Easy Does It - Ambulatory Surgery Center Video

Introduction

Narrator: This is Daniel. He is 7 years old, and he lives in New Jersey. Today is a big day for Daniel. He's at The Children's Hospital of Philadelphia Surgery Center in Voorhees, and he's having an operation on his ear. And guess what? We get to come along.

Karen B. Zur, MD: It's very natural for parents to be overwhelmed by the concept of kids having to go through anesthesia and through a surgical procedure. The next level of anxiety is often: Where is the surgery going to be done?

Douglas A. Canning, MD: So the concept was to bring CHOP, to try to export CHOP, out to the neighborhood.

William P. Potsic, MD: And we started with an Ambulatory Specialty Center and then expanded beyond that to our ambulatory surgical centers.

Karen B. Zur, MD: CHOP offers surgical services at three centers outside of the main hospital. In Pennsylvania they are in Bucks County and at the Exton facility, and in New Jersey, is at Voorhees.

What is Ambulatory Surgery?

George Karpovich, RN: Ambulatory surgery is basically the idea of having your surgery and going home the same day.

William P. Potsic, MD: Things in an Ambulatory Surgical Center are predictable.

Douglas A. Canning, MD: We try to select cases that we can start and end at a reasonably predictable time.

William P. Potsic, MD: There are no emergencies. There are no add-ons. Everybody is focused on what's being done that day and the patients there are there that day, so it makes a real pleasure.

George Karpovich, RN: It's convenient. It's next door to your house. It's right in your community. Okay. The parking issue-- there are none. You park under a tree here. You get to walk 10 feet, and you're in the building.

Steve Givens, Father: We're as about as far south in Jersey as you can get. And to have something this close, this easy to get to...

Kathy Givens, Mother: Main roads all the way.

Steve Givens, Father: And I think it's easier on the kids not having to walk into that big hospital.

William P. Potsic, MD: The primary benefit is the environment, the calming and soothing nature of the environment.

George Karpovich, RN: The little things that we try to do for the families-- we try to offer them to tour, to make them and their children feel more comfortable.

William P. Potsic, MD: They're less stressed. They're more calm. They can concentrate on the explanation of what's going to be done and, with adequate preparation, it's just a much more pleasant environment for the family and for the child.

George Karpovich, RN: We're trying to set the times up so that families come in, and they're not waiting long.

Douglas A. Canning, MD: We want patients ready. We want surgical teams ready. And we don't want patients to have to wait.

Karen B. Zur, MD: There's a wide range of surgical procedures that are done at the ambulatory centers.

George Karpovich, RN: From as simple as an ear tube to as big as an ACL reconstruction. Just about any procedure that you can have and go home the same day, we do here at the surgical centers.

Karen B. Zur, MD: There are a variety of specialists who perform procedures at the ambulatory centers, the ear, nose, and throat specialists, eye doctors, orthopedists, urologists, plastic surgeons, general surgeons, and gastroenterologists.

George Karpovich, RN: Every one of the employees here are employed by CHOP.

William P. Potsic, MD: The nurses are fully trained, fully certified, and CHOP-quality nurses.

Ellen C Jantzen, MD: All of the anesthesiologists and surgeons who work at the surgery centers are CHOP physicians as well.

Douglas A. Canning, MD: The beauty of the satellites is that they're interchangeable. You can airlift a satellite and attach it to CHOP, and you wouldn't notice any difference.

Kathy Givens, Mother: It's all the same staff. They're just in different places. Dr. Kazahaya -- I think they're cloning him. He just pops up there. And pops up here and pops up. We've the same anesthesiologist, so it's the same staff that you would have in Philadelphia.

Ellen C Jantzen, MD: We know each other well, and we are accustomed to working with each other in all different types of circumstances and under all different types of conditions.

William P. Potsic, MD: Each of the surgical centers is also attached to a specialty center. That's basically an area where consultations are done, patients are examined and seen. Decisions are made as to whether they need additional care. And it's not just surgical care in those specialty centers, it's also specialty pediatric medical care.

George Karpovich, RN: Usually, the child will see their own pediatrician and then be referred to one of the CHOP surgeons.

Douglas A. Canning, MD: Referring physicians are our eyes and ears. They're the ones that identify the problems in their patients, in their general pediatric family practice, and they send the patients to us.

Karen B. Zur, MD: Depending on what the medical issue is, we make a decision whether or not surgery is indicated. And then once a decision to go through a surgical procedure is made, the next level of decision making is, "Is the child appropriate for a procedure to be done as an outpatient at a center such as this, an ambulatory center which is off campus?"

Douglas A. Canning, MD: We're very selective about the patients that we bring out. The children have to be basically healthy. If they have a significant cardiac history, if they have a significant neurological history, if they have an airway history that would make it difficult for an intubation, those patients that have those known problems don't come to the satellites.

The Day of Surgery

Narrator: Here's what happens when Daniel and his family get to the Surgery Center.

George Karpovich, RN: Two days prior to surgery, we will call each family that's having surgery and give them a time to be here. We try very hard to spread out the times so that the children that come here aren't waiting all day.

The day of surgery the child will come in, meet the secretary at the desk, and then sign a few papers to allow us to take care of the child, and the child will be taken back to the pre-op area with their parents to go over, again, the health history, but also check their vital signs, make sure that child's healthy. The child, in that period of time, whether it's two weeks or a week has not come down with anything, has not gotten sick.

Douglas A. Canning, MD: We don't take any risks here or at CHOP.

George Karpovich, RN: Giving anesthesia — that's a scary thought to anyone because it's one of those things where parents don't have control.

Douglas A. Canning, MD: There's no surgeon at CHOP that doesn't — that isn't here because of the anesthesia. None of us could do anything that we do without a very strong anesthesia team. And I came to CHOP, in part, because I never wanted to worry about what was going on on that side of the field.

Ellen C Jantzen, MD: As an anesthesiologist, my first contact with the family on the day surgery is when the child and the family are in the preoperative area. In that area is where I meet the child and the family.

George Karpovich, RN: Children over the age of 1 will be offered a Valium-type medication, which relaxes them, which will take away the separation anxiety of the child from the parents, making it not only easier for the child, but easier, again, for the parents.

Ellen C Jantzen, MD: An anesthesiologist during the preoperative interview of the family is always thinking about what the best plan would be for that particular patient as well as the type of surgery that is going to occur.

We do have a basic plan that we consider that we'll use, but we adapt that and even completely change it according to the patient's physical status and the planned surgery.

I begin with what's called our "identifying data" to make sure I indeed have the correct patient and all of the basic information-- date of birth, the medical record number. And then I proceed with my questioning about general health and then I address things that are pertinent to the physical exam. After that in my mind I've made an assessment. And then I explain what the anesthesia will involve.

George Karpovich, RN: That day also the surgeon will meet them, the operating room nurses. So they'll meet a lot of different people prior to surgery to make everyone feel as comfortable as possible. Following that, the procedure is done.

Steve Givens, Father: Seeing the doctor, the preparatory stuff, your day kind of rolls along. But once they get in there, it's like ugh, it's the waiting that's the toughest part.

George Karpovich, RN: We take very seriously the procedures that we do here. Even though the child is able to go home, there is no such thing as a minor procedure.

Ellen C Jantzen, MD: Because for every family, any surgery is major.

William P. Potsic, MD: Just like when you have an anesthetic done, it's major anesthesia for your child.

Ellen C Jantzen, MD: And we're here for not only the child, but for the family. So we take very seriously no matter what the procedure is.

William P. Potsic, MD: The safety standards at our facilities are the same wherever we're providing care.

George Karpovich, RN: Children's Hospital has made that the number one initiative in everything it does. It's all about safety.

William P. Potsic, MD: And so we have a culture of safety at CHOP that's really very, very important to us and, of course, every one of our facilities conforms to all of the procedures that provide the maximum safety for the children.

Ellen C Jantzen, MD: In anesthesia we have extensive monitoring that we use for every single patient and every single anesthetic. We never subtract monitoring, no matter how minor the procedure may seem.

Douglas A. Canning, MD: There is a tremendous esprit de corps, in part, because these 12 or 13 children that we're going to operate on today is all we're doing. That's all we're focused on. There's no emergency room. There's no clinic. There's no phone calls. So we're focused, and we're one team. And as a result, there's tremendous teamwork that happens. Once the child has left the operating room, the child rolls into the PACU.

George Karpovich, RN: The PACU is the Post Anesthesia Care Unit.

Douglas A. Canning, MD: They are waiting for that child. Two or three, maybe as many as four nurses, ready to embrace that child as he or she lands into a PACU module or room. And those nurses recover that child.

George Karpovich, RN: We're going to do our best to have the parents back there within the first five minutes. The child stays as long as they need to, but we want to make sure, number one, that the child has no pain and that we go over the teaching with each family of the specific procedure that they're having done.

Healthcare Professional: Any signs of infection, drainage —

Kathy Givens, Mother: They're going to give you the list of things that you should do or should look for. What to expect when you get home and what might signal problems.

Steve Givens, Father: Basically just prepping you for anything that you should be aware of and be looking for.

Kathy Givens, Mother: Daniel, time to get up we're going to go home. See Ryan. See Claire.

Karen B. Zur, MD: One of the most exciting parts, talking about with recovery process with the children is the ICEE machine, and every day there's a choice of two flavors. And it's something that the kids look forward to, and they almost always ask about it in the waiting area.

George Karpovich, RN: The idea of the ICEE machine not only makes the kids smile, it makes the parents smile too. So more often than not, you're not only handing out one ICEE to the child, you're handing out one to the parents also, usually the dads.

Steve Givens, Father: ICEEs are big, real big. When we go in there today, he's going, you know, he'll probably have three of them before we get out of here.

George Karpovich, RN: It's just one of the little things that CHOP does to make the experience the best it can be. The child will go home, but the visit for us doesn't really end until the child's better. So after they go home, we will call every family the next day to see how they're doing, make sure everything's going well.

William P. Potsic, MD: We're available to them if they call us. But they also have the primary care physician who's there to help during that period.

Karen B. Zur, MD: They're the completion of the circle. The child goes back to their care. So they're an important part of the team.

Douglas A. Canning, MD: And I think they rely on us to support them if they identify a problem. And if we do our jobs well, it should be seamless.

Caring For the Family

Narrator: At the Children's Hospital Surgery Center they take care of Daniel's mom and dad too.

Karen B. Zur, MD: Family-centered care and safety of the children is a priority at The Children's Hospital of Philadelphia. And we really make sure to listen to our families.

Douglas A. Canning, MD: Because at the end of the day, we don't get to help their child until we connect with the parents.

Ellen C Jantzen, MD: Care of the family impacts how the patient does, and we all believe that at Children's Hospital.

George Karpovich, RN: To have the number one children's hospital within distance to take your child to. We don't realize how lucky we are.

William P. Potsic, MD: We are fortunate if you ever had to use it. And you're also fortunate if you've never had to use it. Because it's an incredible facility that's there if you need it, when you need it.

George Karpovich, RN: Every single day I walk into the Wood Building downtown and feel proud to walk into CHOP, and when I see these glimmering specialty care centers, I feel proud to walk into them.

Ellen C Jantzen, MD: We have the same goals, which is to take the best care we can of the patients and their families.

George Karpovich, RN: It's the very pinnacle of care for children and, yes, I think it's one of the wonderful things about being in Philadelphia. It's one of the wonderful things about being on the East Coast. It's one of the wonderful things about being in this country. We have the ability to provide care that far surpasses anything that I could ever dream of.

William P. Potsic, MD: We're all very pleased and honored and proud to be part of the CHOP family.

Karen B. Zur, MD: It's wonderful to be able to provide this level of service to our patients in the ambulatory centers.

Narrator: Now Daniel's ear is all fixed, and he gets to go home. That was a really good operation.