Examine programming for extended recovery care
Choose procedures and patients carefully
(In this second part of a two-part series on extended recovery care, Same-Day Surgery gives you advice on how to select patients and procedures. Last month, we covered formats for extended recovery care programs, information on state regulations, a financial outlook, and information from a recent survey.)
While state regulations are the obvious first obstacle to clear when setting up a recovery care center, the next step is to look carefully at programming, says Joni Steinman, managing principal for AUSMS Healthcare Consultants in San Diego.
Also, be sure you know which procedures are likely to result in a recovery care stay. These procedures will differ from program to program. Be sure your staff are trained to handle recovery by these patients and the facility is properly equipped, she adds.
The types of procedures that will generate recovery care patients vary based on your mix of surgical specialties, but they can include total knee replacement, mastectomies, and a variety of plastic surgeries, says Mark Mayo, administrator at Valley Ambulatory Surgery Center in St. Charles, IL.
Define your patients carefully, too, says Trent Kaufman, executive director of Gem City Bone and Joint, an orthopedic same-day surgery center in Laramie, WY. "We screen patients carefully and do not accept any that might have underlying conditions that could result in a transfer to a hospital," he explains. For example, they don’t accept anyone with a history of cardiac or respiratory illness, he adds. In the event a patient develops a complication that requires hospitalization, Kaufman’s center has a protocol for transfer and a formal transfer agreement with the local hospital.
Hospital-based programs need to place their recovery care units as close as possible to the outpatient surgery area, suggests Debbie Proctor, RN, department head of the outpatient center and surgical admissions center at Promina DeKalb Medical Center in Decatur, GA. "Surgeons appreciate the convenience, and it does make it easier for family members," she says.
Look carefully at staffing, she says. "Survey your existing staff to see if they have skills you need in a recovery care center." Staff members with operating room and post-anesthesia care unit experience alone will probably not be the best choices, she says. "A recovery care center needs nurses with hospital unit experience as well as familiarity with what surgical patients experience during recovery."
If you need to bring in new staff members, it might not be as difficult as you think, says Jackie Street, chief executive officer at Idaho Falls (ID) Recovery Center.
Staffing her hospital-licensed recovery care center hasn’t been a problem because staff from the local hospital see it as an attractive alternative to traditional hospital nursing, she says. "The atmosphere is more relaxed, and patients are not as ill."
The facility staffs with a high enough nurse-to-patient ratio so that a nurse rarely has more than two patients at a time, Street says. "This gives a nurse time for teaching the patient and family and to care for the patient."
Valley Ambulatory Surgery’s recovery care center has an all-RN staff who also operate on a low patient-to-nurse ratio, says Mayo. Not only does the nurse have time for more patient education, but the patient can ambulate earlier because the nurse has the time to spend with him or her, he adds. Mayo says a mix of RNs and LPNs can work well in a recovery care center, but LPNs with surgical experience are not available in the state in which he is located — Illinois.
One of the key training issues for his recovery care center was to teach nurses to be more aggressive with pain control, points out Mayo. "Our nurses are used to patients with epidurals and PCA for pain control, and they know that an anesthesiologist is on call at all times and must come in to see the patient within 15 minutes of the nurse’s call."
In addition to paying attention to nursing staff, determine how you will meet your patients’ needs for meals, lab services, pharmacy services, and other ancillary services during their stay, says Mayo. Providing meals may represent the biggest change for many centers, but Mayo’s and Kaufman’s centers both use a combination of frozen meals that can be heated by the nursing staff and takeout menus from local restaurants.
Another benefit of a recovery care center is the extra attention and amenities that patients can enjoy, says Kaufman. "We have patients describe our center as a spa. We keep a refrigerator stocked with snacks in the hotel-style room, and the television and VCR are located in an armoire," he explains. The amenities of the Wyoming center also include a radiant-heat panel in the ceiling over the bed, fresh flowers in the room, a comfortable bed, a terry cloth robe and slippers, and even a massage therapist on-call if needed.
Even without a lot of extra amenities, patients enjoy a stay in a recovery care center because there is less traffic in the hallways, less noise from staff and visitors, no hospital smell, and a more homelike environment, says Mayo.
The real key to a recovery care center’s success is the extra attention patients receive from staff as compared to inpatient care. "I believe that [in recovery care] we are talking about a level of patient care by RNs that blows hospitals away," he says.
Sources
For more information about tips to cut length of stay, contact:
• Sandy Berreth, Director, St. Alexius Same-Day Surgery Center, P.O. Box 4046, Bismarck, ND 58502-4046. Telephone: (701) 530-5000. E-mail: [email protected].
• Sharon Gelinas, Administrator, Doctors Hospital Surgery Center, 635 Washington W. Drive, Evans, GA 30809. Telephone: (706) 868-3110.
ReSource
For more information about recovery care, contact:
• Joni Steinman, Managing Principal, AUSMS Healthcare Consultants, P.O. Box 16948, San Diego, CA 92176-6948. Telephone/Fax: (619) 283-0245. E-mail: [email protected].
• Jackie Street, Chief Executive Officer, Idaho Falls Recovery Center, 1957 E. 17th St., Idaho Falls, ID 83404. Telephone: (208) 529-5285. Web site: [email protected].
• Trent Kaufman, Executive Director, Gem City Bone and Joint, 1909 Vista, Laramie, WY 82070. Telephone: (800) 446-5684 or (307) 745-8851. Fax: (307) 742-0961. E-mail: tkaufman@gcbj. com.
• Debbie Proctor, RN, Department Head, Outpatient Center and Surgical Admissions Center, Promina DeKalb Medical Center, 2701 N. Decatur Road, Decatur, GA 30033. Telephone: (404) 501-5523. Fax: (404) 501-5447.
• Mark Mayo, Facility Director, Valley Ambulatory Surgery Center, 2210 Dean St., St. Charles, IL 61075. Telephone: (630) 584-9801. Fax: (630) 584-9805. E-mail: [email protected].
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