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351 - Preparing for Outpatient Surgery (Mallory Pruess, MSN, RN)
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Preparing for outpatient surgery can feel overwhelming, especially when you're balancing pre-op instructions, questions about anesthesia and concerns about recovery at home. Mallory Pruess, manager of St. Luke’s ambulatory surgery, joins the podcast to discuss what patients need to know before, during and after outpatient surgery and shares practical tips to help reduce stress and support a successful recovery.
To learn more, visit unitypoint.org.
If you have a topic you'd like Dr. Arnold to discuss with a guest on the podcast, shoot us an email at stlukescr@unitypoint.org.
This is LiveWell Talk On... preparing for outpatient surgery. I'm Dr. Dustin Arnold, Chief Medical Officer at UnityPoint Health St. Luke's Hospital. Preparing for outpatient surgery can feel overwhelming, especially when you're balancing pre-op instructions, questions about anesthesia, and concerns about recovery. Join us today is Mallory Pruess, manager of St. Luke's Ambulatory Surgery, to discuss what patients need to know before surgery, during, and after outpatient surgery. Share some practical tips and help reduce stress and provide support for successful recovery. Mallory, welcome to the podcast.
Mallory PruessThank you for having me.
Dr. ArnoldWhich you admitted prior to the podcast that you don't listen to this podcast on a regular basis. So this is your first podcast experience. It is. I can remember being a volunteer here uh in eighth grade, so 1981, 82. I was a lab runner. But like patients then would get admitted for cataract surgery and like state like a week, you know. Um my dad had open heart surgery, one of the first ones that was done here, it's like in the top 10. I think he was here like two weeks, and everything went fine. You know, so times have changed.
Mallory PruessThey have changed.
Dr. ArnoldYou know, I can remember being a resident house staff in the late mid-90s and having it was like shocking that we extubated a open heart surgery like right after surgery. Yeah. You know, it was that was like and they only spent one night in the ICU, you know, and that that was just such a change. And when it comes to outpatient surgery, you know, that's really changed dramatically too. It has. Tell us what is outpatient surgery and what what would the team that you lead, what do they do?
Mallory PruessYeah, so outpatient surgery is where a patient comes into the hospital and then is discharged the same day. Um, it's often referred to as same-day surgery or ambulatory surgery. Um, you know, advances in surgical technology, which you just referenced and pain management, make it possible for those procedures to be performed day of and then patients go home. Um, where it differ from inpatient surgery, you know, those inpatient surgeries are typically more complex and require um a little bit longer recovery period.
Dr. ArnoldYeah, the old Five West, you know, when they did Ian, earnose and throat and gyne surgery, you know, that kind of just went away. Yeah, those cases when I get admitted. What can a patient expect with uh outpatient surgery? That I mean, it if you've never had surgery before, you don't have anyone in the family that has experience with it, that can be kind of intimidating to say you're gonna have surgery and go home. So, what what what can people expect after they've had surgery and going home? And what what what's what's that like for the patient? How can you prepare them for that?
Mallory PruessYeah, so the typical process, you know, they're gonna meet with their surgeon and decide that they're having a surgery on the outpatient side. Um, they will need to make sure they're completing all of their pre-op testing. They're gonna meet with a star nurse to go over all of the pre-op instructions, the medications, and you know, the overall expectations of surgery prior to coming. And then when they come on site, they're gonna check in at the surgic care reception area. Once they're here, a surge care nurse will take them back to a surgic care room, they'll um review their medications, their history, um, they will place an IV, get in necessary lab work or any necessary things needed for their procedure. Um, they'll meet the OR nurse, they'll meet anesthesia provider, they'll meet their surgeon prior to going back to the OR. Um, once it's time for them to go back to the OR, the operating room nurse will take them back to the OR. They'll have their procedure, and then they'll end up in the recovery room or the post-anesthesia care unit. Um, they will be monitored very closely there, and when it's time for them to um get on home, they they'll go over to the phase two area. In the phase two area, they monitor them closely again.
Dr. ArnoldUm they make sure they're phase two is basically where they start.
Mallory PruessIt is where they started, yeah. Um, they'll make sure they're comfortable, their pain is managed, they're feeling, you know, up for discharge. And then once they meet all their discharge criteria, they'll the nurse will go through all the discharge instructions with their caregiver and the patient, and then they will head on home. So um, in their instructions, they'll make sure they know what to do when they're at home. Um, they'll know when they need to go for their follow-up appointments, when to call for help. Anything to set them up for success when they go home. We don't want to rush them out the door.
Dr. ArnoldYeah. And it does patient selection pay a part?
Mallory PruessI mean, yeah, you know, we want to make sure that our patients are optimized and not coming in sick and having a lot of underlying issues because that can delay or cancel, cancel cases. We want to make sure that everything is good to go prior prior to them going back to the OR.
Dr. ArnoldAnd would uh since they're getting anesthetic, I'm sure we have a policy about they can't drive themselves home, right?
Mallory PruessSo they have to have Yeah, they have to have a driver. You know, certain medications can interfere with anesthesia, and you know, certain medications also make you at risk for bleeding. So we'll we'll give patients instructions about when to hold medications, but you should never just go off your medications without someone on the healthcare team telling you to do so.
Dr. ArnoldNow, do is there any follow-up phone calls from your team?
Mallory PruessYeah, we complete follow-up phone calls on all the patients that are um leaving surgery care if they're outpatient, outpatient surgeries.
Dr. ArnoldWhat uh if you and your team had like one thing that you wanted patients to know prior to the surgery, what would you what would it be?
Mallory PruessI think a few things. I think one thing is to trust our teams. You know, we have a very structured process here, and you know, we treat every patient the same. We want to make sure that you guys are set up for success when you're coming through the door. Um, you have to have a driver if you're having any sort of sedation or anesthesia. And I think a lot of patients think, oh, this is just a minor procedure. Yeah, I don't need to have anyone with me. And that is something that it's it's I know.
Dr. ArnoldI mean, just from getting um transitioning into those conversations, that does happen where patients show up and it happens a lot. They don't have a driver, yeah.
Mallory PruessYeah, yeah.
Dr. ArnoldUm what else would you want them to know?
Mallory PruessI think you know, making sure you follow up all follow all of your pre-op and post-op instructions. You know, those instructions are there for a reason. We don't just make these up. These are guidelines that we, you know, we have to, we have to follow. So making sure you're following all of your instructions um and then elevate your concerns to your healthcare team. Like if you're hesitant, you know, tell tell your provider or tell a nurse or tell someone before you get here or when you're here day of, because you know, we don't want you to feel uncomfortable with the surgery that you're having.
Dr. ArnoldYeah, that was my next question. Is there is there a mechanism for okay, the I'm the patient and all of a sudden I don't think I can go home? What I mean, we you don't just dump them out on First Avenue, do you? No. No.
Mallory PruessUm, you know, if a patient does feel like they can't go home, we will contact um the surgeon and you know, sometimes the NSC provider to just make sure that everyone is on the same page. And, you know, if they can't go home, we'll get them headed in the right direction and on the inpatient side.
Dr. ArnoldRight. Okay, well, that's that should be reassuring for patients. Now, I think one of the things that it's hard for the lay patients and lay public to understand is sometimes surgery can be delayed because of other surgeries. Kind of walk us through that. How often does that happen?
Mallory PruessAnd you know, it really it's you can't put a number on it on how often it happens. It it's just it's part of the it's part of the surgical arena. You know, we we plan to start cases at a certain time every day, and you know, it the patient might be delayed or the room before might be delayed, the surgeon might be delayed. There's so many factors that go into it. But you know, we we again have such a structured process that we tr try our best to stay on time. And if we are delayed, we are informing families, and we, you know, do we just don't want to we want them to have a good experience even if they are delayed.
Dr. ArnoldYou know, one thing I think that patients, this is nothing by mouth, NPO. You know, why do we do that? I mean, I know why we do it, but I want to you to describe for listeners why that's important um and why the patient should have the discipline uh to do that as instructed.
Mallory PruessYeah. So, you know, we always make patients NPO, nothing by mouth, which means nothing, um, no food, no drink, anything like that, because it can cause serious complications, you know, risk for aspiration and you know, then further further complications. And, you know, just because you think that it's okay to have a small amount of cereal or something like that, you can you're can't you will get canceled. Yeah. And I I think the general public doesn't know how serious it is.
Dr. ArnoldBut I also think, don't you think it's just this just like there's a lot of days where I don't have anything to eat or drink after midnight till mid morning, you know, yeah, busy morning and don't just don't have time.
Mallory PruessYeah.
Dr. ArnoldI don't think twice about it. Right. But if you told me nothing to eat or drink after midnight, you know, I would yeah.
Mallory PruessAnd the guidelines have changed a little bit. Um, food typically is, you know, you cannot have it after midnight, but you can typically have like clear liquids up to three hours prior, so that they aren't as the guidelines aren't as strict as what they what they used to be.
Dr. ArnoldI I know, but I'm still old school. I just I think I know myself, yeah, right. I totally if there's one person I know it's me. And if you said, well, you can have, you know, some half a cup of coffee, it's gonna be a whole cup, right? You know, and it's maybe a second cup. I mean, you you give me an inch, I'm gonna take them off.
Mallory PruessYeah, you know, and you know, I think you do have to have the discipline when you are a patient coming in because it's important, you can easily get canceled. Yeah.
Dr. ArnoldThat that is yeah, and then then that has all the downhill consequences for that. Um chief medical officer over the preceding 16 years that like I don't want to say that that put me in awe was the number of team members and clinicians that touch a patient prior to during and after a surgery. Yeah. I never had any concept because I, you know, I trained internal medicine, I didn't train in the surgical world. I I mean, I I just thought the surgeon called a number, hey, I'm gonna do you know, Mallory's gallbladder today at four, and that was it, right? You know, because that's the site I would see sitting next to the surgeon. But there is so much that goes into that uh planning and it it's it's amazing. It really is.
Mallory PruessI don't think most people know how much planning goes into it. It is it's a process. Yes, and we have to have a process so patients aren't canceled when they when they arrive to surgic care.
Dr. ArnoldI mean it's all about I mean we the process is intentional, yeah. It's all for safety and quality. Yeah. What is the one thing that uh you think makes your team so successful? I mean, I think the Pac U team, I think your leadership has demonstrated that. What do you like about your team?
Mallory PruessUm I I love a lot of things about them. They they work so well together, and the patient is always at the forefront. You know, we do this for our patients. They they work together so well as teams and they care about each other as well. They don't just come to work and they're not just here to do a job. They they truly do care.
Dr. ArnoldYeah. Yeah, it it's noticeable. I mean, I I interact with them um on a limited basis, but I do interact with them. They seem to take pride in their work, and I really enjoy that.
Mallory PruessYeah. The teams in our our surgical services division, they they work so so well together. They're constantly communicating and you know, setting up the patient for success.
Dr. ArnoldDo most people in your experience because some patients are afraid of going under, etc., but they've really refined anesthesia, I think, in my career. That I mean, most people do okay and wake up fine and don't have any problems.
Mallory PruessYeah, I think I think there's a a big misconception. You know, you you think it's gonna be so bad. And when you do it once, you're like, okay, I got this. But you know, again, we have such a structured process that it I think that makes patients feel a little bit at ease.
Dr. ArnoldRight. So I'm a patient, I'm gonna have surgery. I've seen my surgeon, my surgeon has scheduled a date for the surgery. I've in addition to seeing my primary clinic physician who will perform a history and physical, yeah, which is for listeners, you if you're good, you have to have that done within 30 days of the procedure for if you're gonna receive anesthesia care. And um, that's important, you know, to just to tie that up. But okay, so I've had those things done. Yep. Now I'm gonna meet your team to start off my well, who do I meet first from your team?
Mallory PruessYeah, so you're gonna meet the star nurse first, and the star nurse, it's all um on a phone call. You don't, you're not in person with anyone. They're gonna call you and they're gonna um review all things about you as a patient, you know, your medications, your medical history, if you've been out of the country, you know, all all things pertinent to to the surgical surgical care. They're also gonna review all right, do you have someone that's gonna be with you for the next 24 hours? Do you have a driver? You know, you're gonna come at on this day at this time, just reviewing everything that they need to know prior to OR day.
Dr. ArnoldOkay.
Mallory PruessAnd then uh this when you get here. Now we're here as at the hospital in surgic care, and you're gonna come in contact with more nursing staff, um, the clinical team, a surgic care nurse, probably a surgic care tech. You know, you might um require a clip prior to surgery because you know you have hair on your chest and you're having a chest procedure done or something like that.
Dr. ArnoldUm and why is it why why don't we shave? That's important to why what? What we clip instead of shave.
Mallory PruessOh, yeah. Um, just risk for infection.
Dr. ArnoldYeah, but shaving can higher risk of infection.
Mallory PruessYes, yep. And then the PACU side, you have nurses that are specifically trained in perianest or post-anesthesia care, and they're gonna manage um pain, they're gonna manage your nausea, they're gonna manage, you know, just to make make sure you're you're sitting sitting well in the recovery area.
Dr. ArnoldAnd those are the nurses that get to hear all the silly things patients say. Yeah.
Mallory PruessWhat happens in the recovery room stays in the recovery room.
Dr. ArnoldYeah, just like Vegas. Okay, good. Oh, that's good to know.
Mallory PruessYeah.
Dr. ArnoldSo now I'm out of the pack you. I go to back to where I start.
Mallory PruessYep, in the phase two area, and then you'll be um in a private room with your family at the bedside, and then the phase two nurse will review all the instructions, make sure that you are feeling good about going home before they they take you out.
Dr. ArnoldAnd about how long does a phase two encounter?
Mallory PruessYou know, it kind of depends on what sort of procedure you have done. There's different requirements for different procedures. I would say anywhere from, you know, 45 minutes up until, you know, we sometimes have patients for three hours, just depending on how well they um recover from anesthesia. Sometimes it takes people a little bit longer to come to.
Dr. ArnoldOne one less question. I remember you started out, you went to nursing at Mount Mercy, right? Kirkwood. Kirkwood.
Mallory PruessKirkwood, yeah. I started here as a patient care tech when I was 18. On the skilled year, I remember.
Dr. ArnoldYeah, we had quite the crew back then. Um I remember that well. And then you what was your first job in nursing?
Mallory PruessUm, I worked on Four West, which used to be Ortho. Yeah. And then I stayed um in the ortho world for a few years, then I transitioned to Pac U. And then I was there for eight years.
Dr. ArnoldAnd then you came.
Mallory PruessAnd then I stepped away for a little bit, and then I transitioned into this role.
Dr. ArnoldYeah, the leadership role. Yeah, yeah. Proud of you.
Mallory PruessThanks. Happy to be here.
Dr. ArnoldWhy'd you choose nursing?
Mallory PruessYou know, I think there's so many opportunities in nursing. You know, you could work remote, you could do bedside care, you could do research. It's, you know, there's the opportunities are endless. I love to take care of patients. I I I think that taking care of them when they are the most vulnerable makes me, you know, makes me satisfied and makes me happy because I'm able to help them. Um I especially love the surgical population because it's a fast-paced environment. And, you know, you're taking care of them when they are in a very stressful situation. You can advocate for them. And, you know, we work together so well as a team to meet the needs of a patient. And then, you know, as a leader in in the um peri-anesthesia area, I get to watch my teams and the OR teams work so well together. And that, you know, that's one of the greatest pieces of it. Like you just you come up, you see it come all yeah, full circle.
Dr. ArnoldDo you think playing softball at Kirkwood uh kind of helped you with this kind of team building?
Mallory PruessI think so. You know, I think I've always had a team, a team mindset, and I that's I just I want our teams to work well together because when our teams work together, our patients are well taken care of. I think they go hand in hand.
Dr. ArnoldThat's playing college football. I mean, that's it, it's you're working with a group of people to accomplish a goal. Yeah. And uh I I yeah, I draw back upon that experience a lot, yeah. Quite honestly. Mallory, thank you again for joining me in discussing what patients need to know about preparing for outpatient surgery. Once again, this is Mallory Pruess, manager of St. Luke's ambulatory surgery. To learn more, visit uph.link/CR-Surgery. Thank you for listening to LiveWell Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcast. We're available on Apple Podcasts, Spotify, Pandora, or wherever you get your podcast. Until next time, be well.