Surgical Services at UPMC Passavant:

Improving the Process for Patients and Waiting Families

Patient Comfort, Safety are Top Priorities

Every day, between 40 and 60 patients undergo surgery at UPMC Passavant. Some of the surgeries are relatively simple and can be done on an outpatient basis; others are much more complex and require an extended hospital stay. But no matter why a person is undergoing an operation at the hospital, the surgical services team is committed to making sure that every patient receives the highest quality care.
“As we have grown from a community hospital into a tertiary care center, we have worked to put processes in place that allow us to enhance both patient care and patient satisfaction,” explains Donna Jasko, vice president of Ancillary Services at UPMC Passavant. “People no longer have to leave their own community to receive state-of-the-art care.”

According to Kathy Gordon, interim unit director of the operating room (OR), the number of cardiac surgeries performed at UPMC Passavant has increased 45 percent over last year, and the hospital is on target to do more than 500 open-heart surgeries this year. The year-old surgical oncology program has continued to grow, and in 2007, more than 1,000 spine procedures were performed by the Division of Neurosurgery. The expertise of the surgeons at UPMC Passavant has become so well-known, in fact, that patients are referred West Virginia, Ohio, New York, and as far away as Georgia.

As these surgeons’ reputations continue to grow, so does UPMC’s ability to provide patient care at both the McCandless and Cranberry campuses of UPMC Passavant. “The Cranberry campus has seen surgical growth with the addition of new surgeons, and the overall surgical volume has increased significantly as it continues to meet the needs of the community,” says Elaine Wolford, clinical director of Surgical Services at UPMC Passavant. “In addition, the McCandless campus recently broke ground on a $100 million, seven-story tower, which will enable the Surgical Services Department to expand both its facilities and the number of surgeries that can be performed.”

Pre-Op Efficiency Increasing

In years past, a patient coming into the hospital for surgery would first register in the downstairs reception area before checking in at the surgical department on the second floor. To make patients’ visits easier, all of the registration procedures recently have been moved to the Surgical Services Department, so that patients and their families need to check in only once.
“We’ve tried to make the check-in procedure more convenient for patients by making the preoperative area a one-stop shop,” says Tammie Carroll, RN. “If a patient needs lab work or an EKG, we can do that on this floor, instead of sending him or her back downstairs for preoperative testing.”

Approximately three days before surgery, a nurse calls each patient to collect information on his or her history and medications, and to tell the patient how to prepare for the day of the operation. “Once the patient comes in, we go over this information and verify that everything is correct,” says Ms. Carroll. “The patient’s family then registers with the nurse liaison, who keeps them regularly updated on the patient’s progress throughout the day.”

New technology also is enabling even better communication with patients’ families. In November, a coaster pager system was established to enable those waiting for progress reports to travel throughout the hospital without losing contact. Similar to a restaurant pager, the device is carried by patients’ families and alerts them when there is an update on the patient’s condition.
In addition to this technology, a new case tracking system is being established that will allow families to track their loved one’s progress. SurgiNET features a 42- inch flat screen monitor, similar to an airport arrival and departure screen, that will let families know when patients are in
pre-op, surgery, and post-op, and when they are ready to go home, or to be transferred to a hospital room (see sidebar). A nurse liaison still will be on hand to answer any questions that a patient’s family may have. The nurse liaison will continue to contact family members who have had to return to work or home by cell phone.

For family members who choose to remain in the waiting room, the hospital has added amenities, including a coffee bar that features coffee, tea, hot chocolate, bottled water, fresh fruit, and nutrition bars. The area is also furnished with newspapers and wireless Internet access.

Patient Safety Comes First

Once a patient is taken into the pre-op area, he or she is given a private room with a private bathroom and briefed on what to expect. “Patients used to be separated by only a gurney and curtain, which didn’t provide much privacy,” says Ms. Carroll. “They definitely appreciate the fact that we can close the door while talking to them about their health issues.”

Patients also appreciate UPMC Passavant’s new IV process, which was established this past March. “Nurses used to do their own IVs, but we recently hired two IV nurses who do all of the IVs in the department,” says Ms. Carroll. “This is especially helpful because these nurses also can do a patient’s blood work at the same time, so patients don’t have to visit the lab, and they only have to undergo one needle stick instead of two.”

To ensure that everything has been done to properly prepare a patient for surgery, the hospital has established two visual systems to signal what needs to be done. A color-coded system outside each patient room tells nurses which procedures have been completed, and no patient can go to surgery until a ‘GO’ card is placed on the room. “We put these procedures in place to ensure that our ‘transfer of care’ meets national patient safety goals,” says Ms. Wolford. Pre-op nurses also meet face-to-face with OR nurses to ensure that all necessary information is relayed during the transfer of care.

Once a patient is out of surgery, he or she goes to the PACU (post-anesthesia care unit), unless the patient has undergone open-heart surgery or direct transfers to the ICU from the OR. “In the PACU, we work to control a patient’s pain, so that there is minimal discomfort,” says Jolene Kroll, RN. “Nurses stay at a patient’s bedside until the patient is stabilized, and when the patient meets certain criteria, that nurse is able to leave.”
In addition to offering constant reassurance, nurses continually evaluate the patient’s condition. After the patient is signed out by an anesthesiologist, inpatients are transferred to a hospital room, and outpatients meet with nurses who counsel them on postoperative care and give them something to eat. When patients are ready, they are transferred to the front door of the hospital by wheelchair, and nurses call them the next day to make sure that they understand their medications, and that their pain is manageable.

Enhancing the Patient Experience Even More

As UPMC Passavant continues to grow, so does the hospital’s ability to provide more life-saving procedures to patients. With the expansion of the McCandless campus, the surgical services area will increase in size in order to better serve patients undergoing everything from knee surgery to open-heart procedures.

“With the expansion of the McCandless campus, we’ll be adding six new operating rooms for a total of 21, as well as increasing their size to provide the space needed for extremely complex cases,” says Ms. Gordon. “We’ll also be adding an angiography suite and an oncology room outfitted with video-integrated technology that will allow surgeons to communicate with other hospitals, as well as see specimens under a microscope without leaving the OR.
Preoperative rooms will increase from 18 to 24, and the PACU will expand from 15 bays to 38 bays. Surgeons will have their own SurgiNet case tracking board within the operating room area to use as a communication tool.

“Since we began making improvements in the Surgical Services Department, we have seen our patient satisfaction survey numbers increase every month,” says Ms. Wolford. “Once the new Patient Tower is built and we have expanded our services even further, we expect to continue this upward trend.”

One Patient’s Story: Neal Davis

It’s not often that a patient travels from Atlanta to Pittsburgh to have surgery, but in the case of Neal L. Davis Sr., it was the only choice he had. Originally diagnosed with pancreatic cancer, Davis actually had appendiceal carcinoma, which required debulking surgery — the surgical removal of part of a malignant tumor that cannot be completely removed.

“I just knew Neal didn’t have pancreatic cancer,” says his wife, Connie. “So I got on the computer and I researched his condition, and came up with a different diagnosis.”

Mr. Davis’ condition was confirmed by the family’s new doctor, who advised them to contact the National Cancer Institute. He was referred to UPMC Passavant and David Bartlett, MD.

“Dr. Bartlett thought that he could do me some good,” says Mr. Davis.

After a 10-hour debulking surgery, Mr. Davis spent more than a month in the hospital recovering. His wife stayed by his side the entire time. “The nurses at UPMC Passavant are now our best buds,” says Mrs. Davis. “They’ve always taken care of me — I told my kids, if anything happens to your dad, there are people here who will take care of me; they are wonderful, wonderful people.”

While in Pittsburgh, Connie Davis was able to stay at the Kearns Spirituality Center, as well as in one of the hospitality rooms at La Roche College set aside by UPMC Passavant for the families of patients who will be staying a long time. “It was extremely nice to be so close to the hospital, and the cost was very reasonable; practically nothing compared to what a hotel would cost,” says Mrs. Davis.

Seventeen months after his surgery, Mr. Davis returned for a second similar procedure that took about seven hours. “The doctors here are extremely dedicated,” he says. “Now I’m doing great; I’ve already gone hunting twice, and my wife and I are currently spending time at Disney World.”
“While I still have to watch and wait, I enjoy life now,” he added. “I can do anything I want to do thanks to UPMC Passavant’s advanced surgical team.”

Making the Wait Less Worrisome: The SurgiNET Case Tracking System

One of the hardest things to do when a family member or friend is in surgery is to sit in the waiting room, wondering how your loved one is faring. Realizing the need to provide real-time information, UPMC Passavant will be installing the SurgiNET Case Tracking System in the waiting room in January to keep families updated on patients’ progress. UPMC Passavant is the second hospital within UPMC to offer this advanced technology.

Families will be able to monitor a patient’s progress from the time they begin the preoperative process until they are ready to leave the hospital or be taken to a room. “Patients will be assigned a number that family members can track on an LCD screen to see where in the process the patient is,” explains JoEllen Daugherty, RN, MSN, eRecord Project Lead, UPMC Corporate ISD, Hospital Division. “This is a great benefit for families’ peace of mind.”

A 42-inch, color-coded screen will show when each patient starts the preoperative process, starts surgery, completes surgery, and reaches the PACU. Phase II of this software, which will be added at a later date, will show when outpatients are ready to leave the hospital and when inpatients have been taken to their rooms.

“Before families were often in the dark, thinking that their loved one had been in surgery the whole time, when they were actually in pre-op or recovering in PACU,” says Ms. Daugherty. “Because the screen refreshes every two minutes, families will now have access to real-time information.
“When this system was installed at UPMC Shadyside, patients’ families practically jumped up and down; they were so excited about the board,” she adds. “Since its installation, the hospital has received very positive reactions about this addition to the waiting room.”

Through the SurgiNET System, which is tied into UPMC Passavant’s computer system, hospital personnel also are provided with more accurate documentation because they are not depending on anyone’s handwriting to relay patient information. More than one person can view patient information on the computer, and a large screen installed in the operating room area will enable doctors and nurses to track patients as they go through the system. “The advantage of SurgiNET is that it allows the staff to generate reports and to see where there might be delays,” says Ms. Daugherty. “It enables them to troubleshoot problems and to better utilize the operating room area.”