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Surgical Services, Sterile Processing and PACU

Members of the surgical services, sterile processing and PACU teams

Nov. 20, 2019 – Today’s visit took me to the Warren Family Surgical Center, which provides general and specialized surgical services for infants, children and adolescents. Here, surgeons perform more than 20,000 procedures each year, making Rady Children’s one of the busiest surgical centers on the West Coast. In order to get the full experience, I was assigned the role of a patient who was arriving at the Hospital for a surgical procedure.

Checking out the Kelp Cam!

I began at the colorful ocean-themed surgical services check-in desk in the Acute Care Pavilion, where I received a surgical services passport. Unlike my personal passport, this one is designed to give families an idea of what to expect and guide them through their day. Families also get a phone call a day ahead of time to help them prepare and answer any questions. The comfortable waiting room has plenty of distractions for kids, including the Kelp Cam, a live video feed from Birch Aquarium.

Once my name was called, I moved on to the registration desk, where insurance and consent forms are processed, and patients and parents receive hospital bracelets. About 30 patients check in here every day. Next, I moved to pre-op, where a nursing assistant checked my vital signs and gathered data including my height and weight, blood pressure and oxygen levels. Good to go! Next, I went back to a pre-op room and met with more medical staff, all with the goal of making me more comfortable for my upcoming surgery. I even got to choose a flavor for my anesthesia mask (watermelon!).

Smelling the options for my anesthesia “flavor”

This team is continually looking for ways to enhance the patient and family experience. Examples include collaborating more heavily with child life specialists, who can now conveniently be requested through Epic; allowing parents to go back to surgery with their child for the mask induction; developing a pre-op video for families; and making special arrangements for children on the autism spectrum.

Now it was time to head back to surgery. I put on a “bunny suit” since we were entering a sterile area. First, we stopped at the command center, which is a wall of monitors that display details about all of the surgeries happening in the 16 surgical suites. The largest volume of cases happens between 7:30 a.m. and 5 p.m. Efficiency is key, as even a small delay in the morning can have a ripple effect on later cases. The state-of-the-art surgical suites are assigned by specialty, such as orthopedics, heart, neurosurgery and urology.

A wild ride on the way to surgery!

In keeping with my role as a child headed to surgery, I had the opportunity to drive myself to the operating room in a scaled-down Dodge Ram truck! I can see why this would be an awesome experience for kids, who have the option to choose from a fleet of different vehicles. For me, it was a bit tight, but still a lot of fun.

After the surgery tour, we headed to the 18-bed post-anesthesia care unit. This is where kids are taken after their surgery to wake up from anesthesia. Rady Children’s is unique in that nurses are the ones who extubate patients. Using a well-monitored protocol and tracking outcomes, the results have been quite phenomenal with extremely low reintubation rates. This forward-thinking approach is something to be proud of! PACU nurses also guide patients through their recovery, assessing their vital signs and helping with pain management. Depending on the surgery, patients can spend between 30 minutes and six hours in the PACU. About 85 percent of patients head home after surgery and 15 percent, such as NICU babies and kids with complex heart surgeries, are admitted to the Hospital. Everybody (who is old enough) gets a Popsicle, though!

I really got to go behind the scenes during my next stop in sterile processing, which is on the floor beneath the operating rooms. This is the area in the Hospital where the cleaning and sterilization of devices used in medical procedures takes place — and with more than 20,000 surgeries in fiscal year 2019, there is a lot to do! Typically, an instrument coming from the operating room arrives in the decontamination room to be thoroughly cleaned through several processes, and then sterilized. Once sterilized, the instrument is either sent back to be used again or into storage until needed for a procedure. This team also sterilizes equipment from 50 offsite clinics. It’s such an important part of keeping our patients safe, and this team takes their responsibility very seriously.

Learning about sterile processing from Gary Johnson

I dropped in on the 3 p.m. team huddle during shift change. Team members were discussing important updates that all had the common theme of improving efficiency and safety. Manager Gary Johnson is focusing on ways to standardize instruments and systems to accomplish those goals, including a system that will automatically track instruments as they travel from sterile processing to the operating rooms and back.

We then headed to the break room where a large contingent of the teams was assembled. Here, we took a few photos and I stamped my passport (not the surgical one!) with the largest actual stamp I’ve seen yet on these visits (check it out to the right of the blog). The team also had a yummy bag of goodies for me.

The importance of surgical services, sterile processing and the PACU to making kids better cannot be overstated. Our families entrust their kids to your care every day, and you consistently prove that their trust is well-placed.