The right place for same-day procedures

These days, an ever-growing number of operations are performed on a same-day basis, with no overnight hospital stay. And many Americans are choosing to have these procedures not in hospitals, but in outpatient facilities known as ambulatory surgery centers, or ASCs.

These days, an ever-growing number of operations are performed on a same-day basis, with no overnight hospital stay. And many Americans are choosing to have these procedures not in hospitals, but in outpatient facilities known as ambulatory surgery centers, or ASCs. These are the places you can go for less-complicated procedures. But are you as safe having your operation at one of these centers as you are in a hospital?

You are if it takes place at the CARES Surgicenter, located in the Center for Ambulatory Resources (CARES) next to Saint Peter’s University Hospital, says Richard Colavita, M.D., the facility’s medical director. "Should anything ever go wrong-which happens very rarely-a team from Saint Peter’s can simply cross the bridge that connects us to the hospital and lend us a hand."

And if the patient requires a hospital admission, something that occurs in only 0.6 percent of all their cases, Dr. Colavita says, it is handled quickly and seamlessly at the CARES Surgicenter. "At a stand-alone facility, they literally have to call an ambulance to transfer the patient to a hospital," he says. "We can wheel them right over to Saint Peter’s."

Safety goes beyond emergency readiness, though. The vast majority of surgical cases go off without a hitch, but there are safety and quality issues with every procedure. And for those, the CARES Surgicenter proved it meets the highest national standards for healthcare quality and safety when it earned The Joint Commission’s Gold Seal of Approval this past spring. The Joint Commission, an independent, not-for-profit organization, is the leading national body entrusted with setting standards and accrediting hospitals and other healthcare facilities, including ASCs.

"The Gold Seal is a real feather in our cap," says nurse Margaret Kaminsky, the surgicenter’s clinical director. "It’s tough to get accredited."

She says the commission’s auditors conduct "patient tracers: They choose random patients and follow them through the entire process to see if staff is asking the right questions-about drug allergies, for instance-and if we take proper health histories," she says. "They also check to see that we perform ‘time-outs.’That’s where the surgical team pauses before every procedure and conducts a safety check. The lead surgeon, for example, will say, ‘This is Mary Smith, and we are doing a knee arthroscopy on her left knee.’ The Joint Commission wants to make sure all the i’s are dotted and all the t’s are crossed."

The Joint Commission also checks the building structure, the equipment and the processes and procedures involved in patient care. And they conduct surprise inspections to ensure that facilities maintain those standards. "The Gold Seal tells the public we meet the highest standards at all times," Kaminsky says.

The surgicenter has earned other national distinctions as well. One of them, which it shares with Saint Peter’s itself, involves breast surgery. This June, Saint Peter’s University Hospital was recognized by the National Accreditation Program for Breast Centers, administered by the American College of Surgeons. "We were only the second institution in the state to achieve accreditation for its breast center, and one of just 53 nationally," says Kaminsky. "Our breast care patients can know they are receiving care at one of the elite hospitals in the country, and that extends to our surgicenter."

At 25,000 square feet, the CARES Surgicenter, which is a member of the Saint Peter’s Healthcare System, is larger than most ASCs, says Marjorie Romano, administrator. "Most have four or five operating rooms. We have seven, plus two additional procedure rooms for less-invasive procedures such as colonoscopy and other gastroenterology cases," she says. There are also nine preoperative rooms and 23 beds in the recovery area.

The CARES Surgicenter is busier than other centers as well. "We have a high volume, performing more than 10,000 cases a year," says Romano.

The center’s relationship with Saint Peter’s, of course, contributes to that volume. The surgicenter is co-owned by Saint Peter’s and a group of surgeons. Most other centers are owned solely by surgical groups, and those owners are the only users.

"We have close to 200 physicians on staff at the hospital who represent a wide range of specialties," says Dr. Colavita. "That gives us wider flexibility in the types of cases we can perform. The fact that non-owners choose to practice here also tells you something about the quality of our care."

In fact, more than half the procedures that take place at the center are performed by non-owners, says Timothy Hosea, M.D., of University Orthopaedic Associates, the surgicenter’s chairman of the board and a surgeon co-owner who operates there two
days a week. "We provide great services for all physicians," he says.

The surgicenter’s physical link to Saint Peter’s also allows surgeons like Dr. Hosea to bring with them specialized equipment that smaller standalone centers typically don’t have. Some orthopedic procedures, for instance, require plate-and-screw sets
to repair certain fractures. "These are very high-cost, low-volume items that a stand-alone place may not be able to purchase, but we can share them with the hospital’s operating room,"says Dr. Colavita.

That also permits the center to perform more complex procedures than the typical ASC. For example, the center can handle
younger patients that other centers can’t, some as young as one month old, because it has access to fellowship-trained
pediatric anesthesiologists.

"We can offer tremendous depth and breadth and care," Romano says, "and we are very focused on patient satisfaction and customer service. Maintaining a stable staff is a big advantage for us. The staff has worked with our surgeons for many years. They can anticipate their needs, and that improves care, reduces time under anesthesia and leads to quicker recoveries and better outcomes. It also increases the satisfaction of our surgeons-and they’re our customers just as our patients are."

As chairman of the board, Dr. Hosea not only heads the center’s monthly meetings, overseeing policies and procedures and reviewing financial reports-he and the rest of the board are also charged with thinking ahead. He predicts that in the coming years the scope of care ASCs provide will increase.

"In the future, I believe we will move more complex cases out of hospitals and into ambulatory surgery centers," he says. Saint Peter’s CARES Surgicenter also accepts many health insurance plans, which makes it a convenient, cost-effective option for many.

Dr. Hosea envisions more general surgery and certain types of hip and knee replacement and spine procedures taking place at
ASCs, as more minimally invasive procedures are developed to allow for less-invasive operations with quicker recoveries. Improvements in pain management techniques will also help move more procedures out of hospitals.

"The hospital should be for sick people," he says, "not for people getting fixed. Expanding ambulatory services is a great benefit to everyone in the community."

When that can be done with the backup-and peace of mind- provided by a contiguous hospital, so much the better.