pediatric surgical problems. He is the site director for pediatric surgery at UVH.

In the spring of 2018 Dr. Skarda became the Senior Medical Director of Intermountain Healthcare’s Center for Surgical Value. This center has three areas of focus:

Decrease cost. . . Increase value through procedure (similar patient cohort) specific device standardization and cost reduction.

Improve outcomes. . . Increase value through procedure (similar patient cohort) specific improvement in outcomes.

Embrace and standardize change. . . Increase value through standardization, procurement and management of small (commodity items) and large capital purchases (OR robot, OR hardware such as tables/lights/anesthesia, imaging, power, etc.) including evolving/new technology.

In 2015 Dr. Skarda became the Senior Medical Director for Surgical Services for Intermountain Healthcare. In this role he was responsible for development and implementation of all surgical care process models (CPM) for both adults and pediatric patients for all 22 Intermountain facilities and for all surgical subspecialties including General Surgery, Oncology, Plastic Surgery, ENT Surgery, Ophthalmology, Orthopedic Surgery, Spine Surgery, endoscopy, and anesthesia. Additionally, he was responsible for standardizing and managing surgical operations including OR scheduling, preoperative patient communication, the development of a perioperative surgical home, same-day surgery operations, central processing coordination, instrument sterilization, OR policies, WHO universal protocol implementation and compliance and outcomes monitoring and evaluation for all 22 Intermountain facilities.

Specific System-wide Intermountain Quality Improvement Projects Include:

Appendicitis CPM: This CPM is designed for all patients (pediatric and adult) at all intermountain facilities and directs the pre- and postoperative management of appendicitis including pain medication, antibiotics, anti-emetics, fluids, diet, discharge criteria and appropriate follow-up pathways. Implementation occurred in 2016 and current compliance system wide is approximately 40% with some individual facilities reaching > 95%.

Geriatric Hip Fracture CPM: This CPM is designed for older patients at all Intermountain facilities with hip fractures and directs the pre- and postoperative management. Specifically, the CPM risk stratifies patients by ASA class and includes the hospitalist in the management of sicker patients. The focus of the CPM is the mandate of definitive surgical intervention within 22 hours of admission. Current compliance system wide is 80%.

Bariatric Surgery CPMs: These CPMs are designed to direct the use of weight loss surgery for all Intermountain facilities and define indications for intervention, standardized preoperative evaluation and patient teaching, standardized preoperative, perioperative, and postoperative management, and long-term outpatient follow-up and outcomes measures. All 5 bariatric surgery sites in the Intermountain system use these CPMs for all patients.

Low-risk Cholecystectomy CPM: This CPM is designed to minimize the immediate postoperative symptoms of pain, nausea, and vomiting in an effort to decrease both the rate of postoperative admission as well as postoperative same-day surgery length of stay. This CPM focuses on the utilization of preoperative oral narcotics, acetaminophen, and scopolamine patch with intraoperative ketorolac, dexamethasone, morphine, and subtle alterations in anesthesia technique to accomplish this goal.

Blood Utilization: This project is designed to decrease the utilization of PRBC transfusions in the Intermountain system. Dr. Skarda sent out an email once a month to every clinician (surgical and non-surgical) in the system that ordered a PRBC transfusion during the past month reminding them that 2-unit transfusions are usually unnecessary and specifically detailing appropriate Intermountain system-wide criteria for PRBC transfusion. Although this project was started before Dr. Skarda’s role in the clinical program began, it has flourished during Dr. Skarda’s tenure. Dr. Skarda made several changes to the project including: (1) the attribution of PRBC transfusion to the clinician that ordered the blood rather than the admitting attending, (2) the content of the email, and (3) the inclusion of ED, critical care, and anesthesia physicians in the project. This project has decreased the rate of 2-unit PRBC transfusions by 80% and decreased the overall rate of PRBC transfusions by 60% system wide. This currently decreases the cost of care by more than $10,000,000/year in the Intermountain system.

Creation of the Blood Utilization Development Team: In an effort to capitalize on the success of the PRBC utilization project above Dr. Skarda created the Intermountain Blood Utilization Development Team that included Dr. Skarda, Dr. Sarah Ilstrup (pathologist), Dr. Sarah Majersic (Trauma Surgeon), and Dr. Chris Cowley (Cardiac Anesthesiologist). This group meets directly monthly and indirectly by email and phone calls as needed to standardize the use of blood products in the Intermountain system. They created all the blood utilization order sets for the bone marrow transplant teams, emergency department, critical care, trauma, transplant, and cardiac surgery environments. Additionally, they implemented TEG-study based blood utilization at all Intermountain Healthcare trauma centers. Dr. Skarda attended the Blood Utilization Development Team meetings and gave final approval for all order sets, projects, and utilization decisions. He is very excited about the development of a system-wide preoperative anemia clinic that will allow the organization to intervene during the weeks before scheduled elective operations to improve blood-related operative risk, decrease the need for intraoperative blood transfusion and improve outcomes.

Creation of the ENT Development Team: Dr. Skarda created the Intermountain ENT development team, led by Dr. Jeremy Meier, designed to standardize perioperative care for patients of all ages with ENT-related illnesses. This group standardized the use of perioperative and pre- and postoperative antibiotics for ear and nose issues. Additionally, this group standardized the surgical technique and device utilization for T&A operations systemically. Dr. Skarda also directed a cooperative effort with the development team and the Intermountain Pediatric Clinical Program to decrease the rate of ear tube and T&A operations in the intermountain west. Dr. Skarda attended the ENT Development Team meetings and gave final approval for all order sets, projects, and utilization decisions.

Creation of the Plastic Surgery Development Team: Dr. Skarda created the Intermountain Plastic Surgery development team, led by Drs. Rob Ferguson and Mark Jensen, designed to standardize the perioperative care for patients with plastic surgery related illnesses. This group has recently standardized the vendor and type of breast reconstruction implants for the system. They are also creating a standardized CPM for this this process. Dr. Skarda attended the Plastic Surgery Development Team meetings and gave final approval for all order sets, projects, and utilization decisions.

Surgical Services Narcotic Stewardship Project: Dr. Skarda led, developed and implemented the Intermountain Surgical Services Narcotic Stewardship initiative. This project was based upon the belief that a large percentage of narcotics prescribed following surgical procedures are not consumed, get stored in a medicine cabinet, and then have the potential to cause significant harm within our community. This project was centered on the concept that if physicians have solid information regarding the actual number of doses consumed that they will decrease the number of doses they prescribe to the number actually consumed. Additionally, the project also focused on the belief that if patients are given proper disposal instructions when they are done using the narcotics they will be more likely to properly dispose of their narcotics. Starting in 2017 all patients who underwent a surgical procedure in the Intermountain system (~50,000/year) received an email from Dr Skarda two weeks after discharge that invites them to complete an online survey regarding their narcotic consumption (both prescribed and actually consumed) and also gives them zip code specific instructions for appropriate disposal. Our survey completion rate was 28% and allowed us to give procedure specific and prior opioid exposure specific prescription recommendations for the 5 most commonly performed procedures for each surgical subspecialty. This led to a reduction in opioid prescription volume of > 40%.

Colon Surgery Bundle: In 2015 Dr. Skarda developed and implemented the Intermountain colon surgery bundle (ERAS) designed to decrease total length of stay by implementing early ambulation, and directly stimulating GI motility with alvimopan. Additionally, the colon bundle is designed to decrease surgical site infection rates by standardizing the glucose control, skin cleansing before surgery, hair trimming, OR skin prep, perioperative antibiotics, and decreasing transfusion rate. This has been implemented at all 22 Intermountain facilities with compliance rates between 50 and 90%.

Hysterectomy Surgery Bundle: Patterned after the Colon Surgery Bundle, in 2016 Dr. Skarda created the hysterectomy bundle designed to decrease surgical site infection rates by standardizing the glucose control, skin cleansing before surgery, hair trimming, OR skin prep, perioperative antibiotics, decreasing transfusion rate, and influencing the indications for hysterectomy. This has been implemented at all 22 Intermountain facilities with compliance rates between 30 and 90%.

Concurrent Operations Policy Development and Ratification: Dr. Skarda created the concurrent operations policy using input from surgeons system wide for Intermountain Healthcare in 2016. This policy allows concurrent operations to occur as long as the “key or critical portions” of concurrent operations are not occurring at the same time. It allows the surgeon to define what is “key or critical” and also requires transparency with patients and their families regarding the possibility that not all of the procedure will be done by the attending surgeon. This was ratified by the system-wide Clinical Operations Leadership Team during the summer of 2016 and became policy for Intermountain Healthcare during the summer of 2016.

Updated Procedure Consent: Dr. Skarda updated the Intermountain Procedure Consent in 2016 to include the transparency statement required by the Concurrent Operations Policy. This updated consent also included several other new items including: (1) preauthorization for infectious disease testing in the event a staff member is punctured during the operation, (2) preauthorization for photography, (3) preauthorization for training during the procedure, and (4) preauthorization for postoperative contact for quality improvement initiatives. This new consent was ratified by the system wide Clinical Operations Leadership Team and is now used at all Intermountain Healthcare clinical sites for all procedures.

Updated Surgical Site Classification System: Dr. Skarda updated the flowchart guide for circulating nurses and surgeons to document “wound” classification for surgical procedures in the Intermountain Healthcare system in 2017. Intermountain accuracy for correct documentation was < 10% system wide and that guides provided to assist in this documentation were both confusing and misleading. Dr. Skarda created an updated “wound” classification flowchart and implemented this at all 22 Intermountain facilities. Compliance with the new process is currently between 80 and 95% system wide.

Pediatric Sedation, Anesthesia, and Procedural Care Policy Development and Ratification: Dr. Skarda created the Pediatric Sedation, Anesthesia, and Procedural Care Policy using input from surgeons, anesthesiologists, administrators, and OR management system wide for Intermountain Healthcare in 2017. This policy defines who can do what where with respect to the sedation, anesthesia and procedural care of children in the Intermountain Healthcare system. This was ratified by the system-wide Clinical Operations Leadership Team during the summer of 2017 and became policy for Intermountain Healthcare during the fall of 2017.

Between 2011 and 2015 Dr. Skarda practiced pediatric surgery at Primary Children’s Medical Center (now Primary Children’s Hospital) and focused his academic and administrative work on improving the management of appendicitis, pyloric stenosis, and gastroparesis.

During this same period of time Dr. Skarda has taken an active role in the development of the practice of pediatric surgery at Utah Valley Regional Medical Center (no Utah Valley Hospital). He has cared for pediatric patients at that institution and he remains the Pediatric Surgical Director at UVH.

Dr. Skarda has also authored and published several case reports including EC-CPR for pediatric hypothermic arrest, ECMO for respiratory failure in pediatric trauma patients, and persistent hemobilia after percutaneous liver biopsy. He presented the EC-CPR for pediatric hypothermic arrest data in Shanghai, China at the meeting of the Pacific Association of Pediatric Surgeons.

Between 2011 and 2014 Dr. Skarda was the site director for the general surgery residents and medical students as they rotated at PCH. In this capacity, he remodeled the PCH rotation for both first- and third-year surgical residents with an emphasis on education and mentoring rather than service obligations and he ensured the system was ACGME compliant in all aspects. He taught the pediatric surgery lecture for each rotating group of third-year medical students and he assisted with esophageal reflux lecture for second-year medical students. He continues to teach the pediatric surgery fellow and rotating surgery residents and medical students at PCH. Additionally, he provides direct instruction to the pediatric surgery fellow, general surgery residents, rotating medical students, and nurse practitioners in the operating room and during clinical rounds.

07.09.2018