Vital Stats
Nursing director: Marlene Brunswick, RN, CNOR
Administrator: Cheryl Cunningham, RN, BA
Types of surgeries: Multispecialty; includes otolaryngology, ophthalmology, orthopedics, general
Staff: 42 - 25 RNs, 2 LPNs, 6 techs, 1 materials manager, 8 office
Procedure rooms: 2
ORs: 4
Operating surgeons: 35
Monthly case volume: 525
Years in operation: 4
Ownership: 50 percent physician, 40 percent Blanchard Valley Regional Health Center, 10 percent management group

Like many surgery facilities, the staff is where you'll find much of the story and much of the success of the Findlay Surgery Center in Findlay, Ohio. All but one of the all-female staff is a working mother.

"An all-female staff wasn't by design," says Director of Nursing Marlene Brunswick, RN, CNOR. "It just happened. But it has provided for a very cohesive group with very little turnover."

A flex-time policy lets the surgical staff of soccer moms work eight-, nine- or 10-hour shifts that start at different times, depending on the day's caseload. As the center has grown, so has the number of part-time staffers; employees who work 32 hours a week are eligible for full-time benefits. Cross-training is mandatory.

"Some staff like working early, some don't mind staying late," says Ms. Brunswick. "We have become very flexible to accommodate everyone's needs. We have a lot of similar outside interests. We run into each other at our children's sporting events and extracurriculars. We are close-knit, so we're willing to help each other."

Making benchmarking work
Administrator Cheryl Cunningham, RN, BA, is the woman behind Findlay's use of Surgical Outcomes Information Exchange (SOIX) benchmarking, which they've used since March 2000.

"With more than 6,000 cases a year, it's easy to get data," says Ms. Brunswick. "By comparing against national data, we've reaffirmed the things we thought we were doing right, but weren't sure. With information from SOIX reports, we've reduced stays in recovery for several types of surgery."

For example, SOIX demonstrated that the average facility discharged its tonsillectomy patients considerably sooner than Findlay. After sharing the data with staff, Ms. Brunswick and Ms. Cunningham pinpointed where the problem lay.

"The problem was comfort level - we had to change the mindset from hospital to ambulatory mode," says Ms. Bruns-wick. "With improved pain management and anesthesia monitoring, patients are a lot more alert when they arrive in recovery. They're stable sooner."

"With the findings," adds Ms. Cunningham, "the surgeons felt comfortable making changes in their discharge orders."

Post-op phone calls made to all patients validated the move: No recurrences of post-operative nausea and vomiting or admissions to the hospital for pain control or fluids have been reported, says Ms. Brunswick.

Educating themselves
To fulfill most of the continuing education courses required for licensure in Ohio, Findlay uses Healthstream.com, an online medical-education program, and provides staff with on-site ACLS training. The center also participates in in-services offered by sales reps and vendors to get the latest information on products used in the facility as well as new technology and products. Findlay's pharmacy consultant gives at least one talk annually, often on PONV or pain, which nurses are always trying to reduce for patients.

"By applying our education, we've developed better pre-op questionnaires, which have led to better PONV prophylaxis," says Ms. Brunswick. "And we started using anti-nausea relief-band bracelets for patients with a history of PONV. We've made getting patients through more seamless."

- Stephanie Wasek