Category:OR

From Guide to YKHC Medical Practices

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OR/Surgical Services

Surgical Services consists of five distinct areas, each with a defined scope of service to include independently assessing patient needs and condition, monitoring patient care and safety, education and evaluation of the care provided.

Pre and Post Operative Care Unit

There are five pre- and post-operative beds and a Phase I and Phase II Recovery Room. This service is provided from 8 a.m. until no longer required Monday – Friday and as needed for emergencies.

Treatments and other activities include patient assessment, pre-op teaching, education assessment, nursing history, implementation of pre and post operative physician orders, post-operative assessment, discharge teaching, verification of discharge criteria, documentation of care provided.

Staff

Staff in the pre and post operative Phase I and Phase II Recovery Room will be provided by Registered Nurses, CRNAs, physicians and other support staff. All RN staff, CRNAs and physicians are BLS, ACLS, and PALS certified.

Post Anesthesia Care Unit (PACU)

The PACU is available to provide intensive, individualized post anesthesia care to all ages 24 hours a day, 7 days a week. Post-anesthesia nursing care will be provided by a registered nurse. The nurse/patient ratio will be 1:2 with variations based on individualized patient need.

Treatment and activities will include

  • RN’s will assess the patient on admission to the unit and every 5 minutes for the first 15 minutes and every 15 minutes for the first hour, then every 30 minutes thereafter.
  • Assess for adequate ventilation, body temperature and hemodynamic status.
  • Follow physician orders as designated.
  • Verify discharge criteria met
  • Document care provided
  • Post-anesthesia care may be provided in other areas (ED) when patient needs dictate. The same standards of care and practice will apply.
  • Care in the PACU will be provided by registered nurses, nurse anesthetists, and physicians and assisted by support staff as needed.

Anesthesia Services

Scope of Care Provided

All levels of anesthesia services are provided for our patient population. The clinical ages range from 2 years old to the elderly. We do not offer elective surgery to patients under two except for short procedures, i.e. myringotomies. We do not offer elective services to patients with American Society of Anesthesiologist (ASA) classification 3 or above except in emergency circumstances.

The Department of Anesthesiology provides services for elective procedures Monday – Friday, 8 a.m. – 4:30 p.m. Anesthesia services are available on-call for emergencies and emergent cases 24 hours a day, 7 days a week, including holidays.

Mechanisms Used to Identify Patient Care Needs

The Anesthetist in conjunction with the Operating Surgeon performs the patient evaluation. The ASA classification and anesthesia plan is agreed upon after review of the evaluation by the Operating Surgeon except pediatric dental where additional clearance by the Pediatricians is required.

New agents or techniques are introduced into the practice by didactic learning at a university-sponsored Anesthesia Seminar and may be reinforced with clinical training taking place at ANMC under the tutelage of the Chief of Anesthesiology or his designee. New agents and techniques are first introduced through the Surgical—Anesthesia Committee, and then approved by the Medical Staff.

How the Unit is Staffed to Meet Patient Care Needs

A Certified Registered Nurse Anesthetist (CRNA) who works under the general direction of the Chief of Surgery staffs the Department. The Anesthetist is an Independent Practitioner who also has consultative access to the Chief of Anesthesiology at ANMC.

The Anesthetist is a member of the Acting Medical Staff and is credentialed through the Medical Staff Office.

Process used for Acting on Positive or Negative Variances

The Anesthetist is on-call 24 hours a day, 7 days a week. Arrangements have been made for this individual to be off six days each month. An Anesthetist who has been credentialed by the Medical Staff provides coverage.

In case of sudden unavailability of the Anesthetist, all cases would be diverted until a satisfactory replacement could be found.

Endoscopy

Only screening and diagnostic procedures are performed. Patients who needing therapeutic procedures, whether routine or urgent, require referral to a higher level of care.

Endoscopy is only performed for low-risk patients. Therefore patients must meet the YKHC endoscopy criteria.

The lower age cutoff for endoscopy is variable and dependent upon the patient's anticipated anatomy as well as the endoscopist's comfort level. Most endoscopists are comfortable performing procedures on teens who have adult anatomy, regardless of chronological age.


Outpatients

Screening, surveillance, and diagnostic procedures are offered for outpatients. Patients should be referred after their comorbidities are well controlled and meet the YKHC endoscopy criteria.


Inpatients

Only diagnostic procedures are offered for inpatients. There should be sound rationale for why the procedure should not be postponed until the patient has been discharged and has returned to their normal baseline state.

Screening procedures are only provided for outpatients whose health status is optimized. The risk/benefit ratio for screening procedures does not justify performing procedures when patients are below their baseline health status (which is almost certainly the case for any inpatient).

EGD Screening EGD's are controversial and should be discussed with an endoscopist prior to referral. If ordered, the referral should specify that the patient be scheduled with the endoscopist who has agreed to do the case.

Colonoscopy Diagnostic, screening, and surveillance colonoscopies are offered.

Urgent Cases Endoscopy is performed Tuesday through Friday. Urgent cases, from either the ER or inpatient, can frequently be added for the next morning. This is initiated by contacting the endoscopist.

Surgical Services/ Operating Room

The Operating Room provides inpatient and outpatient elective, urgent and emergency surgical care to patients of all ages (under age 2 for short procedures) Pre- and post-operative areas include Pre-op room and a Phase 1 and Phase 2 Recovery Room. The surgical suite consists of 1 endoscopy room, 1 operating room with a back-up operating room in OB for emergent situations. Elective surgeries are scheduled Monday–Friday from 8 a.m. to 4:30 p.m. depending on patient needs, physician utilization and staffing levels. Emergency or urgent surgeries are provided 24 hours a day, seven days a week. Surgical services are provided for

  • Limited General Surgery
  • Limited Gynecological Surgery
  • Limited Orthopedic Cases
  • Dental Surgery
  • Limited Urology
  • Limited ENT procedures
  • Obstetrical Surgery

Staff

OR staffing includes four Registered Nurses, a Certified Scrub Technician, one to two CRNAs, one Case Manager and one OR scheduler, which are overseen by the OR Nurse Manager. This staffing provides pre- and post-operative and intraoperative care in the OR and endoscopy suite. In addition, the RNs provide pre-operative and post-operative teaching to all patients and their families as necessary and appropriate.

Surgical services provided on other units in emergencies will follow the same standards of care and practice.

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