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for ways to enhance the delivery of care and improve outcomes. For example, in 2013, Dr. Angstadt identif ied that approximately 15 to 20 percent of the prog ra m's pat ient s presented w it h si g n i f ic a nt p o s t op er at ive n a u s ea . Dr. Angstadt's team reevaluated its anti- nausea protocol and, based on intensive review of pertinent literature, began prescribing an anti-nausea medication developed for chemotherapy patients as part of the standard patient discharge process. This small amendment to the standard process shortened postopera- tive hospitalization to one day for most patients and reduced readmission rates. In 2014, the bariatric team identified access of Medicaid patients to bariatric surgery as a key area for improvement af ter determining that most of their p a t i e n t s w e r e p r i v a t e l y i n s u r e d . Dr. Angstadt worked with key members of the hospital administration to develop an agreement that made the hospital's bariatric services more a‚ordable for patients on federal insurance plans. Last year, the Weight Loss Surgery Center improved its educational pro- cesses for patients by simplifying and sta nda rdizing a ll of the educationa l m at er i a l s d i s t r ibut ed t o ba r i at r ic patients from various programs across the system. Every process improvement is driven by the higher goal of enhancing patient care, and this understanding of t he inter play bet ween processes and patient outcomes is part of what di‚erentiates St. Charles Hospita l's bariatric program. "O u r foc u s i s exc el lent pat ient ca re," says Nik hi lesh Sek ha r, MD, FACS, FASMBS, bariatric surgeon at St. Charles Hospital. "What we bring to the table is a persona lized level of ca re. Despite its sma l l size, the hospita l's a¥liation with New York Bariatric Group means patients enjoy the attention and care of a community hospital provided by highly experienced bariatric surgeons." TECHNOLOGY AND QUALITY: STRIKING A BALANCE Dr. Sekhar comes from a background in robotic surgery. After training in general surgery at Lenox Hill Hospital, Dr. Sekhar completed a fellowship in bariatric and minimally invasive surgery at Vanderbilt University in Nashville, Tennessee, where he performed a full range of endoscopic and minimally invasive procedures. After serving as chief of surgery at Children's Hospital of Wisconsin-Fox Valley, he became one of the first surgeons in the United States to apply robot-assisted surgical techniques to foregut surgery. "I don't employ robotics in bariatric surgery because, in my experience, the technology is e‚ective for a very specific subset of surgical procedures and doesn't o‚er a significant advantage for bariatric patients," Dr. Sekhar says. "However, my background in robotics has made me more comfortable in harnessing new surgical techniques when appropriate, as well as more discerning when considering emerg- ing techniques." This discernment is ingrained in the bariatric program's culture and approach to patient care. "We try to stay on what I would call the 'cutting ' edge, but not the 'bleed - ing' edge," Dr. Angstadt says. "We o‚er proven procedures that are innovative but not experimental." Laparoscopic sleeve gastrectomy is the most popular form of bariatric surgery on Long Island and accounts for three out of four weight-loss surgeries. Nikhilesh Sekhar, MD, FACS, FASMBS, bariatric surgeon at St. Charles Hospital, performs an upper endoscopy to assess a newly completed sleeve gastrectomy. 0 8 C O V E R S T O R Y 0 8