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Same Day Services, Surgical Excellence, Simplified

Director of Pullman Regional Hospital Same Day Services, Dustene Johnston, talks about common procedures, new services, and the patient experience.
Same Day Services, Surgical Excellence, Simplified
Dustene Johnston, MS, BSN, RN
Dustene is the new director for Pullman Regional Hospital’s Same Day Services Department. While new to the role, Dustene has been a registered nurse and has worked at the hospital for many years.

Deborah Howell (Host):  You know, it used to be that a surgery could keep you out of work and even out of your home for quite a while. But happily, these days, many surgeries can be performed as same-day surgeries and outpatient procedures. To talk about same-day services and surgical excellence at Pullman Regional Hospital, today we're joined by Dustene Johnston, the new Director for Pullman Regional Hospital Same-Day Services Department. While new to the role, Dustene has been a registered nurse and has worked at the hospital for many years. Dustene, what a total pleasure to have you here with us today.

Dustene Johnston, MS, BSN, RN (Guest): Thank you so much for having me here today.

Host: It's our pleasure. Can you tell us what a same day surgery unit does?

Dustene: Sure, it's pretty big array. In same-day we offer a lot of services to our patients, including a pre-operative specialized registered nurse area with RNs who conduct history and physical interviews, educate pre-procedure and perform tests needed before surgery. After the patients are there, we then also admit and prepare patients for their procedures and their surgeries. We have a post anesthesia care unit also known as a PACU where specialized trained RNs provide critical care in the immediate post-surgery period. We have a phase two recovery in same-day where patients further recover and are discharged home after they meet discharge criteria.

We have an endoscopy suite where we assist surgeons in performing upper endoscopy's, colonoscopies, esophageal dilations, foreign body removal, surveillance of GI bleeds. And soon we'll be offering pH monitoring using the Bravo system. The RNs who work in endoscopy have very specialized knowledge   that encompasses all aspects of endoscopy, including anatomy and physiology of the GI tract and specialized equipment expertise. We also recently upgraded to the newest Fujinon endoscopy equipment, giving our providers even better technology to use while performing these procedures.

Also within same-day, we provide infusion and transfusion services to the community. We administer a large range of treatments in this area on a daily basis. We run a pain management clinic through same-day in collaboration with Pullman Anesthesia Associates, who are the CRNAs that provide anesthesia services at Pullman Regional Hospital.

We do cardioversions and transesophogeal echocardiograms that are performed by Dr. Jones of Palouse Heart Center within same-day. And finally, the RNs in same day provide the majority of the procedural sedation for scheduled cases within the hospital. And all the RNs in same-day are currently undergoing a procedural sedation certification.

Host: Okay. And what's the difference between outpatient and inpatient procedures?

Dustene: An outpatient procedure means that the patient is going to arrive for their procedure and be discharged in less than 24 hours from the hospital. The majority of those are going to go home in less than six hours and some will stay one night, but then inpatient procedures require that the patient stays in the hospital at least overnight. And some times for two or three nights.

Host: And these procedures are handled differently?

Dustene: Really within same-day, there's very few differences for the inpatient versus outpatient procedures. An inpatient stay will require a little additional charting and a little in more in depth assessment. And so the admitting RN might ask the patients a little more background information. And also the majority of the outpatients will discharge, you know, within a few hours of being admitted while the inpatients will go to the medical surgical unit to be discharged.

Host: Got it now, Dustene, can you tell us a little bit about the staff that comprises this unit?

Dustene: Sure. All of the RNs in same day are trained to admit and discharge procedural and surgical patients. They all can administer highly complex medications via infusions and provide procedural sedation. Of all the RNs and same-day, some are trained to work in endoscopy, and some are trained to work in the PACU and everyone who works in those two areas take call and respond when emergency procedures must be done. Additionally, we have specialized trained RN who conduct the preoperative interviews and education, cardio versions, and TEEs, PICC line insertions and pain management procedures. And an RN who works in same-day really has to have a very wide and specialized knowledge base to be able to work in a number of areas throughout their day.

Host: Sure. Now, can you walk us through a surgical experience from the perspective of a patient?

Dustene: Sure. Usually our patients are scheduled from their surgeon's office, one to three weeks before their case. And then we call the patient about two to seven days before their procedure to go over their health history and gather records from other offices such as a cardiologist or their primary care provider. Also during this interaction, we educate the patient on what they need to do the night before surgery and the day of their surgery. And to answer any questions, sometimes their surgeon requests that instead of doing this pre-operative interview on the phone, that it's done in person in same-day.

So for those cases, we see them in same-day, also about two to seven days before their procedure to interview them, educate, do tests such as EKGs or blood work. And then they often will see other providers such as pharmacists, anesthesia providers, or hospitalists. Sometimes surgeons schedule changes a number of times throughout you know, from the time they start booking until the cases are actually performed. And that can happen for a variety of reasons, such as emergency surgeries, cancellations, or additions of other patients, or the surgery times are longer or shorter. So, then the patients will usually hear from us the day before their surgery to confirm their surgery time.

The next day, the patient will arrive to the park, to the hospital and park in the front parking lot that's right by the front door. There'll be greeted by the Pullman Regional Hospital Volunteers at the front desk. And they will get them to the registration staff. After the check-in process is complete, which only takes a couple of minutes, the patient then comes back into same-day services and goes to their admitting room where they are greeted by one of our same day CNAs.

There we get their height, their weight, their vital signs, help them get changed into our surgical gowns. If there's any kind of orders for compression devices or like a surgical prep of the area, the CNAs will also do that. Then admitting RN will come in and confirm the patient's identity, their procedure, their surgical site, and then do an assessment, start their IV. That RN will explain kind of what, how the rest of the day is going to go, answer any questions.

They'll even start a lot of the discharge teaching and get ready for the patient to see the next person who was then the CRNA or the anesthesia provider. They'll come in and they'll interview the patient. They'll develop a plan of care and collaboration with the patient and their family. Often the CRNA will order a few preoperative medications to help decrease preoperative anxiety and post-op pain and nausea.

Then admitting RN will give you, give the patient, those medications, and then the patient will get ready for the OR. Right before the patient goes back, the surgeon will meet with them to answer any last minute questions and then the circulating, or also known as the OR RN will meet the patient, take them to the OR. In a lot of instances, the patient receives a small dose of anti-anxiety medication before going back. And therefore often doesn't remember much after leaving their same-day room.

After surgery, the patient will wake up in the PACU with one of the same-day RNs at their side. This RN will be managing the patient's care for the immediate post-op period. And often patients only remember bits and pieces of this time in PACU because they're really just starting to emerge from their anesthesia.

And once the patient meets PACU discharge criteria, they're then transferred back to same-day if they're an outpatient, or to the medical surgical unit, if they're an inpatient and stay in overnight. If they're back in the same-day, the patient will be able to see their loved ones again, at this point. And they'll go through some discharge criteria, get to eat something, get their pain under control, get some fluids, and then they'll get to go home.

Host: So are nerves common before surgery for a lot of people? And how does the staff ensure patient comfort and confidence?

Dustene: Sure, it is really common for patients to be nervous before surgery. It's often a fear of the unknown and being in an unfamiliar environment and feeling vulnerable. The same-day staff recognizes that, although this is our everyday environment, it is not for the majority of our patients. One of the greatest ways that we can help relieve this is by answering questions and providing as much education to the patients that they're receptive to. Sometimes when you're really nervous, you really don't want to hear anything. But knowledge is power and the more the patient understands the process, the more comfortable that they'll feel. Additionally, our admitting RNs work to develop a level of trust with our patients and they are the patient advocate really in the preoperative environment. And are there to make our patients comfortable. Sometimes that comes in the form of a warm blanket. Sometimes in someone holding your hand, sometimes just giving the patient a few minutes alone to process and sometimes getting some anti-anxiety medications. Those of us that work in same-day are comfortable in this environment. We want our patients to feel as comfortable as we are.

Host: I love it. And what would you tell a patient considering surgery at Pullman Regional Hospital? Why have your surgery here?

Dustene: At Pullman Hospital, we strive for surgical excellence simplified. We work very closely with the surgeons and their offices to coordinate all aspects of the surgical procedure, to make it as easy as possible for our patients. Additionally, we are in the process of developing a new surgical services website that will be an incredible resource for our patients pre and post operatively. The thing that really sets us apart at Pullman Regional Hospital and really above the rest is the people that we work with. You can tell when someone loves the place they work, it shines through in their demeanor, their patient care and their overall happiness. The employees at Pullman Regional Hospital love working here. It's such a kind, caring, a nurturing environment to be in. We are all very much like a family and we like to keep the atmosphere that way and extended to our patients as well.

Host: Can't ask for more than that. Dustene, we appreciate your time so much and everything you do. Thanks so much for being with us today.

Dustene: Thank you for taking your time.

Host: For more information, as well as more podcast episodes, learn This email address is being protected from spambots. You need JavaScript enabled to view it. . This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.