Just shy of 7 a.m. the surgical tower at Southeast Alabama Medical Center is a flurry of activity.
More than 100 staff nurses, technicians and other support staff don sterile scrubs, their daily uniform for work in the Perioperative Department. Mentally, they are focused and prepared for a busy day of assisting 23 highly-skilled surgeons who will occupy one or more of SAMC's 23 operating rooms.
As it turns out, this day will be another record day in surgery. Volume is up more than 50 percent over a typical day.
"We've worked to allow our physicians to schedule more early cases, which has increased our volume," said Chris Holland, RN, CNOR, RNFA, manager of surgery. "We've watched the schedule fill up for several days. We are at capacity." As a footnote, Holland said 60 to 75 percent of all surgeries are elective.
The surgeons operating on this particularly busy May morning represent all kinds of specialties, from orthopedic to heart, urology to brain. Time spent in surgery might be 10 minutes or it might be 10 hours, depending on the procedure and the complexity of the case.
They are operating in a Joint Commission accredited facility, guaranteeing the highest standard of care is provided and rigorous protocols are followed for patient safety.
On this day, patients ages 2 to 82 enter the hospital from Outpatient Registration and are escorted to Same-Day Surgery where they are prepared or "prepped" for a surgical procedure.
Part of the prepping for surgery includes receiving sedation if they are a little bit anxious, and an IV may be started. The patient's condition is assessed, history is reviewed, the surgery site is marked and everything readied for the operation.
At this point, family members are escorted to the waiting area where they can view a monitor that keeps them informed of every stage of the operation. Telephone calls from physicians and nursing staff are patched through to family members anxiously awaiting word.
"Everything is fine," the surgeon says. Spouses and parents smile and thank the doctor.
Surgical procedures begin between 7:15 and 7:30 a.m. each day. Scheduling is important as operating rooms must be cleaned and disinfected after each procedure and stocked with the proper instruments for the next procedure. Staff is shifted from one room to the next, as are physicians.
Andrew Bullington, MD, of Southern Bone & Joint goes from an ACL knee repair in operating room 14 to a broken clavicle in 13. Another team awaits 14.
Like all their coworkers behind the O.R. doors, schedule coordinators Patsy McGowan and Janie Williamson are awash in blue. Surgery is a blue world with high beam concentrated lights that appear blue and blue drapes for sterilized instruments and high-tech equipment. Some supplies are packaged in blue. Even the rooms are blue.
Just outside the 18 primary operating rooms, McGowan and Williamson, both registered nurses and long-time employees, maintain multiple patient tracking boards. Like air traffic controllers, they follow patients, assign operating rooms, help physicians and coordinate staff and anesthesiologists.
Atop these boards, located in a high-traffic corridor, is a video feed of every operating room. This allows staff to know where everyone is and to see what everyone is doing.
There is constant movement.
"The schedulers keep the flow going," Holland said.
Schedulers are in their zone.
"It looks like Dr. (O.H. 'Skip') Chitwood (of Southern Bone & Joint) is finishing up in 12," says McGowan.
Another nurse walks by and alters the board. "We're done in four," she says.
A surgery tech makes her way into seven, where she thoroughly cleans, disinfects and sterilizes all equipment. It is a key element to patient safety. Trays containing up to 50 instruments are removed for decontamination and sterilization.
Telephones ring. One patient is late arriving. Two more cases are added to the schedule after physicians' morning rounds revealed surgery is needed.
Two, no three, surgeries come in from the Emergency Department.
One is an aneurism; a craniotomy is needed. A busy day just got busier.
"I've got to find a room for Dr. (Praful) Patel (of Women's Medical Center)," Williamson says.
McGowan nods. "We don't want a surgeon to have to wait," she explains. "And we hate for a patient to have to wait. They're all our customers."
Robert Schuyler, MD, of Urological Associates of Dothan walks through, headed to O.R. number eight for a robotics prostatectomy.
Inside Operating Room 14, Dr. Bullington is back with another knee.
Prior to beginning any surgery, certain protocols are followed. As music plays on an Ipad, PA Kent Odom, scrub techs and anesthetists gather inside a black circle painted on the floor, designating a completely sterile area. An RN circulator mans a monitor just outside this area.
The patient has already been "marked" in receiving. A physician or a designated team member identifies the surgical area and the physician signs it. Once in the O.R., staff has a "time out" where the same information is reviewed with the patient.
Anesthesia works in tandem with the O.R. team. A surgical check list is reviewed after Bullington arrives. A risk assessment is taken, allergies and medications reviewed, and soon the procedure is underway.
All but two operating rooms are in use. Holland said two rooms typically are kept empty for either an emergency C-Section or heart procedure. Three C-Section rooms are located in the Family Birth Center and two endovascular suites are adjacent to the primary O.R. These designated suites are convertible for various procedures required for complex heart cases.
If schedulers are air traffic controllers, Holland sees his job as more like a floater. He has worked behind the O.R. doors for 11 years, handles the day-to-day operations and oversees a staff of more than 100.
"I make contact with surgeons and see to their needs. If there is a decision to be made about who gets a room or what comes next, I make it," Holland said. "Sometimes it comes down to who's ready and who has the most cases."
Perioperative Services at SAMC consists of Surgery, Same-Day Surgery, Pre-Surgical Testing and the Post Anesthesia Care Unit (PACU).
"Periop has many moving, complex parts," Holland said as he makes his way down the sterile corridor where supplies are kept. "All the parts work together and they complement each other."
After surgery, 95 percent of patients go to PACU for recovery. Heart patients go to the Critical Care Unit on the fourth floor and C-Section mothers go to a room in the Family Birth Center.
Patients having less invasive procedures go to Same-Day Surgery holding for an assessment and vital signs monitoring; they are usually sent home within an hour after the procedure. For those patients being admitted, they advance from PACU and go straight to a bed on the specialized nursing floor.
Hours pass with a constant flow of O.R. patients. The surgical load dwindles as the day wears on. Team members see light at the end of the tunnel, knowing they will be back the next morning, just after sunrise, to do it all again.
"Caring for patients, knowing that we are helping somebody – that's why we're here," Holland said. "Helping our surgeons take care of our patients is an awesome responsibility and a privilege. We aim to please."
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More than 100 board-certified physicians in various
specialties utilize the 23 operating rooms at SAMC.
Types of surgery performed:
• Ear, Nose & Throat • General* • OBGYN
• Orthopedic • Neurosurgery • Eye
• Cardiology • Vascular • Plastic
* General surgery includes gall bladder, thyroid, abdomen and colon.
Screening Program Receives Grant From Avon
The Avon Breast Health Outreach Program has awarded a $45,000 one year grant to Southeast Alabama Medical Center Foundation in support of the Southeast Regional Health Screening Program (SRHSP) to increase awareness of the life saving benefits of early detection of breast cancer. It is the fifth year that the program has received funding from the Avon Foundation for Women to support its work on this important health issue, and in recognition of the program's excellence.
Southeast Regional Health Screening Program at SAMC educates Wiregrass area women and refers them to low cost or free mammograms and clinical breast exams in their own communities through a state of the art 40 ft. mobile medical unit. The vital program will also provide nurse navigation service to women diagnosed with breast cancer through SRHSP.
Since September 2007, the SRHSP at SAMC has reached more than 5,000 women with information about the importance of early detection of breast cancer. In the past two years alone, the program has performed 2972 mammograms and clinical breast exams, 70 of which had abnormal results.
The Avon Breast Health Outreach Program awarded a $45,000 one year grant to the SAMC Foundation in support of the Southeast Regional Health Screening Program. The money will be used to increase awareness of the lifesaving benefits of early detection of breast cancer. Pictured left to right are: Scott Griffin, director of the Southeast Cancer Center; Jarrod B. Adkison, M.D., radiation oncologist at Southeast Cancer Center; Steven Stokes, M.D., radiation oncologist and medical director at Southeast Cancer Center; Debra Stringer, program coordinator, Southeast Regional Health Screening Program; and Valerie Barnes, executive director of the SAMC Foundation.
Breast cancer is the most common form of cancer in women in the United States, and the leading single cause of death overall in women between the ages of 40 and 55. According to the American Cancer Society, 288 new cases of breast cancer will be detected in Alabama this year and 54 lives will be lost. Nationwide, there is a new diagnosis every three minutes and a death from breast cancer every 14 minutes. While advances have been made in prevention, diagnosis, treatment and cure, early detection still affords the best opportunity for successful treatment. Programs such as the Southeast Regional Health Screening Program help ensure that all women have access to early detection information and options, even poor and medically underserved women.
"We are proud that the Avon Foundation for Women shares our mission and has chosen to support our program. With these funds we will continue to provide the highest quality of breast health education and screening throughout the Wiregrass," stated Dr. Steven H. Stokes, medical director for the SRHSP.
Since 1993, the Avon Foundation has awarded more than 1,550 grants to community based breast health programs across the United States, including the SRHSP at SAMC. These programs are dedicated to educating underserved women about breast cancer and linking them to early detection screening services.
The Avon Foundation for Women and Breast Cancer Crusade
The Avon Foundation for Women, an accredited 501(c)(3) public charity, was founded in 1955 to improve the lives of women and today is the world's largest corporate-affiliated philanthropy focused on issues that matter most to women. The Avon Breast Cancer Crusade, which observes its 20th anniversary in 2012, has placed Avon at the forefront of the fight against breast cancer; today, Avon is the leading corporate supporter of the cause globally. In the 20 years since the Crusade's launch, Avon breast cancer programs in 58 countries have donated more than $740 million for research and advancing access to care, regardless of a person's ability to pay. Avon raises funds for the Crusade through the sale of Avon "Pink Ribbon" products, and through events and walks, such as the U.S. Avon Walk for Breast Cancer series, which is the Foundation's largest fund-raising source.
The Avon Breast Health Outreach Program
The Avon Breast Health Outreach Program is administered by Cicatelli Associates Inc. to support community-based, non-profit breast health programs across the country. The Fund's National Advisory Board selected Southeast Regional Health Screening Program at Southeast Alabama Medical Center as one of 120 new grant recipients nationwide in the 2012 cycle of Avon Breast Health Outreach Program grants. These organizations were chosen based on their ability to effectively reach women, particularly minority, low-income, and older women, who are often medically underserved.
For more Information
For more information on the Southeast Regional Health Screening Program at SAMC, please call Debra Stringer at 334-793-8080. For more information about breast cancer, contact the American Cancer Society at 1-800-ACS-2345 or www.cancer.org, or the National Cancer Institute at 1-800-4-CANCER or www.cancer.gov.
To learn more about the Avon Foundation for Women, call 1-866-505-AVON or visit www.avonfoundation.org, where you can access free printable Breast Health Resource Guides in English and Spanish. For information or to register or support the Avon Walk for Breast Cancer events, visit www.avonwalk.org or call 1-888-540-WALK.
Twice last year little George Anthony Santiago tried to enter this world prematurely, giving a young soldier and his wife quite a scare.
First in February 2012, at just 23 weeks, and again in April at 32 weeks, Amcy Santiago went into pre-mature labor. Her physician, Ellen Phillips MD, discovered the probable cause was a small mass or fibroid.
While uterine fibroids are typically non-cancerous and pose little to no danger, a small percentage of women can miscarry or go into preterm labor with a fibroid, especially if the mass grows.
Dr. Phillips, a partner with Guy Middleton, MD and Thomas W.C. Robinson, MD at Dothan OBGYN, ordered bed rest. It was a remedy that greatly altered the lives of Amcy and her husband Jorge who came to Fort Rucker from Puerto Rico.
"The fibroid was getting bigger and there was concern it was going to be an issue," Jorge said. "The doctor told us she was high risk. If she delivered too early, there was a good chance the baby would probably not make it. If he did, he would still have issues."
This was the not the news Jorge wanted to hear.
As a "Soldier of the Year" in the Puerto Rican National Guard, Jorge was selected for training in the United States. He began his Basic Officer Course studies last year and completed the Warrant Officer Course in January, earning the class Leadership Award. He is training to be a helicopter pilot and will return to Puerto Rico next year.
"There is a lot of pressure for me to complete this on time. It is expensive to produce a pilot and I felt a great responsibility."
Because of her condition, Amcy was to do no household activities such as cooking or cleaning. Bed rest meant bed rest.
Jorge's instructor understood the physician's directive.
"He came to me and said to take time off and take care of my family," Jorge said. "The major talked to my commander. The military is very pro-family. Everyone said they would work with me."
So Jorge's schedule changed to reporting each morning for daily exercises, checking in with his commander for additional tasks, then going home and being available if needed.
"For three months," Amcy said, "that's what it has been like."
The initial goal was to get George Anthony to 32 weeks so he could have a chance at a normal life. That goal got pushed up to 35 weeks. The couple celebrated when 38 weeks came and went.
"We are so grateful for Dr. Phillips. We travel 45 minutes to see her. She has always, always been there for us. Throughout this whole thing we have felt like God put people in our paths to help. We are very grateful," Jorge said.
Amcy delivered a healthy 7-pound, 9-ounce son at 5:07 p.m. on Thursday, June 7 2012, six days before her June 13 due date.
"I feel thankful to God," Jorge said. "Dr. Phillips was not on call but she made a choice to come and deliver the baby. She has great dedication to her patients.
"We've also had such great support from our family and friends at Fort Rucker and in the unit back in Puerto Rico. FaceBook is blowing up with well wishes."
Dr. Phillips shares a special bond with military moms. Her husband, Jay, a Dothan city firefighter, was on his second deployment, to Kosovo with the U.S. Army National Guard, when the couple's youngest son, Jeff, required emergency open heart surgery.
At the time, Dr. Phillips was a third-year resident working long hours at the Medical College of Georgia in Augusta. "For all practical purposes, I was a single parent with three kids. Jay was Special Forces. He had to go."
Dr. Phillips' son was diagnosed with a heart condition at nine weeks old and went into surgery with 50-50 odds of surviving. Surgeons successfully repaired her infant son's heart.
"That experience made me more empathetic," Dr. Phillips said. "It allows me to say 'I've been there,' to the patient whose baby has a heart defect and to the military families who can sometimes feel isolated. I know the sacrifices made by military families."
At 26, Jorge has more than the typical military father's responsibility. He is also the guardian and father-figure to his three younger siblings, who were orphaned in 2010 with the death of their father. Jorge and Amcy are raising two boys, Jesus, 15, and Gabriel, 11, and a girl, Marangely, 12.
They smile as they realize their home will soon be filled with teenagers and a toddler.
"During the pregnancy, the kids helped, but it is not fair to them to have to do this. They are children. They should have a childhood. It's what we want for
George Anthony as well."
As they reflect on the last few months, Jorge and Amcy breathe a sigh of relief. "It was all worth it," Jorge said. "Everything we had to do. I look back and think, this is our baby's war story. This is how he came into the world. Challenges can be overcome. We are so blessed."
Dothan OBGYN is located on the fourth floor of the Doctors Building inside SAMC. For an appointment with Drs. Phillips, Middleton or Robinson or to see nurse practitioner Jennifer Muraski, call 334-673-3633.
To arrange for a tour of the Family Birth Center, please call 334-793-8956. Tours are available on the first Saturday of every month.