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A patient walks into a surgery center that is beautifully decorated with local artwork. She changes out of her clothes in an admission bathroom, which has lockers for her clothes and shoes. She uses a key to secure the locker. She is told that after surgery, she will be able to access her clothing and dress in a discharge bathroom on the other side of the lockers. She goes to a cubicle, where she undergoes her preoperative interview in privacy with the anesthesiologist. Her husband remains in the cubicle with her until the time of surgery. After the procedure, she goes to a private room, where she remains until she is discharged that evening. Before she leaves the center, a nurse hands her a medication that was pulled from a dispensing machine in the center.
Although this scenario sounds a little futuristic, it actually incorporates ideas that already are being used at surgery centers around the country. (For information on the prescription-dispensing machine, see next month’s Same-Day Surgery.) In addition, managers also have developed some innovative cost-sharing ideas. (See "How can you save money? Use volunteers, students," in this issue.) Consider these suggestions:
• Display local art. When the Chesapeake Surgery Center in Salisbury, MD, was built, administrator Joseph Walters, PA-C, wanted to use art to decorate the center. In his work as an accreditation surveyor, Walters had seen a surgery center display local artists’ work. He contacted a local art institute and gallery, which has an "art-at-work" program that allows artists to display their work at businesses, which pay a nominal fee.
The institute’s representatives examined the walls and spaces at the surgery center to determine where the art should be placed. No art was placed in the operating rooms, where blood or other fluids could damage the works. The artist’s names and the cost of the works are displayed on placards below the pieces. The displayed art includes sculpture, photography, and paintings.
When a patient or staff member is interested in purchasing a piece, the center’s managers simply notify the art institute. "We have contacted the art institute for at least two patients in the waiting room who became interested in buying pieces while they’ve been here," Walters says. When the art is sold, the institute replaces it with other pieces. Art that isn’t sold is replaced after six months.
• Use double-sided lockers for patients. Chesapeake Surgery Center has custom-made wooden patient lockers that are double-sided. The cost was comparable to traditional metal lockers, Walters says. The lockers create a separating wall between the admission bathroom and the discharge bathroom. Patients change out of their clothes in the admission bathroom and put them into a locker, which locks with a key. Family members or friends keep the key if they are staying inside the facility during surgery. Otherwise, the key is put on the patient’s chart. After surgery, patients go to a discharge bathroom on the other side of the lockers and use their key to open the locker containing their clothes.
"In other places, you’d have to wait for someone to get out of a bathroom, or someone has to get your clothes out of a locker, or patients have to wait somewhere," Walters says. "We tried to minimize the amount of walking patients or family members have to do. And nothing gets lost."
If Walters had the opportunity to redo the lockers, which are 1 foot by 1 foot, he would make them bigger so patients could put their clothes and shoes in the same locker, he says. On the positive side, the lockers allowed Walters to put the two bathrooms next to each other, which allowed the plumbing fixtures to be in one place. He recommends that surgery programs keep an extra set of locker keys for the rare case when a friend or family member loses one.
• Use cubicles for preoperative patients. When Palo Alto (CA) Surgecenter was built, it was designed with cubicles for its preoperative patients. The 8-foot by 10-foot cubicles have floor-to-ceiling walls on three sides and a curtain across the front. What’s the advantage? Privacy, says Lorraine Pucher-Petersen, RN, former director of nursing at the center. "That was the No. 1 intent when we designed them that way."
When patients meet their anesthesiologists on the day of surgery, they can have the preoperative interview in private. An additional advantage is that staff can have the supplies for each patient in the pre-op cubicle, Pucher-Petersen says. A chair is located in the cubicle, which allows a family member or friend to wait with each patient. "We think we’d make them a little larger next time to allow for another person," Pucher-Petersen says. "Or if we decided to administer sedation preoperatively, we could monitor patients. It would allow more flexibility."
• Use private rooms in the place of the post-anesthesia care unit (PACU). Indiana Surgery Center is a network of freestanding surgery centers in central Indiana that offers 23-hour care. Patients use their private rooms in the place of PACU, as well as preoperatively. While private rooms aren’t unusual for 23-hour patients, about 90% of Indiana Surgery Center’s don’t stay that long, says Amy Glover, RN, BSN, CNOR, administrator. "But even if patients don’t spend the night and just stay until 8 or 9, it’s a long stay," she says.
The primary reason for the patient rooms is patient privacy and comfort, Glover says. "We feel the private rooms enable that far more than larger, traditional rooms with beds separated by curtains," she says.
The cost of the rooms is low, Glover says. The rooms are small with a hand sink, a window, a bed, and piped-in oxygen. Some have private half-baths. The décor and furniture resemble a hotel more than a health care facility, Glover says. Patients appreciate the privacy of the rooms, she says. "With all the questions patients and families are asked before and after surgery, other patients aren’t put in a position of hearing that," she says.
When building private rooms, don’t use a layout that resembles a hospital corridor with rooms off both sides, Glover suggests. That type of layout is noisy and creates a lot of traffic, she warns. Also, there’s a tendency for visitors to look inside open doors, she says. Instead, lay out the rooms with private hallways that lead to a "pod" of four to five rooms, she suggests.
[Editor’s note: Do you have an innovative idea you’d like to share with your peers? Contact Joy Daughtery Dickinson, Senior Managing Editor, Same-Day Surgery, P.O. Box 740056, Atlanta, GA 30374. Telephone: (229) 377-8044. Fax: (229) 377-9144. E-mail: email@example.com.]
For more information on innovative ideas for improving patient satisfaction and cutting costs, contact:
• Amy Glover, RN, BSN, CNOR, Administrator, Indiana Surgery Center, 8040 Clearvista Parkway, Indianapolis, IN 46256. Telephone: (317) 621-2070. Fax: (317) 621-2005. E-mail: firstname.lastname@example.org.
• Joseph Walters, PA-C, Administrator, Chesapeake Surgery Center, 804 Snow Hill Road, Salisbury, MD 21804. Telephone: (410) 546-0300. Fax: (410) 546-8364. E-mail: email@example.com.