| Description |
With the recent COVID-19 pandemic, the healthcare world has changed a great deal. Hospitals and health systems have sought ways to both reduce community transmission of the coronavirus while maintaining normal operations. In an area such as surgical services, a significant source of revenue for a hospital, this balance became crucial as Best et al. (2020) stated that the pandemic brought a significant drop in income for hospitals in the US as elective surgeries were cancelled. The Ambulatory Surgery Center Association (n.d.) provided guidelines on how to proceed cautiously to allow patients to receive urgent surgical care in an appropriate way, including when to postpone or when to proceed with surgical cases. If surgery can be delayed it should be delayed, and if it is urgent, it is appropriate to schedule the procedure accordingly (Ambulatory Surgery Center, n.d.). Outpatient surgeries have been resumed in creative ways in order to decrease the burden on inpatient units of the hospital, including sending some patients home the same day who historically would have been admitted to the hospital. In this facility discussed, a same-day surgery case often has a stay from 30 minutes to 3-4 hours, a 24-hour observation is typically admitted for approximately 24 hours, and an admission is anywhere from 24 hours to longer. While some facilities have shifted towards this approach prior to the pandemic, it became necessary for a local facility in Utah and the medical group as a whole to begin thinking of a new process of relieving the inpatient burden. The most common surgical procedures that became outpatient procedures were total joints (hips, knees, and shoulders), hysterectomies, total thyroidectomies, and laparoscopic gastric sleeves. Recently added to this list are arteriograms under vascular surgery. In addition to these select newly adjusted same-day procedures, the surgical center continues to support an anywhere from 40-60 same-day procedures daily. The surgical service area is a unique place in a hospital where individuals may receive outpatient services without the need to be admitted, and alternatively may be admitted after procedures that may necessitate observation or multi-night stays. Patient and patient caregiver education is a crucial aspect of surgery that requires forethought and planning. Without appropriate education before and after a procedure, patients can experience adverse effects. Kang et al. (2020) cites Kassin et al. (2012) in saying that nearly half of post-operative complications and readmissions can be reduced through using effective discharge education. According to Kruzik (2009) effective preoperative education of patients before surgical procedures can lead to better outcomes and reduced patient anxiety, and preferably should be initiated in the preoperative visit with the surgeon. The surgery center provides a plethora of information to patients related to their recovery, but this is one area that could be looked at to improve upon. The deidentified facility that is discussed in this paper has created a process for their total joint procedures that is one based on evidence and best practice. Patients receiving total joint procedures are closely monitored due to regulations for reimbursement and other necessary criteria. These recommendations indicate only a small population are candidates for a total joint procedure to be done same day. Once the patient is scheduled for surgery, they receive a great deal of follow up and education including an education course to prepare them for surgery and planning for care at home after surgery. There is a great emphasis on education prior to surgery. On the day of surgery, the patient receives the excellent care that any other surgical patient would receive, with the addition of specific pre-operative cares based on bundles to prevent infection. After the surgery, the patient must meet specific requirements for discharge and the recovery nurse ensures the patient has all necessary equipment and teaching required for home. This model for total joints is effective and can be an example for other specialty groups to look towards. |
