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O U T P A T I E N T
E V O L U T I O N
Outpatient Evolution
This is the first installment of a year-long series that will make the case
for performing more procedures in outpatient surgical facilities, where
more efficient care leads to significant cost savings and improved
patient satisfaction. Check back next month for a look at ventral hernias.
something surgical facilities can and should start to consider.
My patients (and their parents) are a select group. They live within
an hour-and-a-half of New York–Presbyterian Hospital, a tertiary care
medical center in New York City where I operate, so they're not driving as far for care as they might in less-well-served areas. We exclude
children who have medical conditions such as severe asthma, bleeding disorders, cranio-facial abnormalities and morbid obesity — anything that would place them in a high-risk population.
Presby is filled with incredible pediatric anesthesiologists and nurses who understand how to maintain safe, efficient care. Nurses spend
more time with surgical patients than physicians do, so having seasoned RNs who work as a team is essential to performing these cases
on an outpatient basis. The recovery room staff is highly trained in
monitoring pediatric adenotonsillectomy patients, having undergone
in-services with anesthesiologists and otolaryngologists. An anesthesiology resident works in the PACU and is available for nurses to consult if questions or concerns arise during recovery. Plus, I'm always
around and available.
The kids undergo a great deal of observation by highly trained caregivers before being discharged. We assess underlying medical conditions that could raise red flags, and review surgeries to determine if
they were routine or more difficult than expected. Patients have to
tolerate a minimum of 6 to 8 ounces of fluid, depending on their age.
Their oxygen saturation level needs to be above 95% for at least 2 to 3
hours after the administration of pain medication.
