Routine surgery is now more convenient and easier to access for University of New Mexico Hospital (UNMH) patients, thanks to the Outpatient Surgery and Imaging Service (OSIS), one of UNM’s newest health care facilities. What used to require several hours in the operating room and an overnight stay in the hospital is now performed in a fraction of the time on an outpatient basis.
“Since UNM Hospital surgical activity has increased three-fold over the past fifteen years and was carried out in the same operating room suite that was opened in 1966, there was a need for a significant expansion that would allow UNM to offer state-of-the-art care in a contemporary environment,” say Steve McKernan, Associate Vice President for Clinical Operations. “The new Outpatient Surgery and Imaging Service is a wonderful addition to the hospital facilities and offers services competitive with the best teaching hospitals in the country.”
Guided by four core values—to treat patients and co-workers with respect and dignity; to respect the skills and talents of each co-worker; to always strive to provide excellent customer service; and to continually evaluate the scope of their services for appropriate utilization – the OSIS team boasts a high rate of patient satisfaction.
“We had a dream of what we wanted to accomplish when we began planning the OSIS,” says Donna Sulier, Unit Director of Outpatient Surgical Services. “So we created an operational statement and a mission statement with our core values to accomplish that dream. We use both as the foundation for everything we do here.”
Sulier says that the key to the success of the OSIS is the fact that the building is filled with caring and competent people who exercise those core values. “We’re patient-care focused and we use the personalities here as a strength to get the job done with the right attitude.”
The OSIS is composed of Surgical Services, Radiology Services and the Pain Clinic. Through the integration of these components, everything from the smallest cosmetic procedure to complicated knee surgery can be managed with the greatest level of care and minimal inconvenience and pain.
Approximately half of all surgeries performed at the OSIS are orthopaedic cases, with the majority being hand surgeries. “Many of our patients who need outpatient surgery never have to go to UNM Hospital,” says Moheb Moneim, MD, Professor and Chairman for the UNM Department of Orthopaedics and Rehabilitation and Chief of the Division of Hand Surgery. “Their appointments, surgeries and check-ups are all done here.”
But, according to Moneim, convenience is not the only thing that makes the OSIS special. “This facility has allowed us to provide state-of-the-art medicine in outpatient surgery,” he says. “Not only am I able to utilize more cutting-edge procedures, but I am also able to perform a significantly greater number of hand surgeries than I was able to at UNM Hospital.”
One reason for this is that the only surgeries performed at OSIS are elective and scheduled. “It used to take me all day to do four hand surgeries at UNM Hospital,” Moneim recalls. “Now I can usually do at least six hand surgeries by 2 p.m.”
Moneim attributes his efficiency to the fact that there are no emergency or trauma cases coming in to the OSIS, which often can delay scheduled surgery. “The OSIS has a much more controlled environment enabling us to plan ahead,” he says.
Planning ahead means scheduling patient and operating rooms, doctors, nurses, and anesthesiologists – anesthesiologists who are trained to use the latest regional block techniques. One of those anesthesiologists is Randy Rosett, MD, Assistant Professor of Anesthesiology and Medical Director of Outpatient Surgical Services.
According to Rosett, regional blocks, unlike traditional anesthesiology methods that provide sedation to the entire body, are applied to the specific part of the body where the surgery is being performed such as a hand or a leg. In comparison, a “local” anesthesia is used for smaller procedures, such as putting stitches into a cut.
In a regional block, a local anesthetic medication is injected around a large nerve or bunch of nerves, which give sensation to the site of the procedure. The injection paralyzes the muscles in the area and once the injection takes its full effect – usually after only a few minutes – the patient is unable to feel any pain in the blocked area.
“There are several advantages to using a regional block,” Rosett says. “Foremost is the fact that the patient doesn’t feel pain, is less likely to experience nausea and/or vomiting after the surgery, and is usually able to go home within a short time after the procedure.”
One innovative way the OSIS team is using regional blocks is during women’s surgeries. “We are the only team in the state that currently performs breast surgery under a regional block,” Rosett explains. “This means a much quicker recovery period for breast surgery patients – a step in the right direction when it comes to women’s health.”
We try to perform a majority of all surgeries at the OSIS under regional block –making UNMH a benchmark for other hospitals. Orthopedic surgery lends itself well to regional anesthesia, and we try to perform most of these cases under a type of nerve block. “Not many places are doing regional blocks with the frequency that we are,” says Rosett. “Others might do one-half to one-third of their surgeries using regional blocks. We try to use them whenever possible.”
Although clinical procedures are the major focus of OSIS, a key part of its mission is educational. On any given day there are three to four medical residents and fellows gaining valuable skills through hands-on experience in the operating room, the recovery room and the pain clinic.
Moneim believes that compared to other universities, this puts UNM on the fast track for medical education. “The operating room in the OSIS is prime real estate for higher learning,” Moneim says. “Where else can students get a real-world experience in this kind of a setting?”
Whether it’s the covered circular patient pick-up area, the spectacular mountain views, the private rooms, or the leaves painted on the ceiling of the recovery rooms to give patients something pleasant to look at—the OSIS has taken much of the worry out of surgery.
Christine Archuleta and her 11-year-old son, Mario, agree. When Archuleta was told that Mario needed to have corrective surgery on his hand, she wasn’t sure what to expect. “I was worried about how complicated the process might be,” Archuleta recalls. “I wondered where I was going to park and whether I would be able to find my way through the hospital.”
For Archuleta, whose only previous surgery experience was an unscheduled procedure at UNMH, the process was surprisingly simple. “The OSIS was so much more convenient,” she says. “Everything went well and the doctors and staff were very nice.”
This is exactly the response hospital administrators were hoping for when they opened the facility in April 2003. Now, eighteen months later, patients continue to be pleased with the care they receive at the OSIS. A survey conducted by a nationally recognized health care satisfaction and improvement firm shows that the OSIS maintains an impressive 98 percent patient satisfaction rating.
“There has been a significant increase in patient satisfaction in all aspects of the care provided at the OSIS. It was designed to be patient friendly and it appears to have worked out just as planned,” says McKernan.