Surgical Services - Operating Room

3-Blue
Evergreen Hospital Medical Center

PROFILE
The Main Operating Room is comprised of eight Operating Suites. A variety of surgical specialties are performed on a daily basis and include, but are not exclusive to general surgery, thoracic, peripheral vascular, neurosurgery, plastic/reconstructive, orthopedics, gynecological, advanced spine, urological, ESWL, minimally-invasive endoscopy, ENT and bariatric surgery. Surgery is performed on patients from all age groups, except neonates. We perform cutting edge surgery using state-of-the-art technology such as minimally invasive techniques and lasers. Current areas of growth include total joint, computer assisted navigation system surgery, brachytherapy, advanced spine program and deep brain stimulation.

UNIT FOCUS
The Department of Surgical Services is a vital component of Evergreen Hospital Medical Center, supportive of the mission, beliefs and practices of the institution, and dedicated to the provision of holistic, comprehensive and visionary care. The focus of the unit is to provide excellent patient care to our surgical patients by working with the interdisciplinary team of care providers.

PATIENT CARE DELIVERY MODEL
Surgery can be one of the most difficult and stressful events in a patient's life. It is the belief of the Department of Surgical Services that the patient and his/her family are the central focus of all care activities. The nurses of the Main Operating Room provide patient-focused, individualized care to each surgical patient and serve as their advocate throughout the operative process. This begins when the OR nurse greets the patient in the pre-surgical holding area and starts by developing and nurse to patient relationship.

The patient care delivery model is highly collaborative and inclusive of all members in the operating room team, including the physician, anesthesiologist, nurse, surgical technician and patient. The practice of nursing by registered nurses encompasses responsibility for the roles of the caregiver, leader, teacher, mentor, consultant, change agent and researcher. Fulfillment of these roles is necessary to meet the goal of holistic care for all patients.

TEAM MEMBERS
The main operating room team is comprised of the director, manager, assistant manager, clinical educator, clinical specialty coordinators, lead technicians, anesthesia technician, materials coordinators and staff. We recognize that the provision of health care is dependent on a staff and environment that is dynamically responsive to health care needs. This is essentially why we have developed a clinical cluster model in which surgical specialty areas are grouped together under the leadership of a clinical specialty coordinator. This allows for physicians and staff caring for each specialty group of patients to have a resource as well as hands-on clinical expert in the area.

The RN is always the circulating nurse. The nurses can function in both the scrubbing or circulating role. The nurse to patient ratio varies depending on the complexity of the procedures, but minimally there is one RN and one surgical technologist assigned per patient.

SCHEDULING PRACTICES
Staff schedules are driven by the need to support patients, 24/7. We enjoy a permanent day and evening staff with 8, 10 and 12 hour shifts. Call is assigned to each staff member on a monthly rotational basis. It generally consists of 3-4 shifts of night call per month, with one of those being a 12-hour weekend day/evening. We try to be flexible with scheduling in order to accommodate personal and educational needs.

STAFF ORIENTATION
The Main Operating Room provides for education and training designed to maintain the knowledge and skill of all personnel. Education is based on patient population, type and nature of cases, staff needs, advances in healthcare technology, findings from performance measurement/improvement activities and findings from peer/management reviews.

Each new hire's education program is designed with learning objectives based on performance expectations which address the knowledge, skills and behaviors appropriate to the individual's job responsibilities and performance. The design of the education and training provided utilizes cognitive, psychomotor, and other methods to accomplish the learning objectives. The learning is then assessed through performance appraisals as well as self-assessment tools.

EDUCATIONAL AND DEVELOPMENT OPPORTUNITIES
In addition to the staff orientation, the Main Operating Room leadership team is committed to continual education for staff. This education and development may occur at one of our weekly in-services, where we discuss new and upcoming equipment and/or procedures. The physicians, vendors or clinical specialty coordinators generally provide these in-services.

There is also opportunity for staff involvement in process/quality improvement within the unit through participation in our bi-monthly Clinical Practice and Continuous Quality Improvement Committee. This leadership team collaborates to discuss practice and/or process concerns within the unit and development resolutions and process improvements to improve future outcomes. We support staff driven practice and unit improvement ideas.
 
In addition, certification is encouraged in all areas, but is not considered mandatory with the exception of surgical technologist certification and certified nursing assistant.