Healthcare is a Team Effort

Why do hospital doctors and nurses ask the same questions 100 times? Find out.
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If you have ever admitted your child to the hospital, especially in an emergency situation, it can be an overwhelming, confusing and isolating experience. Patients will wonder, “Why are there so many different people coming in and out of here?” “Why am I getting asked the same question multiple times?” “Why does it take the doctor so long to come back?” and most commonly, “When can we go home?!”

In the absolute best scenario, a hospital experience (especially one that involves surgery) should feel as though you are part of a well-oiled machine. Though you cannot see all the moving parts, there is a great deal of coordination happening behind the scenes to ensure your experience is as seamless as possible.

To begin with, it may feel as though you are being seen by 20 different people, but there are actually different teams that each specialize in a specific area of care and all are required to ensure the best experience for your child. Let’s use surgery as an example:

When you arrive and check in at the hospital with your child, you are first seen by the pre-operative team, consisting of a receptionist, technicians who take your vitals, and specialized pre-operative nurses. This team ensures that you have a clear understanding of what surgery your child is to receive that day, that all of the preparations and paperwork for surgery have been done correctly and that there are no new health concerns that could alter the surgical plan.  This team is the first line in ensuring that your child receives a safe, successful operation.

Once the pre-operative team has done their job, the operative team takes over. This team consists of a circulating nurse, nurse anesthetist and anesthesiologist, scrub technician and your child’s surgeon. The circulating nurse is trained to ensure that the operating room is ready for your child, and verifies the information obtained by the pre-operative team (hence the redundant questions). The nurse anesthetist and anesthesiologist verify it is safe to proceed with anesthesia (usually involving more redundant questions), and ensure that your child’s pain, nausea and anxiety are all well-managed before, during and immediately after surgery. The scrub technician operates with your child’s surgeon, managing the instruments, and with the circulating nurse, ensures the operative environment is clean, sterile and safe for your child. The process is a well-practiced one, and has been well-coordinated with your child’s surgeon. Just prior to going back to the operating room, you should see your child’s surgeon, who discusses and confirms the information obtained by the pre-operative and operative teams, and will review the surgical plan with you. Once in the operating room, your child’s surgeon and the operating team work in a coordinated fashion to once again confirm that everything is safe to proceed. Many of these steps may seem redundant or inefficient, but they provide a system of checks, double checks and even triple checks to ensure maximum safety and a smooth operation.

When surgery is complete, your child is brought to the PACU (post-anesthesia recovery unit).  Here is another team of nurses and assistants who are specially trained in managing a child’s emergence from anesthesia and surgery.  The body’s process of emerging from anesthesia is a gradual one, marked by well-defined stages.  The PACU team knows these stages and how to spot problems early. They are in close communication with the operative team, and are the first alert that closer attention may be needed.  Stable breathing, well-managed pain and well-managed anxiety are just some of the things the PACU team is trained to monitor.

To make matters more complicated, not all of the people listed above may be employed by the same organization. For example, all the physicians at Pediatric Surgical Associates have operating credentials at both Novant Health and Carolinas Healthcare System. Depending on the procedure, the anesthesiologist might also be part of a different independent practice that is contracted by the hospital. And yes, this is why you receive bills from different providers after your hospital stay.

At face value, the whole process may seem overly complex. By the time I see families in the pre-operative area and repeat the same questions they have been asked several times already, they occasionally ask me, “I just answered those questions, don’t you know?” As I have explained performing surgery is a complex process, even for so-called routine procedures, and our highest priority is for a child’s safety. A safe and successful surgery requires multiple professionals who are specially trained for pre-operative, peri-operative and post-operative care, but who also overlap in their responsibilities to ensure no detail goes un-checked. Specialization is absolutely necessary to providing the very best medical care available, but that care is only effective if doctors, nurses, physicians assistants, primary care physicians, anesthesiologists, etc., are communicating and working as a team to ensure your child gets the best care.

Stay tuned for the upcoming post titled “It’s Complicated,” from my friend and colleague, Dr. Daniel Bambini. He will continue to de-mystify specialization and give you specific tips on what you can do to ensure your medical teams are talking to each other and including you in the conversation.

Dr. Andrew Schulman is a board-certified Pediatric Surgeon with Pediatric Surgical Associates in Charlotte. For more information on keeping your child safe and well, visit www.pedsurgical.com.