Letters & Emails

At What Price Turnover?
Re "One-two Punch Is Key to Room Turnover" (August, page 14). As a clinical director of a multispecialty ambulatory surgery center, I'm very concerned with decreasing our turnover time, but not at the expense of foregoing recommended infection control practices.

I question the practice of having someone in sterile OR attire opening sterile supplies and then transporting them from one room to another. Per AORN standards for maintaining a sterile field, "Sterile supplies should be opened as close as possible to the time of use. The potential for contamination increases with time because dust and other particles, stirred up by movement of personnel, can settle on horizontal surfaces. The number and movement of persons involved in a surgical procedure should be kept to a minimum. Bacterial shedding increases with activity. Air currents can pick up contaminated particles shed from patients, personnel and drapes and distribute them to sterile areas."

Per AORN Clinical Issues August 2004, pg.321: "If a set up is used for another procedure, that procedure must be performed in the room in which the sterile supplies were opened. Moving the opened sterile set up from one room to another could result in contamination."

I'm concerned that some readers would implement this practice without researching proper standards. I am an advocate for change in the perioperative setting, but never at the expense of potential sacrifice of quality patient care.

Ann Purvis, BSN, CNOR
Clinical Director
SurgiCenter Services of Pitt, Inc
Greenville, N.C.
writeMail("[email protected]")

Dr. John Wood replies: My thanks to Ms. Purvis for her thoughtful comments. AORN standards are clearly an important guideline; we believe our protocol to be in compliance. The treatment room where we set up cases is a sterile environment that we don't use for procedures on an operative day. This room is closed to the non-sterile environment. Passage from this room to the OR takes place through the sterile prep area, a distance of approximately four feet. One person is involved in this movement. With this carefully planned preparation, we minimized extraneous movement within the OR.

AAAHC carefully reviewed and approved our protocol. We've had no infections for the last seven quarters (more than 6,000 intraocular cases). Since our article was published, we've received our CON to operate our treatment room as a second OR, so we no longer use this system. For those who have a similar physical layout as we originally described, we wouldn't hesitate to recommend this system. We're confident that his approach doesn't compromise quality patient care.

Inconsistent OR Reports
Re: "Getting Reimbursed for Mesh" (September, page 24). Your sample op report says "Local standby" under Anesthesia. Under Operative Procedure, it states, "satisfactory general endotracheal anesthesia was obtained." I would think that an insurance auditor might have some doubts about the validity of the whole report with that rather glaring inconsistency. Otherwise, keep up the good work.

Jay S. DeVore, MD
Anesthesiologist and medical director
Regional Medical Center Surgery Center
Kitty Hawk, N.C.
writeMail("[email protected]")

I noticed in the sample op report "Local standby" and general endotracheal anesthesia in the body of the operative procedure. Which was it? Either is appropriate depending on the skill of the surgeon and anesthesiologist.

Most anesthesiologists would prefer you use the term "Monitored Anesthesia Care" or "MAC" instead of local standby. MAC indicates the anesthesiologist was actually participating in the care of the patient during the surgery as opposed to standing by, which sounds distant.

Dean B. Berkus, MD
Anesthesiologist
Specialty Surgical Center
Beverly Hills, Calif.
writeMail("[email protected]")

Ms. Lolita Jones replies: That is an actual operative report; I only changed identifiers. In real life, OR reports frequently contain incomplete or conflicting documentation. This is unfortunate, but this is a reality.

Non-MDAs Administering Anesthesia
In an age when most institutions and regulatory and accrediting agencies are seeking to improve patient safety by reducing errors, the American Society for Gastrointestinal Endoscopy and the Society of Gastroenterology Nurses and Associates seem to be moving in the opposite direction.

They have opined that for moderate sedation, the GI nurse monitoring the patient may perform interruptible tasks at the same time. There interruptible tasks will tax the capabilities of the monitoring nurse, and will result in errors (mishaps). This is contrary to the standard for conscious sedation promulgated by JCAHO.

The Institute of Medicine pointedly states that the anesthesia society is one of the few healthcare groups that has made appreciable improvements in patient safety over the past few decades (similar to the aviation industry). This was accomplished by increased vigilance, decreased distraction, stricter demands and improved technology.

Now is not the time to be taking shortcuts or relaxing standards. True cost savings in healthcare will be achieved by making the system safer and less error-prone.

Tom Mitros, MD
Administrator
Surgery Center of Salem County
Salem, N.J.
writeMail("[email protected]")

For the Record
? The typographical error in the Alcon ad on page 47 of the November issue was the responsibility of the Outpatient Surgery ad production staff, not Alcon. Outpatient Surgery regrets the error.