By Christine Gooley, APRN, BC

Would you ever guess a hospital the size of Brattleboro Memorial Hospital performs around four thousand surgical procedures in a year? It’s true. During the twelve months from October 2010 to September 2011, 2,389 surgeries and 1,612 minor procedures took place in our facility. That figure includes a broad range of surgeries in several specialties, in addition to colonoscopies and upper endoscopies. That’s a lot of patients coming and going on a daily basis.

Evidently, we are not the only hospital keeping busy. In the past 9 months I have gotten several phone calls from hospital administrators across the country saying they found me in a Google search and wanted a copy of my job description. I am the Nurse Practitioner and Clinical Coordinator of the Preoperative Assessment Clinic at BMH; and while major medical centers like Dartmouth have been using nurse practitioners or physician’s assistants in this role for some time, community hospitals are just now starting to discover the value of midlevel providers in preoperative care.

The motto for preoperative care is: “No Surprises.” Patient peace of mind is huge. The whole goal is to ensure patients and their families know what to expect both before and the day of their surgery, and to make sure they are ready, physically and emotionally. Research has shown that better preoperative preparation reduces anxiety levels for patients and leads to them experiencing less pain following their surgery.

Getting patients physically ready for surgery means making sure it’s safe for them first and foremost. Every surgeon’s office has unique preferences and requirements, and preop departments must learn what each surgeon feels is important in order to provide support. My training as an advanced practice nurse enables me to take patient histories and conduct physical examinations when necessary. I do a lot of ordering and interpreting of tests (x-rays, EKGs, blood work) which is why my office in the Richards Building is near the Laboratory Services and Radiology Departments. I conduct anesthesia evaluations and collect and interpret records from other hospitals to ensure an anesthesiologist has all the information in hand before proceeding.

When it comes to the anesthesia piece, mental preparation is as important as physical. Patients typically identify this as their major concern. In Preop Assessment we assure them that by the time they have their one-on-one meeting with the anesthesiologist, he is going to know everything he needs to know including a patient’s preconceptions. Working with patients individually and letting them know they have some say in what happens really helps alleviate their anxiety.

It’s important to educate the family, as well as the patient, about expectations. We live in a time when many people are doing their own research online and having conversations with friends and family who may have had a surgical experience. We want to clear up any misconceptions they might have and present any new information if what they have is not up to date. For example, we do a large number of total joint replacement surgeries here, and encourage families to attend the classes we conduct twice each month for joint replacement candidates.

Taking the stress out of surgery is really just good customer service. Everyone who comes here gets a phone call or has an on-site visit prior to their procedure. The personal touch is important and we are mindful of treating people like individuals. The nurses who make the calls are some of the most senior members of our staff. They can tell intuitively, even on the telephone, when a patient needs more support in one area or another. I feel lucky to have such an elite staff of experienced RNs working in the preoperative area.

We’ve instituted double-check systems into every work area, starting with the nurse phone call to putting charts together and making sure everything matches. It’s cumbersome but it’s necessary. I don’t think we’ve had a cancelled surgery because we missed something since I came on board four years ago. And with BMH switching from handwritten notes to electronic medical records, this process has improved greatly and enhanced patient safety. I can type in direct quotes from patients and the next person can read their exact words.

Last summer, we conducted a satisfaction survey with 100 randomly selected postoperative patients. Positive responses to the four questions we asked ranged between 89 and 98 percent.

We were really pleased because it meant people felt like they were prepared for their surgery. By the time some patients walk through the door, they have needed to have surgery for years. They have been living with pain for a long time. The role midlevel providers play in preoperative assessment of removing the anxiety that accompanies their decision to have surgery can make that pain go away that much faster.

Christine Gooley, APRN, BC, is the Preoperative Assessment Clinical Coordinator at Brattleboro Memorial Hospital.