Inside look: Behind the OR doors

It is normal to feel nervous about what to expect during surgery. From what the environment will be like in the operating room (OR) to what happens while under anesthesia, patients have many questions. Advocate Sherman Hospital’s OR team is focused on alleviating these concerns through open communication and compassionate care.

“The care patients receive at Sherman is completely focused on patient advocacy and safety,” says Paula Morton, director of perioperative services at Sherman Hospital, in Elgin, Ill. “We recognize patients’ anxieties and fears and try to make them feel as comfortable as possible.”

Meet the OR team
Each member of the OR team plays an important critical role during surgical procedures.

According to Dr. Shawn Palmer, orthopedic surgeon at Sherman Hospital, a collaborative team approach is essential due to the many critical tasks involved during surgery. “Each person in the OR has a defined role, which ensures reliability and accountability.”

The key players on the OR team, which vary based on the procedure, include:

• Circulator nurse: Monitors patient safety and serves as the patient advocate during surgery. Positions and prepares the patient for surgery, ensures accurate counts and documentation and maintains a sterile environment.
• Surgical scrub technician: Provides surgeons with sterile instruments and assists them during surgery by anticipating their needs.
• Anesthesia provider: This may include an anesthesiologist or nurse anesthetist. The anesthesia provider is responsible for administering anesthesia to the patient and monitoring critical life functions.
• Anesthetic technician: Assists with the technical aspects of anesthesia, such as setting up lines, mixing medications and assisting with pain block placement.
• Surgeon: Board-certified physician performing the surgical procedure.
• Physician assistant (PA): Assists the surgeon during surgery.
• Perfusionist: Operates heart-lung machine during open-heart surgeries.

All about Anesthesia
A common source of anxiety for patients is the anesthesia process. According to Victoria Russell, nurse anesthetist at Sherman Hospital, patients undergo general, regional or monitored care anesthesia (MAC). “With general anesthesia, a patient is unconscious and unable to feel pain,” Russell says. “The medication is either in IV form or through an inhaled gas.”

Regional or local anesthesia involves a specific part of the body being blocked from feeling pain, such as during a knee replacement or shoulder surgery. MAC anesthesia, or conscious sedation, is the use of intravenous medications to produce varying levels of sedation.

Before surgery, the anesthesia provider meets with the patient to discuss his or her health history and any past issues with anesthetic. In some cases, patients will have a choice on the type of anesthetic they receive. “We advocate that patients are an active participant in deciding what anesthetic they are going to receive during surgery,” Russell says. “However, patients need to understand that there are often types of anesthesia that are better suited for them based on their medical condition.”

During surgery, the anesthesia provider monitors the patient’s vital signs, blood pressure, heart rate and oxygen levels.

Dedicated to Patient Safety
Another concern among patients is how their safety is ensured during surgery. “Patient safety begins with scheduling the procedure,” Dr. Palmer says. “Patient identity, diagnosis, indication for surgery and plan for recovery are all initiated at this time. This information is cross-checked by each care team member to ensure a culture of safety.”

Patients are encouraged to take an active role in their safety as well. For example, they are given instructions on how to effectively scrub their body before surgery to cleanse skin. This process has been shown to significantly minimize the risk of infection.

At Sherman Hospital, the focus is on patient safety, advocacy and excellent outcomes. “Each member of the OR team has a defined set of responsibilities that together provide a safe, efficient and expected outcome for the patient,” Dr. Palmer says.