It's not uncommon for our surgeons to cross the skybridge that connects our main hospital to our outpatient facility so that they can perform inpatient cases in our outpatient ORs. Surgeons truly appreciate this added convenience.

Let's say a GYN surgeon has three outpatient hysteroscopies and one inpatient abdominal hysterectomy scheduled for the morning. We'd classify the inpatient needing the abdominal hysterectomy as an early admit. We'd admit her in the outpatient pre-procedure area, perform her procedure in one of the four outpatient ORs and let her recover in the outpatient post-procedure area. We'd then transport her to an inpatient room in the main hospital. This lets the surgeon follow the outpatient procedures with the inpatient procedure in the same OR suite and avoids the inevitable delays inherent in a main OR with a trauma designation. We follow a similar process for inpatients who are already admitted to the main hospital. Keys to making this idea work for you:

• When the surgeon schedules his inpatient procedure, he requests that it follow his outpatient procedures in the outpatient OR.
• When honoring the request, the scheduler indicates the inpatient status on the scheduling grid.
• The anesthesia screening nurse in the pre-op express evaluates the H&P, lab work and ECG, and discusses her findings with the anesthesia care provider to establish the ASA classification. Anesthesia lets patients classified as ASA I, II, and stable III have procedures in the outpatient OR. The nurse responsible for pre-procedure teaching in the pre-op express starts the inpatient assessment form.
• The outpatient surgery staff provides the appropriate sterile supplies and instruments for the procedure.
• During the recovery phase, the post-procedure staff contacts bed management to confirm the room number, calls the nurse on the receiving unit to give report and transports the patient via stretcher across the skybridge to the inpatient room.

Even though the behind-the-scenes process is complex, all the surgeon knows is he is back to the office in time for clinic and may also have time for lunch. Remember, happy surgeons schedule more cases where they receive the best customer service.

Kelly White, RN, BSN, CNOR
Divisional Director, Surgical Services
Medical Center Hospital
Odessa, Texas
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Trying on a New Size
When patients undergo breast augmentation surgery, they have a certain image, a look, that they hope to achieve. As a plastic surgeon I've heard many stories, though, about patients who ended up disappointed with the results of their surgery - even when the outcome was very good - because the look wasn't exactly what they'd had in mind.

Get help from the patient in getting the implant sizing right the first time. Keep sample implants in a range of sizes on hand. Ask a patient coming in for a consultation to bring along the bra she'd like to fill. A nurse helps the patient position the implants in the bra, then the patient tries on her clothes to decide what look she prefers. Some patients bring friends and husbands along for a second opinion.

Some argue that implants in a bra won't replicate the effect of implants under muscle and skin. But it creates a more accurate approximation than a patient comparing herself to a photo or another person, and it beats guesswork based solely on the surgeon's idea of what the patient wants.

Richard Mladick, MD, FACS
Director
Mladick Center for Cosmetic Plastic Surgery
Virginia Beach, Va.
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Business Cards Make Staff Accessible
We've printed up business cards for our staff members to give to family members so they know how to contact us for the patient's and procedure's status if they have to leave the facility, run errands or get lunch. In addition to the hospital's contact information, there's space for the nurses to write their names and unit numbers. It's an easy way for them to remember whom they dealt with or how to reach us, whether they're seeking information on the day of surgery or sending comments afterward.

Dolores Holland, RN, CNOR
Manager, Surgical Services
Clovis Community Hospital
Clovis, Calif.
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Previewing Patient Benefits
Well in advance of each procedure we do, our insurance billing coordinator calls each payer to verify patients' benefits. She compiles the information on a precertification form. Then she takes a couple of minutes to sit down with patients during their pre-admission visit to explain the insurance process and give them a copy of a cost sheet we've developed. It includes estimates on how much the surgery is going to cost, how much their insurer is likely to pay, how much we'll be adjusting off and the patient's balance. Patients appreciate being able to understand their insurance coverage. Our business office benefits because it knows up front who's going to reimburse us and for how much.

Betsy Sharp
Administrator
Orthopaedic Associates Surgery Center LLC
Augusta, Ga.
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Keep Packaged Instruments Visible
In our hospital system, we have a number of off-campus doctors offices and clinics that send their instruments to our central sterile for processing. Usually they'll send the instruments in plastic trays, and we exchange them for sterilized instruments. With some specialty items, though, they don't want a replacement item, they want this item. So they clean the item and send it to us in a peel pack so they can label it.

If it's an opaque paper peel pack, we can't see what's being processed inside. And any CS that's processing packages they didn't pack really needs to know what's in there, to make sure they're not sending back one-use, damaged or improperly wrapped items. That's why we only use peel packs with a clear side, so the CS tech can monitor what's going into the autoclave. That way, techs are able to keep an eye out for inappropriate items, discard and replace them and notify the facility that sent them over of the proper procedures.

Marcia Patrick, RN, MSN, CIC
Director of Infection Control
Multicare Health System
Tacoma, Wash.
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The Right Tools for the Job
We use major instrument sets for larger cases, such as abdominal procedures, hysterectomies and bowel resections; and minor instrument sets for smaller cases, such as facial procedures and biopsies. But some minor instrument cases call for tools from the major set, so we put together a third instrument set that includes the most-frequently used pieces of the major set. We call it our medium instrument set. We don't have to bring out and then process all 100 pieces of the major set, since we've reduced it down to 30 pieces in the medium set.

Linda Ritter, RN
OR Manager
Wilson County Hospital
Neodesha, Kans.
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