Ambulatory Care

 

Adult ambulatory surgical care is provided in the OHSU DayStay facilities (consisting of the Preadmission Testing Clinic, operating rooms, Gastroenterology Lab, Post Anesthesia Care Unit, and Short Stay Unit) and at OHSU Casey Eye Institute. DayStay is attached to the main hospital but enjoys significant autonomy and is striving to create a patient/customer friendly atmosphere more characteristic of a stand-alone surgical center than a Level 1 Trauma Center. We focus on quality of surgical, anesthesia, and nursing care, rapid turn around time, and minimum waiting room time. DayStay is highly integrated with our nursing staff multi-tasking across the facility.

Adult Day Stay Surgery
Over 3,500 procedures were performed in 7 DayStay operating rooms this past year. Currently two operating rooms feature most advanced imaging capacity [Minimally Invasive Surgery (MIS) Suites]. We are planning on upgrading several more rooms to the MIS standard in the near future. The numbers of ambulatory procedures are expected to grow at the current rate of 10-15% annually.

Ambulatory anesthesia in DayStay embraces the SAFE (Short Acting, Fast Emergence) concept. Short acting anesthetic agents, BIS monitoring and use of regional anesthesia techniques facilitates bypassing of Phase 1 recovery (Fast Track concept) or significant decrease of Phase 1 recovery time.

The Short Stay Unit integrates post surgical and post procedure care for patients with organ transplants requiring multiple biopsies and patients recovering from endoscopic procedures.
Requirements for rapid turn over times in the ambulatory setting necessitate extensive use of modern information technology. Currently, the pre-admission evaluation process is supported by a network based software application capable of accessing all information available on any patient across the entire OHSU Healthcare System. Results of other tests and studies are now also available over the network.

DayStay is outcomes driven. Our recovery room nurses call all patients on the postoperative day 1 and patient responses are entered into database according to protocol. We also perform continuous survey of patient satisfaction using conventional questionnaire tools.

 A number of clinical research projects are being conducted in the outpatient surgery suites.  Drs. Zornow and Kirsch have recently initiated a phase III trial of a novel reversal agent for non-depolarizing neuromuscular blocking agents.  This agent has the potential to quickly reverse profound levels of muscle relaxation in surgical patients with a minimum of side effects.  Additional studies in progress include the use of continuous infusions of local anesthetics for postoperative pain control in ambulatory patients having upper or lower extremity orthopedic procedures.

The GI Lab performs between 20 and 30 procedures per day. Our most recent addition is an advanced Endoscopic Ultrasound System for diagnosis of primarily gastrointestinal malignancies. We have recently established anesthesia supported deep sedation/general anesthesia service for all ERCP procedures.