Bringing the Pre-op Process Up to Speed

The staff members who milled around the front desk of The Reading Hospital SurgiCenter at Spring Ridge were used to hearing one side of a familiar conversation.

"No, ma'am. There isn't a fountain outside of our facility. You're at the wrong place."

"Yes, ma'am, you're not far away. We're just down the road. Don't worry, we won't start your procedure without you."

The SurgiCenter is 1 of 9 surgical facilities within an 11-mile radius in Wyomissing, Pa., and sits only a couple miles from the unaffiliated Reading Surgery Center. Confusing, right? There are far fewer lost patients who need help finding their way now that the SurgiCenter (not the Surgery Center) added pre-admission software that sends patients text messages linking their cellphones to Google Maps, which directs them to the right facility. Not worrying about giving and getting directions on the morning of surgery is a plus for patients and staff alike.

Many patients nowadays appreciate receiving information about their surgeries on their phones. It makes sense then that interest in pre-admission software in steadily increasing — about 45% of Reading Hospital SurgiCenter's patients had logged into the portal 3 years ago; now, 65% to 75% of patients interact with the center online — and why you should also consider capitalizing on the technology's many benefits.

• Patient portals. Reading Hospital SurgiCenter's software platform lets patients complete health histories online, at their convenience.

"The phone tag we often played with patients was a huge dissatisfier for them," says Susan Alexander, MSN, RN, CPAN, CSSM, Reading Hospital SurgiCenter's director of nursing. "We considered hiring a nurse to handle calls in the evenings or on weekends, but weren't interested in working beyond their normal hours."

Ms. Alexander says histories submitted online provide comprehensive views of patients' overall health, so staff can determine if they need specific medical clearance before undergoing surgery.

Nurses still call patients who don't use the online portal, but the number of calls that are made has decreased significantly, according to Ms. Alexander.

"We've gone from 3 full-time nurses handling pre-op phone calls to 2 full time nurses," she says. "We didn't eliminate a position. We've freed up a nurse to focus more on clinical responsibilities."

• Text message reminders. The platform also automatically sends patients text message reminders about their report time on the day of surgery, information about NPO (some patients are permitted to drink clear liquids after midnight based on pathways set up for specific procedures), arrival time on the day of surgery — really any type of communication staff wants to relay to patients.
• Patient-pleasing prgeviews. When Reading Hospital SurgiCenter first opened, the staff invited children who were scheduled for surgery to come in for an after-hours tour of the entire facility with the aim of lessening some of the anxiety they might be feeling about the unknown. Realizing its difficult for parents to take time off from work or pull their kids out of school, the facility produced a video tour of the facility featuring a nurse and a staff member's child (osmag.net/2RkMgB). The video, a huge hit with parents, is now available in an adult version and is now available online and patients receive a link to it in one of the series of texts they automatically receive before surgery.

Patients who bathe at home with Chlorhexidine gluconate (CHG) the night before and morning of surgery are less likely to return home with a surgical site infection. "There's a tremendous advantage of using the pre-admission shower strategy to reduce the microbial burden on the surface of the skin," says Charles E. Edmiston, PhD, CIC, FIDSA, FSHEA, FAPIC, an epidemiologist and emeritus professor of surgery at the Medical College of Wisconsin in Milwaukee.

Patients should apply 118 ml of 4% CHG during each shower, according to Dr. Edmiston. "For it to be maximally effective, the concentration should be sufficient to inhibit or kill the traditional surgical wound pathogens that may be present on the patient's skin," says Dr. Edmiston. "If you let it sit on the skin for about a minute before rinsing, it will get the highest sustainable concentration — a thousand parts per million, which is more than sufficient."

Dr. Edmiston emphasizes CHG must be used at the appropriate dose and with the proper application process. He says researchers at Northwestern University found that providing surgical patients with written instructions about how to properly apply CHG during the baths and the supplies to do it at clinic visits decreased SSI rates from 18% to 4%, documented proof that an evidence-based pre-op bathing strategy works in the real world.

Concerns about possible emergence of resistance with repetitive use of CHG are largely unfounded, according to Dr. Edmiston. "There are studies that suggest we should be concerned about the potential for emergence of resistance, but the data to date do not show there is a problem."

The risk of severe allergic reaction to CHG is extremely low, according to Dr. Edmiston, who says, "I feel very comfortable that we're doing the right thing for patients by implementing pre-admission shower strategies using a standardized process." OSM