Ambulatory Surgery

A trip to the operating room at Community Memorial Hospital is a lot less fretful, thanks to a system that explains the procedures, answers questions and allays fears.

Medical technology has made it possible for many surgical patients to enter the hospital, have the procedure and be home all in the same day. Breast biopsies, arthroscopic surgery (especially knees), hernia repairs and carpal tunnel releases are typical of the ambulatory procedures being performed routinely at Community Memorial.

Of course, the staff is aware that what is routine for the hospital is often a singular and anxious experience for the patient. To help ease the situation, once the physician's office books the procedure and schedules the date of surgery, the hospital sets up an appointment with the patient for preoperative testing and an interview from one to 30 days before the big day.

Community Memorial strives to give patients an active part in planning and implementing their care.

The patient checks in at out-patient admissions where the admitting clerk will take insurance information and ask the patient to sign a general consent. The data, entered into the computer, will save time and hassles on the day of the procedure. The patient is sent to the laboratory so required testing can be taken to detect potential problems.

The preoperative interview with a recovery room nurse lasts about an hour and a family member is encouraged to attend.

The nurse will first deal with a patient's major concerns, then gather a medical history which ends up on a pre-anesthesia record and with the nursing staff. Preoperative instructions, which range from keeping the entire day free to what medications not to take, are given by the recovery nurse. Following the list of do's and dont's, the nurse will go over just how the day of the procedure will unfold for the patient.

Finally, the nurse will begin to lay the foundation for the patient's discharge planning including discussion about the possible need for assistance at home and filling prescriptions. The rest of the patient's testing is coordinated and the patient is assisted to other departments such as lab and X-ray.

Each patient leaves with a phone number to call with any questions.

The working day before the procedure, the patient calls the hospital for the admission time. Community Memorial now uses a staggered admission schedule so patients don't have as long to wait for their appointment in the operating room.

About two hours before surgery, the patient checks in at the main nurses' stations and is taken to the ambulatory surgery unit. The admitting nurse does a basic exam and reviews the medical history and reinforces the preoperative teaching. Nearly every patient has intravenous fluids started and basic surgical preparation takes place.

Forty-five minutes prior to the procedure the "pre-op" begins. Ordered medication - usually antibiotics - is given, jewelry removed, blood pressure checked and last-minute details tended to before the patient is wheeled to the operating room still wide awake. Nurses ask who the patient is, date of birth and what procedure is scheduled, not because they don't know but as an extra measure of safety.

One family member is usually allowed to stay with the patient in the holding area, where the circulating nurse, who will be in charge of the patient's care once inside the OR, is introduced.

The nurse checks the medical history once again and asks if there are any questions. The patient also meets the anesthesiologist, who discusses the medical history and explains the recommended anesthesia. The patient is then asked to sign an anesthesia consent form.

The ambulatory surgical procedures usually last between 30 minutes and two hours. The patient is moved to a table, monitors are placed and the anesthesia, which is regulated throughout the procedure, is begun.

After the operation, the patient is usually awake enough to answer questions but probably won't remember doing so. While the surgeon is letting the family know how everything went, the patient is taken to the recovery room. Monitoring continues and there is a nurse at the bedside throughout the recovery period which lasts 30 minutes to one hour on average.

The typical patient is aware enough within 10 minutes to have something to drink and be told where he or she is. In addition to the general anesthesia, a long acting local anesthesia is used to numb the surgical incision so the patient is comfortable and able to doze peacefully. The idea of people moaning in pain and vomiting is incorrect. The recovery room is a quiet place where each time the patients wake up, they are more themselves.

Once discharge criteria such as level of consciousness, blood pressure and the ability to control activity have been met, the patient is taken back to the ambulatory unit. There, vital signs are monitored and special orders from the doctor are carried out. The patient is allowed to get up and move around and usually within two hours is able to go home and be spoiled for a day or two.

A recovery nurse will call the home to check on the patient and clarify any questions that might have arisen.