Day surgery: Behind the scenes
More than 10,000 day surgeries are performed at London Health Sciences Centre (LHSC) each year. From pre-admission to discharge, there are many different clerical and medical professionals to meet along the way who play a critical role to ensure that the experience runs smoothly.
“There are numerous complex steps involved from the time a patient is referred to LHSC through to their recovery after surgery,” says Dr. Brent Lanting, orthopaedic surgeon. “Our goal is to provide patients with the highest standard of care at each step of this journey. As a surgeon, it is such a joy to work with a compassionate and professional team in support of our patients.”
We followed a patient’s journey through day surgery to see the steps staff and physicians take to ensure a positive and comfortable patient experience. For this particular case, Dr. Lanting and the surgical team performed a total hip arthroplasty using an anterior approach for Gord Jones of Thorndale, Ontario. This approach to hip replacement surgery, adopted by Dr. Lanting and fellow LHSC orthopaedic surgeon, Dr. James Howard, uses one small incision on the front of the hip, reducing the muscle and tissue trauma which occurs in traditional surgery. This approach to hip replacement surgery is performed as an outpatient procedure, meaning no overnight stay is required.
The day starts early with a visit to the Pre-admission Clinic, where Gord checks in two hours prior to his surgery start time. Registration clerks check that his personal information and emergency contact information is correct.
Gord proceeds to the Day Surgery Unit where Registered Nurse Karen Cameron checks his temperature, respiratory rate, pulse and blood pressure, and starts an intravenous (IV) line. Gord is initially given fluid through this IV. He will eventually be given anesthesia, pain medications and antibiotics to minimize his chance of infection. He will also have anti-nausea medication administered to mitigate potential side effects from anesthesia.
Anesthesiologist Dr. Kevin Armstrong meets with Gord and his wife Pat to discuss the type of anesthesia that will be administered, including potential risks and side effects. Dr. Armstrong will be present throughout the surgery to monitor Gord’s vitals and administer medications.
Dr. Brent Lanting meets with Gord and Pat to discuss the procedure and answer any questions or concerns they have.
The Operating Room (OR) nurse arrives in the Day Surgery Unit to check Gord’s pre-operative forms. She transports him to the OR, located down the hall. Pat returns to the waiting area and is able to track on a screen Gord’s location throughout the morning using his patient identification number.
Dr. Lanting and the surgical team which includes residents, medical students, X-ray technicians and nurses meet Gord in the OR and prepare him for surgery. Dr. Armstrong administers anesthesia and the surgery begins.
Throughout the procedure, approximately six X-rays are captured, and each staff member and physician present in the OR must wear personal protective equipment. X-ray imaging helps the surgical team to determine the correct placement of the artificial hip joint. This is integral during a minimally invasive procedure since the incision is small and limits what the team is able to see themselves.
The position of Gord’s legs are controlled and adjusted throughout the procedure at the advisement of Dr. Lanting. Proper positioning enables the surgical team to safely and correctly perform the procedure.
The scrub nurse works in partnership with the surgeons, handling surgical instruments throughout the procedure. Prior to being sent to the OR, all surgical instruments are cleaned and sanitized by the Medical Device Reprocessing Department.
Circulatory nurses are responsible for completing charting throughout the procedure and opening surgical instrument trays.
After 90 minutes, the surgery is complete and Gord is wheeled in to the Post-Anesthesia Care Unit (PACU). PACU nurses check his vitals, monitor pain levels and use warm blankets to ensure he’s comfortable. Time spent in the PACU varies according to how long it takes for each patient to regain consciousness and whether they experience side effects from the anesthesia.
After just 45 minutes in the PACU, Gord is transported back to the Day Surgery Unit where a nurse continues to monitor his vitals. Pat is called in from the waiting area to join her husband.
Physiotherapist Tristan Arsenault-Mehta arrives in the Day Surgery Unit to help Gord take his first steps with a walker, and climb a few stairs with crutches. Since Gord does this successfully, he is cleared for discharge around 12:30 pm.
Gord will have follow-up appointments with Dr. Lanting and his physiotherapist to guide him through recovery. Gord learned exercises prior to having surgery, which will help ease him back into activities over the next several months. “From the time I had my first preoperative appointment to the day of the surgery, the entire team at LHSC was fantastic,” Gord says. “They made me feel prepared and put me at ease throughout the process. It was a great feeling to walk into my house with a new hip the same day I had surgery."