Patient Care

Our faculty have broad interests and have demonstrated innovation in the following areas:

Pulmonary Outpatient Clinic

Dr. Neil Trivedi oversees the organization of this clinic. The SFVAMC pulmonary clinic sees over 200 patients per month and cares for patients with a wide variety of lung diseases. In addition to the general pulmonary clinic, additional rapid diagnostic pulmonary clinics are available throughout the week to help with rapid assessment of patients with possible lung cancer. A monthly ILD conference helps to address the needs of veteran patients with interstitial lung diseases requiring advanced therapies.

Experienced nurse specialists within the VA chest clinic are focused on pulmonary issues, ensuring patient comfort throughout the visit. They collect vital signs, ensure continuity of care, and provide education on lung diseases and pulmonary medications.

nurses VA chest clinic — Left to right: **Joan Erolan** RN, **Recie Tongson** RN, **Jennifer Ryan** RN, and **Malou Medina** RN.

Intensive Care Unit

The VA ICU is a tertiary referral center for complex critically ill veteran patients in a combined MICU/SICU/CCU. The ICU team cares for all MICU, CCU, and surgical subspecialty patients with a multidisciplinary team including residents/interns from medicine, anesthesia, surgery, neurology, and emergency medicine, and an ICU pharmacist, ICU nutritionist, ICU social worker, and critical care attendings (rotating from pulmonary critical care, anesthesia critical care, and surgery critical care). The teams also have participation by the primary nurse and respiratory therapist. The SFVAMC is nationally recognized in the Veterans network of medical centers for having some of the best outcomes for ICU patients. The SFVAHCS cares for a broad range of patients including post-operative care of patients with advance cardiothoracic surgical procedures including robotic thoracic surgery, CABG, and TAVR. The SFVAHCS is the Western U.S. referral center for deep brain stimulators for veterans with Parkinson’s Disease. Dr. Leslie Zimmerman and Dr. James Frank are co-directors of the VA ICU.

Sleep Program

Dr. Ananse Taharka is our Director of Sleep Medicine for the SFVAHCS. He is board-certified in Sleep Medicine (as well as Pulmonary and Critical Care Medicine) and is leading a team of Nurse Practitioners, Respiratory Therapists, Polysomnographic Technologists, and medical support staff to manage and care for our sleep clinic patients. Sleep is the most rapidly growing program within our division. Prior to the pandemic, we saw an 80% growth of the number of patients seen in sleep clinic, averaging ~ 500 patients per month. Our sleep program provides overnight and home sleep studies, assesses patients for routine and complex sleep apnea syndromes, and provides therapeutic PAP device in a wide range of modalities. A new building to house Mental Health and Sleep Medicine is slated to be completed in summer 2022, which will allow for further expansion of our burgeoning sleep medicine service.

Lung Cancer Screening

patient care Lung cancer remains the leading cause of cancer-associated mortality worldwide. As such, early detection of lung cancer is vital to improving the health and lives of all patients. The SFVAHCS is a national leader in the VA in the use of lung cancer screening (LCS) for early detection and reduction in mortality from lung cancer among high-risk Veterans. Dr. Jim Brown founded the SFVAHCS LCS Program in 2014 and continues as its director. Primary care providers can request a consult that is reviewed by a nurse practitioner for patient education and assessment for screening. Screened patients are followed in an electronic data base. Patients with concerning nodules will be reviewed in the Pulmonary Diagnostic Clinic and presented at a multidisciplinary conference attended by thoracic surgery, radiology, oncology, radiation oncology, and pulmonary. The LCS Program was recently selected to participate in the VA’s 18-site Lung Precision Oncology Program (LPOP). The program is designed to enhance quality, scope, and research related to: (i) lung cancer screening for early detection and (ii) precision oncology for conducting treatment trials in those with advanced stage disease. Dr. Jim Brown manages the LCS portion of the program and Dr. Sunny Wang directs the precision oncology components of the program. The SFVAHCS LCS Program will receive $2.5 million over the next five years to develop and implement best practices in lung cancer screening for our Veterans.

Advanced Bronchoscopy Service

Dr. Neil Trivedi oversees the advanced bronchoscopy services at the SFVAHCS, including endobronchial ultrasound and electromagnetic navigational bronchoscopy.

ALS (amyotrophic lateral sclerosis) Clinic

The SFVA is a Recognized Treatment Center by the ALS Association. Pulmonary ALS and neuromuscular disease care for Veterans with respiratory issues resulting from muscle weakness is overseen by Drs. James Frank and Neil Trivedi. A central part of this care is the multidisciplinary ALS clinic. In this patient-centered clinic, patients may be seen in one clinic appointment by a pulmonary physician and providers from 10 other services, including neurology, nutrition, speech, physical and occupational therapy, and others.

Interstitial Lung Disease and Lung Transplant

The SFVAHCS Pulmonary Division cares for veterans with advanced lung diseases like idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, and chronic obstructive pulmonary disease. We offer multidisciplinary evaluations, comprehensive longitudinal medical care, and referral to clinical trials and lung transplantation.

Interstitial lung diseases (ILD) cases are presented at monthly multidisciplinary conferences including a thoracic radiologist, an ILD-focused pulmonologist from UCSF, a nurse specialist, and a rheumatologist or pathologist when applicable.

ILD at the VA — Left to right: **John Greenland** MD PhD, **Jim Brown** MD, **Jonathan Budzik** MD PhD, **Jennifer Ryan** RN, and **Erica Farrand** MD.

The SFVAHCS provides comprehensive pulmonary care for veterans across the spectrum of lung diseases and severities. For veterans who require lung transplantation, we work with the University of California, San Francisco to provide access to some of the best surgical outcomes in the nation. Pulmonologists at SFVAHCS will support veterans throughout the lung transplant process, from initial evaluation through long term follow up, even while some procedures will take place at UCSF. Drs. John Greenland and Daniel Calabrese oversee this program.

Respiratory Therapy / Pulmonary Function Lab

SFVA bridge hallway — Pulmonologists conferring during chest clinic; (Left to right: **Jonathan Budzik** MD PhD, **Neil Trivedi** MD, **Abigail Rostykus** NP, **William Mckleroy** MD, **John Greenland** MD PhD)

Dr. Meshell Johnson oversees the SFVAHCS Respiratory Therapy Department of 20 RTs who provide respiratory therapy care for the hospital as well as support for the Pulmonary Function Lab, Bronchoscopy suite, and Sleep medical services.