4 0 R y J 0 U R N 4 L MAY 1984, VOL 39, NO 6

Ambulatory Surgery Ambulatory surgery centers must compete

for customers-both patients and physicians

A dvances in surgical practices and anes- thesia techniques have now made sur- gical procedures that previously re-

quired hospitalization safe for outpatient sur- gery.

To capture a share of the growing market. ambulatoiy surgery centers must be prepared to compete for customers-both physicians and pa- tients. Identification of each group’s needs is an essential first step to establishing a successful unit. Customer satisfaction is the key to effective competition. This article will discuss factors es- sential for customer satisfaction.

hrough group and one-to-one meetings with physicians‘ office staffs, centers T can establish open lines of communica-

tion. Informal meetings in a nonthreatening en- vironment encourage productive conversation.

Our center invited office personnel to a break- fast. An early morning meeting minimized any disruption to the physicians’ office routine and encouraged office personnel participation. After breakfast we discussed admitting and scheduling practices. reviewed policies and procedures, and encouraged questions. We followed up that ini- tial meeting with individual, informal meetings to discuss particular problems and concerns.

Encouraging tours of the ambulatory surgery center and providing the office staff with written guidelines will also familiarize them with unit practices and policies. Prompt, positive action on problems and concerns promotes a good

working relationship as well. The efficient uriit. Abbreviated and unencum-

bered practices that permit safe and efficient patient care are essential. Policies and proce- dures that restrict center use to low-risk indi- viduals eliminate extensive preoperative prepa- ration and tests. A history and physical, hemo- globin and hematocrit, potassium, and dipstick urinalysis are the tests required for general anes- thesia at our center. Nurse clinicians take his- tories and physicals, and laboratory facilities are available to process patients and minimize de- lays. Methods to minimize paperwork, such as simplified history and physical forms, preprinted admission and discharge orders, and home care instructions result in productive use of physician and staff time.

Qirtrlir.s ctrre. Quality care includes a skilled and knowledgeable staff attuned to patients’ needs and physicians’ preferences and practices. Surgical standards should provide the best possi- ble care for the patient. Staff members must be sensitive to the physical and psychological needs of the patient. Patient questionnaires should be surveyed for comments on care they received, and any necessary modifications should be made. Postoperative telephone calls will provide valuable information on the patient’s postopera- tive condition and identify any deficiencies in care. Encouraging staff members to participate in problem solving and to exchange ideas will help identify problem areas and develop effec- tive strategies. This will assure a high quality of care standard and provide data for corrective act ion.

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Flexible sc*herlulirig. Physicians will more frequently use a unit that is receptive to their surgical practice. When possible, scheduling policies should be responsive to surgeons’ re- quests. Systems that accommodate urgent cases, onsite preoperative testing facilities, and stag- gered work shifts create a more flexible sched- ule. Written guidelines that establish protocols for urgent admissions disrupt the unit less and result in a smooth, efficient admission process. While it is impossible to completely accommo- date the physician, a unit that makes a concen- trated effort to adapt and can effectively handle uncommon situations will enjoy greater success.

he physician may make the ultimate de- cision as to which surgery center is cho- T sen, but the patient can influence this

decision. The ambulatory surgery center should assess the needs of its patient population, includ- ing the following:

Corivrrriencv. Minimizing disruption to the patient’s lifestyle is fundamental. Patient con- venience can be improved through on-site pre- admission testing, advance scheduling, de- creased waiting time, unit accessibility, conve- nient parking facilities, and a comfortable wait- ing area for families. Unit practices that inter- fere as little as possible with the patients’ and their families’ daily activities will be appreci- ated and create a favorable impression of the unit.

The center’s first contact with the patient is a preadmission telephone call that gives the patient relevant information, corrects any misconcep- tions, begins preoperative teaching, assesses po-

Jeffrey Brandon, RN, BSN, is supervisor of the ambu- laton surgery centers and postanesthesia recovery rooms at Grant Hospital, Columbus, Ohio. He re- ceived his BSN from Emory Universiy, Atlanta.

Pat Holley Radoszewski, RN. BSN, is head nurse of the ambulatory surger). centers, Grant Hospital, Co- lumbus. She received her BSN at Jacksonville State University, Jacksonville, Ala.

tential problems, and initiates effective nurse/ patient relations. Written pamphlets can also be effective teaching tools. These pamphlets should be distributed to the offices of physicians who use your center and given to the patient when their surgery is scheduled. The pamphlets should be easy to understand, with key areas highlighted to attract the reader’s attention.

Per-tirirrit inforinntion. Upon admission to the unit, the nurse should give preoperative verbal instructions including

explanation of the surgical procedure description of the surgical area routine surgical practices description of the postanesthesia room routine postanesthesia room practices frequently reported patient experiences, ie, pain and nausea procedures to notify significant others of events when the patient can be reunited with fam- ily members approximate time required for surgical pro- cedure.

Postoperatively, patients should be given writ- ten and verbal home care instructions. Including the telephone numbers of the surgeon and the ambulatory surgery center on the instruction sheets will provide them with a quick resource for problems or concerns. A postoperative tele- phone call made by the center 24 to 48 hours after discharge is an informal opportunity for the pa- tient to ask questions and provide information about their recovery.

Ptrtierit digni?. Maintaining patient dignity can significantly affect the patient’s reaction to the unit . Often, the surgical experience is embar- rassing and uncomfortable. The center that of- fers bathrobes, allows patients to wear under- clothing when possible, delays removing dentures until patients are transported to the OR and per- mits patients to reinsert them soon after surgery promotes patient dignity and control. Establish- ing practices to preserve patient dignity, and at- tempts to honor patient requests will help create a positive patient experience.

Frrinilx involvement. The ambulatory surgery center serves the patient and his or her family or

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significant other. Including family members and significant others in preoperative and postopera- tive activities will minimize the patient’s feeling of isolation and allay everyone’s fears. The time patients arc separated from their families can be an anxious time. Assure the familyisignificant other that they will be informed when the patient arrives in the postanesthesia room, and let them visit the patient at the earliest possible time. Provide a comfortable waiting area with re- freshments, magazines. newspapers, and televi- sion to help them pass the time.

The ambulatory surgery center must be pro- gressive to compete effectively for patients and physicians. This competition is a continuous process. As the health care environment changes. so must the ambulatory surgery center.

A philosophy of flexibility will help centers meet changing needs and demands. A satisfied cus- tomer is your best advertisement. Soliciting physician reaction through questionnaires that seek suggestions for improvement will help evaluate the effectiveness of the unit. Individuals with a positive impression of the center are most likely to return for other surgery and to recom- mend the center to friends and family. The ambu- latory center that correctly assesses its environ- ment, the needs of physicians and patients, and implements effective practices will enjoy greater success. The growth and success of each unit rests in the hands of its clients.

JEFFREY BRANDON, RN PAT HOLLEY RADOSZEWSKI. RN

New Blanket Decreases Intraoperative Heat Loss An aluminized material used for lining survival apparel is being used effectively in a reflective blanket for intraoperative heat conservation. A study, reported in the February issue of A i i P . s t h r s i o l o g ~ , recommends using a reflective blanket when more than 60% of a patient’s body surface can be covered and when the procedure lasts two or more hours.

Denis L Bourke. associate professor, The University of Texas Health Science Center, Houston. and colleagues studied two groups of patients. The first group consisted of 60 patients scheduled for elective carotid endarterectomy . The patients were assigned randomly to either a control group or a test group. The test patients were wrapped as completely as possible in the aluminized blanket and surgically draped the same as the control patients. The second group consisted of 30 patients scheduled for neurological procedures anticipated to last longer than three hours. A copper cable connected the aluminized blanket to the operating table for test patients in both groups.

Patient temperature. monitored with an

esophageal temperature probe, operating room temperature, and relative humidity were recorded at half-hour intervals. Patients were observed for shivering in the recovery room by a nurse unaware of the research study.

In Group I , initial patient temperatures were the same in both the test and control groups. The test patients’ temperatures rose above the initial temperature within 30 minutes and remained above throughout the operation. The control group’s temperatures dropped below the initial temperature at 30 and 60 minutes, but remained stable thereafter. Recovery room shivering occurred in 16 control patients and in 5 test patients.

remained at the initial temperatures throughout the entire operation. Control patients’ temperatures fell below the initial value at one, two, and three hours.

cannot bum patients; are not subject to mechanical or electrical failures; are lightweight, clean, and disposable; do not interfere with x-rays, trap moisture, or increase the risk associated with undetected electrocautery dispersion plate faults.

In Group 2 , the test patients’ temperatures

The researchers said the reflective blankets

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