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Our suburban Ambulatory Surgery Centers allow families access to the services of renowned Children's Hospital surgeons without a trip to the city. Staff at these ambulatory sites are all CHOP employees, and each Center provides outpatient general and specialty surgical services to children of all ages.
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.
Health Care 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.