ast-minute cancellation of surgery is an ever-present, costly problem for the patient, employers, third-party payers, and hospitals. The costs are high not only in dollars and cents, but also in trauma to the patient and disruption to the surgical unit. At Pontiac (Mich) General Hospital, the operating room policy committee has found a solution that reduces the high cost of surgical cancellations and pays big dividends in better patient relations. The hospital’s Pre-Admission Counseling and Testing (PACT) program is proof that hospital staff members can work together to help control rising health care costs and provide improved service t o the patient. At Pontiac General, the operating room policy committee has historically been an innovator of new projects and ideas. Focusing on problems affecting operation of the surgical suite, the committee attempts to find and implement workable solutions to meet the
L
PACT offers perioperative role for nurses Bessie Capsalis, RN Mary Ann Newcombe, RN
Bessie Capsalis
Mary Ann Newcombe
Bessie Capsalis, RN, is clinical director,
Operating Rooms/Recovery Room, Pontiac (Mich)General Hospital. A graduate of Hurley Medical Center in Flint, Mich, Capsalis is chairman of the Michigan Association of Operating Room Supervisors. Mary Ann Newcombe, RN, is director, Am-
bulatory Patient Services, Pontiac General Hospital. She is a graduate of St Mary’sSchool of Nursing in Wausau, Wis. AORN Journal, March 1979, V o l 2 9 , No 4
647
atients approach surgery with tests completed, questions answered, and fears alleviated.
P
needs of patient and hospital staff alike. In 1968, the committee recognized the growing problem of surgical cancellations and appointed an ad hoc committee to investigate preadmission testing as a solution. Inaugurated in 1976, Pontiac General’s initial program grew out of the committee’s findings. Today PACT is being used for all elective surgery patients at Pontiac General and is proving t o be the solution the committee was looking for. The Pre-Admission Counseling and Testing program has nine objectives. First, it must provide early and complete anesthesia and operating room nursing assessments for all surgical patients opportunity for staff physicians (residents) to perform a physical and document history prior t o the patient’s admission adequate time for the credit department to verify the patient’s insurance benefits a more controlled and orderly process of presurgical patient evaluation, thereby enhancing the quality of patient care eventual preoperative care for all patients requiring surgical intervention. PACT is also designed to prevent unnecessary surgical admissions by uncovering conditions that contraindicate surgery make the patient’s evening before
648
surgery relatively pleasant by reducing the usual number of “nightbefore” activities smooth the workload of hospital departments (radiology, admitting, laboratory), thereby increasing their productivity potential increase job satisfaction for operating room nurses by offering more patient contact. In essence, the PACT program allows the patient to approach surgery with his tests completed, his questions answered, and his fears alleviated. Most preadmission testing programs take place one or two days before surgery and only include lab tests, a possible chest x-ray, and an interview with an anesthesiologist. The Pre-Admission Testing and Counseling program starts three or four days before surgery and brings together not only laboratory staff members and an anesthesiologist, but also operating room nurses, resident physicians, and admitting clerks who work together to assure that the patient is thoroughly examined and wellprepared for admission and surgery. The program takes place in the hospital’s ambulatory clinic from 3 to 6 pm, Monday through Friday. Appointments are made to allow approximately 45 minutes for outpatients and 1%hours for inpatients. Scheduling, work flow, and patients’ charts are the responsibility of the PACT coordinator, under whose supervision the program runs
AORN Journal, March 1979, V o l 2 9 , No 4
smoothly and efficiently. During this three-hour period, an anesthesiologist evaluates each patient and prescribes an anesthetic or preoperative medication and, if necessary, additional tests. Two admitting clerks complete patients’ admission records; two laboratory technicians collect laboratory specimens; resident physicians take histories and, when necessary, do physicals; and two operating room nurses counsel patients. The x-ray department, which is adjacent t o the ambulatory clinic, keeps one room available for PACT patients, where x-rays are taken and department staff members do ECGs. All tests and examinations other than x-rays and ECGs are done in the ambulatory clinic where the presurgical patient is the focal point. With staff and equipment at hand in one location, preadmission testing and counseling can be done with a minimum of delays. During a counseling session with a patient, the OR nurse explains the surgical procedure and results that can be expected. He or she also seeks to detect and alleviate any fears the patient may have. Equally important, the nurse discusses other nonmedical concerns that may arise, such as how the hospital will be paid if the patient is not insured or, if the patient is a mother, who will care for her children while she is hospitalized. In cases like these, the patient is directed to the appropriate hospital department or staff member for assistance. The counseling sessions provide information needed for intraoperative and postoperative care. Does the patient have back problems? If so, the OR nurse can indicate on the assessment form the proper position for placing the patient on the operating table to prevent postsurgical back pain. If the patient has allergies, the OR nurse can indicate types of equipment or medication that
PACT program: 700% pa tient part icipafion In a recent Voluntary Effort report citing hospital cost containment efforts across the nation, recommendations of the Voluntary Cost Containment Committee of New Jersey were outlined. Among the New Jersey committee’sgoals for 1979 is the operation of preadmission testing programs in all New Jersey hospitals, with a minimum state aggregate of a 40% preadmissiontesting rate for all elective surgery patients covered by Blue Cross. At Pontiac General Hospital, 100% of all elective surgery patients participate in the Pre-Admission Counseling and Testing Program. should be avoided. Poor veins? False teeth? These are just a few of the considerations that become apparent during these private interviews. Unlike the group sessions many hospitals conduct, Pontiac General’s private interviews allow the patient to speak freely and, in turn, enable the nurse to develop a rapport with the patient that increases her awareness of the patient’s need for and right t o privacy. The OR nurse’s assessment includes not only intraoperative instructions but also a program for the unit nurses who will care for the patient postoperatively. Activities such as coughing, deep breathing, and turning will be indicated in the recommended nursing program. Perhaps more important, the OR nurse will be able to explain the reason for these activities to the patient and their importance in the successful outcome of surgery. In addition t o meeting the patientrelated objectives of the program, PACT makes the patient’s hospital experience more comfortable and less costly. Specifically, early testing shortens the patient’s hospital stay, which means less time away from family and job. It con-
AORN Journal, March 1979, V o l 2 9 , NO 4
649
serves the patient’s insurance benefits, permits better planning of the patient’s personal business, and speeds the admission process on the day of admission. Perhaps most important, the PACT program increases the patient’s trust and confidence in the operating room team through additional contact with team members in an unhurried, pleasant setting. The delicate relationship between patient and staff is crucially important to the outcome of surgery. The Pontiac General program takes the fear and anxiety out of surgery by creating a bond of understanding between the surgical patient and the hospital staff. PACT is Pontiac General’s first step in bringing the OR nurse out of the operating room into greater involvement with the patient. With OR nurses participating in the patient’s presurgical assessment, we are now engaged in the first phase of total perioperative care. In addition, our OR nurses are involved in postoperative care for at least 50% of our surgical patients. When that figure grows to 1OOsI0, we will truly be able to say that operating room nurses at Pontiac General have fully assumed the perioperative role. This expansion of the OR nurse’s role is perhaps the most meaningful recent development in our profession for those of us who have chosen the specialty of operating room nursing. Perioperative care not only assures the patient of better nursing service, but also enriches the nurse’s personal experience by providing the opportunity for greater involvement with the patient. For OR nurses at Pontiac General, this is the most rewarding aspect of the PACT program. The he-Admission Counseling and Testing program pays dividends for the medical staff as well. Like the patient, the physician now spends less time in the admitting process and is able t o plan
650
his office hours and other appointments if the patient’s surgery is cancelled. The program also assures that test results will be available before the critical decision-making time and permits followup evaluation and testing without costly delays in the operating room. The physician is also able to consult with others as to the disposition of the case. In addition, PACT improves communication between the patient and physician by allowing more time between preadmission testing and the actual hour of surgery. The PACT program has resulted in savings for the hospital in time and in dollars. By improving forms flow control, PACT assures that all required forms are completed promptly and, if surgery is cancelled, reduces the possibility of missed charges. FACT also results in better use of beds by eliminating unnecessary admission and allows more efficient use of the operating room by providing enough time to fill a vacant slot with another elective procedure. In addition to its time and cost savings, PACT produces a benefit especially important today-a better image. In a time when health care costs are rising and the entire health care industry is being scrutinized, PACT proves that hospitals themselves, through the cooperative efforts of their staff members, can reduce costs and improve service to the patient. Finally, by reducing the fear and confusion that usually accompany the patient’s presurgical experience, PACT yields the most important dividend-a happier patient. 0
AORN Journal, March 1979, V o l 2 9 , N o 4
L
PACT offers perioperative role for nurses Bessie Capsalis, RN Mary Ann Newcombe, RN
Bessie Capsalis
Mary Ann Newcombe
Bessie Capsalis, RN, is clinical director,
Operating Rooms/Recovery Room, Pontiac (Mich)General Hospital. A graduate of Hurley Medical Center in Flint, Mich, Capsalis is chairman of the Michigan Association of Operating Room Supervisors. Mary Ann Newcombe, RN, is director, Am-
bulatory Patient Services, Pontiac General Hospital. She is a graduate of St Mary’sSchool of Nursing in Wausau, Wis. AORN Journal, March 1979, V o l 2 9 , No 4
647
atients approach surgery with tests completed, questions answered, and fears alleviated.
P
needs of patient and hospital staff alike. In 1968, the committee recognized the growing problem of surgical cancellations and appointed an ad hoc committee to investigate preadmission testing as a solution. Inaugurated in 1976, Pontiac General’s initial program grew out of the committee’s findings. Today PACT is being used for all elective surgery patients at Pontiac General and is proving t o be the solution the committee was looking for. The Pre-Admission Counseling and Testing program has nine objectives. First, it must provide early and complete anesthesia and operating room nursing assessments for all surgical patients opportunity for staff physicians (residents) to perform a physical and document history prior t o the patient’s admission adequate time for the credit department to verify the patient’s insurance benefits a more controlled and orderly process of presurgical patient evaluation, thereby enhancing the quality of patient care eventual preoperative care for all patients requiring surgical intervention. PACT is also designed to prevent unnecessary surgical admissions by uncovering conditions that contraindicate surgery make the patient’s evening before
648
surgery relatively pleasant by reducing the usual number of “nightbefore” activities smooth the workload of hospital departments (radiology, admitting, laboratory), thereby increasing their productivity potential increase job satisfaction for operating room nurses by offering more patient contact. In essence, the PACT program allows the patient to approach surgery with his tests completed, his questions answered, and his fears alleviated. Most preadmission testing programs take place one or two days before surgery and only include lab tests, a possible chest x-ray, and an interview with an anesthesiologist. The Pre-Admission Testing and Counseling program starts three or four days before surgery and brings together not only laboratory staff members and an anesthesiologist, but also operating room nurses, resident physicians, and admitting clerks who work together to assure that the patient is thoroughly examined and wellprepared for admission and surgery. The program takes place in the hospital’s ambulatory clinic from 3 to 6 pm, Monday through Friday. Appointments are made to allow approximately 45 minutes for outpatients and 1%hours for inpatients. Scheduling, work flow, and patients’ charts are the responsibility of the PACT coordinator, under whose supervision the program runs
AORN Journal, March 1979, V o l 2 9 , No 4
smoothly and efficiently. During this three-hour period, an anesthesiologist evaluates each patient and prescribes an anesthetic or preoperative medication and, if necessary, additional tests. Two admitting clerks complete patients’ admission records; two laboratory technicians collect laboratory specimens; resident physicians take histories and, when necessary, do physicals; and two operating room nurses counsel patients. The x-ray department, which is adjacent t o the ambulatory clinic, keeps one room available for PACT patients, where x-rays are taken and department staff members do ECGs. All tests and examinations other than x-rays and ECGs are done in the ambulatory clinic where the presurgical patient is the focal point. With staff and equipment at hand in one location, preadmission testing and counseling can be done with a minimum of delays. During a counseling session with a patient, the OR nurse explains the surgical procedure and results that can be expected. He or she also seeks to detect and alleviate any fears the patient may have. Equally important, the nurse discusses other nonmedical concerns that may arise, such as how the hospital will be paid if the patient is not insured or, if the patient is a mother, who will care for her children while she is hospitalized. In cases like these, the patient is directed to the appropriate hospital department or staff member for assistance. The counseling sessions provide information needed for intraoperative and postoperative care. Does the patient have back problems? If so, the OR nurse can indicate on the assessment form the proper position for placing the patient on the operating table to prevent postsurgical back pain. If the patient has allergies, the OR nurse can indicate types of equipment or medication that
PACT program: 700% pa tient part icipafion In a recent Voluntary Effort report citing hospital cost containment efforts across the nation, recommendations of the Voluntary Cost Containment Committee of New Jersey were outlined. Among the New Jersey committee’sgoals for 1979 is the operation of preadmission testing programs in all New Jersey hospitals, with a minimum state aggregate of a 40% preadmissiontesting rate for all elective surgery patients covered by Blue Cross. At Pontiac General Hospital, 100% of all elective surgery patients participate in the Pre-Admission Counseling and Testing Program. should be avoided. Poor veins? False teeth? These are just a few of the considerations that become apparent during these private interviews. Unlike the group sessions many hospitals conduct, Pontiac General’s private interviews allow the patient to speak freely and, in turn, enable the nurse to develop a rapport with the patient that increases her awareness of the patient’s need for and right t o privacy. The OR nurse’s assessment includes not only intraoperative instructions but also a program for the unit nurses who will care for the patient postoperatively. Activities such as coughing, deep breathing, and turning will be indicated in the recommended nursing program. Perhaps more important, the OR nurse will be able to explain the reason for these activities to the patient and their importance in the successful outcome of surgery. In addition t o meeting the patientrelated objectives of the program, PACT makes the patient’s hospital experience more comfortable and less costly. Specifically, early testing shortens the patient’s hospital stay, which means less time away from family and job. It con-
AORN Journal, March 1979, V o l 2 9 , NO 4
649
serves the patient’s insurance benefits, permits better planning of the patient’s personal business, and speeds the admission process on the day of admission. Perhaps most important, the PACT program increases the patient’s trust and confidence in the operating room team through additional contact with team members in an unhurried, pleasant setting. The delicate relationship between patient and staff is crucially important to the outcome of surgery. The Pontiac General program takes the fear and anxiety out of surgery by creating a bond of understanding between the surgical patient and the hospital staff. PACT is Pontiac General’s first step in bringing the OR nurse out of the operating room into greater involvement with the patient. With OR nurses participating in the patient’s presurgical assessment, we are now engaged in the first phase of total perioperative care. In addition, our OR nurses are involved in postoperative care for at least 50% of our surgical patients. When that figure grows to 1OOsI0, we will truly be able to say that operating room nurses at Pontiac General have fully assumed the perioperative role. This expansion of the OR nurse’s role is perhaps the most meaningful recent development in our profession for those of us who have chosen the specialty of operating room nursing. Perioperative care not only assures the patient of better nursing service, but also enriches the nurse’s personal experience by providing the opportunity for greater involvement with the patient. For OR nurses at Pontiac General, this is the most rewarding aspect of the PACT program. The he-Admission Counseling and Testing program pays dividends for the medical staff as well. Like the patient, the physician now spends less time in the admitting process and is able t o plan
650
his office hours and other appointments if the patient’s surgery is cancelled. The program also assures that test results will be available before the critical decision-making time and permits followup evaluation and testing without costly delays in the operating room. The physician is also able to consult with others as to the disposition of the case. In addition, PACT improves communication between the patient and physician by allowing more time between preadmission testing and the actual hour of surgery. The PACT program has resulted in savings for the hospital in time and in dollars. By improving forms flow control, PACT assures that all required forms are completed promptly and, if surgery is cancelled, reduces the possibility of missed charges. FACT also results in better use of beds by eliminating unnecessary admission and allows more efficient use of the operating room by providing enough time to fill a vacant slot with another elective procedure. In addition to its time and cost savings, PACT produces a benefit especially important today-a better image. In a time when health care costs are rising and the entire health care industry is being scrutinized, PACT proves that hospitals themselves, through the cooperative efforts of their staff members, can reduce costs and improve service to the patient. Finally, by reducing the fear and confusion that usually accompany the patient’s presurgical experience, PACT yields the most important dividend-a happier patient. 0
AORN Journal, March 1979, V o l 2 9 , N o 4
