orm_february-2024 - 23

Leadership
An adaptable force
As a Level 1B complex facility, Ann
Arbor VA treats high volumes of patients
requiring services ranging from cataract
treatment to basic skin cancer removals
to riskier open heart and minimally invasive
robotic procedures. The hospital
also offers bariatrics and gynecology
programs.
Each subspecialty has a lead team.
General surgery, for example, relies on
a nurse and a surgical tech as the go-to
subject matter experts. " They maintain
the preference cards for the surgeons,
and if any special instruments are requested
or something needs to be purchased,
[they] make sure we have what
we need, " Ringlein explains.
However, nurses and techs at Ann
Arbor VA are rarely limited to a single
discipline. For example, a specialized
cardiac surgery team may take care
of cardiac cases, but the nurses and
techs are required to know all the different
services and subspecialties.
All VA clinics employ an RN as the
surgical care coordinator. If a veteran
seen in the clinic needs surgery, then
this nurse usually handles all requests,
working with the provider and the surgeon
to determine whether the patient
needs additional tests.
Ann Arbor's anesthesia department
also has a preop clinic for patients who
need additional clearances for health
comorbidities. After surgery and initial
follow-ups, patients go back to primary
care, Ringlein says.
Staff always look at the surgery
schedule 2 to 3 days in advance to
make sure the OR has all the required
instrumentation and disposable items
for upcoming surgeries. " This helps us
mitigate day-of-surgery cancellations
due to equipment issues, " she says.
Infection control, quality
management
Like most hospitals, every Navy hospital
has infection control and quality management
departments. Facilities with
www.ormanager.com
smaller infection control departments
typically rely heavily on OR nurses " because
we are the subject matter experts, "
Sherrill says.
Navy facilities report quality metrics
to the American College of Surgeons'
National Surgical Quality Improvement
Program for both adults and pediatrics.
Sherrill is stationed at a Level 2
trauma center that reports trauma registry
data to the American College of
Surgeons and the Commonwealth of
Virginia. It also works with the Leapfrog
Group, a nonprofit watchdog that promotes
transparency in healthcare.
Daily within her own MOR, Sherrill
adds, " we track on-time starts, OR utilization,
patient safety reports, traumas,
cancellations, add-ons, and bed management
for the following day's cases. "
All of these metrics are then reported
either internally or
Health Agency.
to the Defense
As is the case for other hospitals, VA
and military ORs have specific temperature
and humidity requirements. At Ann
Arbor, electronic readers monitor each
OR, and automatic email alerts notify
personnel if any rooms are outside of
the required parameters. " If that happens,
then we shut the room down, figure
out what the problem is, and have
the room cleaned again, " Ringlein says.
When the unexpected happens
Indicative of the nature of the work in
the surgical department, for Ringlein
and her team, helping patients and
sometimes saving their lives is part of
Disclosure: Sherrill's views expressed
in this publication are hers and do not
necessarily reflect the official policy
or position of the Department of the
Navy, the Department of Defense,
or the United States Government.
Similarly, Ringlein's views and experiences
are her own, and not the official
policy or position of VA facilities.
the daily job. Ann Arbor has an on-call
team available for emergency surgical
procedures 24/7, including holidays
and weekends. An unexpected problem,
such as bleeding, will always call for a
quick reaction from the OR team.
If a patient's anatomy does not allow
for a laparoscopic or robotic minimally
invasive approach, Ringlein's team
knows how to pivot to an open procedure
and do what needs to be done to
care for the patient safely in order to
mitigate negative outcomes. " I
that
those are the cases that
think
really
stand out for me and the rest of our
team here, " she says. ORM
-Jennifer Lubell is a freelance medical
and health policy writer based in
Rockville, Maryland.
References
Budget in brief: FY 2024 budget submission.
Department of Veterans
Affairs. March 2023.
VA News. Majority of VA health care
facilities receive 4 or 5 stars in
CMS quality ratings, outperforming
non-VA facilities. US Department of
Veterans Affairs. July 26, 2023.
TeamSTEPPS Updates. Agency for
Healthcare Research and Quality.
nd.
Resources
Mathias J M. Tracking orientation,
competencies, and skillsets in the
OR-Military style. OR Manager.
2022;38(5):14-16.
London S. OR efficiency, staff satisfaction
rise with TeamSTEPPS. OR
Manager. 2017;33(9):25-27.
Topic: TeamSTEPPS. Agency for Healthcare
Research and Quality. nd.
Veterans Health Administration. VHA
Invasive Procedure Complexity for
Surgical Programs. Department of
Veterans Affairs. December 13,
2023.
OR Manager | February 2024 23
https://www.va.gov/budget/docs/summary/fy2024-va-budget-in-brief.pdf https://news.va.gov/press-room/va-outperform-non-va-facilities-cms-ratings/ http://www.ahrq.gov/teamstepps-program/updated/index.html https://www.ormanager.com/tracking-orientation-competencies-and-skillsets-in-the-or-military-style/ https://www.ormanager.com/or-efficiency-staff-satisfaction-rise-with-teamstepps/ https://www.ahrq.gov/topics/teamstepps.html#:~:text=TeamSTEPPS%C2%AE%20is%20a%20teamwork,Treatment%20to%20Keep%20Patients%20Safe https://www.va.gov/health/surgery/ http://www.ormanager.com

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