Nursing Excellence: Perioperative Care

Pre-Anesthesia Testing

Coordinator: Melissa Quick BSN, RN, RN-BC
Location: Medical Office Building A, Suite 140

The Pre-Anesthesia Testing Unit (PAT) is for patients having surgery or other interventional procedures requiring anesthesia. There are 7 PAT rooms for nursing interview and assessment, anesthesia assessment, lab, EKG, X-ray and/or any other intervention needed to prepare the patient for their procedure.

The PAT patient is registered in main registration and interviewed by a pharmacy technician, nurse and an anesthesiologist if necessary. A complete systems assessment and tests are performed to make sure the patient has a successful recovery.

The hours of operation are 8 a.m.-4:30 p.m. Monday through Friday. The unit is staffed with 25 team members.

Preoperative Unit

Nurse Manager – Tabbetha Rose MSN, RN
Location: 2 North

The Pre-Operative Unit (POU) is open 24/7 year-round. In-house patients and morning admissions are prepared here for their surgical procedures. POU nurses insert IV lines while the anesthesia team inserts invasive monitoring lines and epidural catheters for post-op pain management, when indicated. Preoperative lab work, EKG or chest X-ray may be ordered. The patient will be assessed by the attending nursing team, as well as the anesthesia team.

The POU is staffed with detail-oriented registered nurses trained to handle critical situations that may occur before surgery. This fast-paced unit is a 14-bed area with curtain dividers, so each patient may be observed as their surgical preparation begins with anesthetic medications. The family waits in the Inpatient Surgery Lounge. This area strives to be a quiet atmosphere that respects the privacy of each patient so he or she can relax before going to surgery.

Ambulatory Surgery Unit

Nurse Manager – Tabbetha Rose MSN, RN
Location: 2 North

The Ambulatory Surgery Unit (ASU) is a 23-bed unit adjacent to the main operating suite on 2 North. It is open Monday through Friday, 6 a.m.-4 p.m.

Preoperative care is provided by registered nurses for patients undergoing surgical procedures that do not require overnight hospital stay. The patient is admitted to the ASU, sent to the operating room, sent to the Post-Anesthesia Care Unit for recovery, and then sent to Phase II Recovery for discharge home. The family waits in the Outpatient Surgery Lounge.

Outpatient surgery is the way of the future for most patients because they can return to work in days rather than weeks or months. As technology improves, the surgical procedures will become less invasive, which means quicker recovery for patients.

Operating Room

Manager: Catie Millsaps, MSN, RN, CNOR
Location: 2 East

The operating room consists of 36 regularly scheduled suites for surgery Monday-Friday. On Saturday, there are three urgent rooms and one trauma room, and, on Sunday, there are two urgent suites and one trauma suite. Average monthly caseload is 1,550 cases, and the weekend monthly average is 25 to 30.

Perioperative nurses work closely with surgeons and anesthesiologists. To practice perioperative nursing to its fullest extent means the nurse assesses and teaches each patient preoperatively; plans, implements and documents perioperative care; and evaluates postoperatively. This definition makes clear that patient advocacy management of the environment, overall comprehensive planning of care and preparation for the surgical procedure belong to nursing. We employ approximately 69 RNs and 52 surgical technologists for a 24/7 schedule.

The main OR is open for elective surgical schedule Monday-Friday 7:30 a.m.-6 p.m. and it is closed on holidays except for emergency cases.

The registered nurse must have completed a perioperative-based OR program or equivalent experience in an operating room. We provide a yearly class for training for nurses new to the OR. The program takes up to nine months of classroom and clinical rotations. The surgical technologist must have completed a program from an accredited surgical school, which usually takes one year to complete. This program also is classroom with clinical rotations.

The RN supervises the room and is responsible for the patient care during the surgery along with the surgeon and anesthesia team. The surgical technologist is responsible for passing instruments and supplies to the surgeon during procedures.

We are a Level I Trauma Center and the operating-room team members pride themselves in serving the community in emergent and non-emergent situations. We strive to give very good care to all surgical patients and return them to their previous lifestyle.

Post-Anesthesia Care Unit (PACU)

Nurse Manager: Lexie Needham, BSN, RN
Location: 2 East

The Post-Anesthesia Care Unit (PACU) facilitates awakening or recovery of patients from anesthesia. These units were created to closely observe post-operative patients and prevent unnecessary mortality and morbidity immediately following general anesthesia.

The PACU is staffed 24/7 year-round. The PACU now is comprised of two united yet distinct units. Between the two units we have increased our capacity to care for 34 patients at one time.

Each bed is equipped with cardiac and invasive monitoring. The unit nursing team includes many people with more than 15 years’ experience in the field. This diverse group comes from emergency, intensive care and medical-surgical nursing backgrounds. Between the two units, 75 to 95 patients are treated during a normal workday schedule. Acuity ranges from a simple procedure requiring local anesthesia and sedation to a complex major trauma patient requiring general anesthesia and one-on-one care.

Nurse Anesthesia

Chief CRNA – Jim Jones, MSN, APRN, CRNA
Location: 2 North

For more than 100 years, nurse anesthetists have been providing safe, high-quality anesthesia care to surgical patients of all ages, in every setting in which anesthesia is delivered and for every type of surgical procedure imaginable.

At the medical center, anesthesia care is provided using a team approach. The anesthesia care team consists of an anesthesiologist, a certified registered nurse anesthetist (CRNA), an anesthesia resident or a student nurse anesthetist. Before surgery, patients are asked to visit the anesthesia preop clinic. At this time, a medical history is taken by a nurse and/or doctor, lab work may be drawn and special tests are ordered. A discussion with the patient takes place at this time about the type of anesthesia suitable for him and the type of surgery he is having done.

On the day of surgery, the patient meets with the anesthesiologist and nurse anesthetist or resident who will participate in his case. Again, a medical history is obtained, and the plan of anesthesia care finalized. An anesthesiologist is present as the patient goes to sleep, intermittently during the case and then as the patient wakes up. An anesthesiologist is always immediately available if needed. The nurse anesthetist or resident assigned to the case remains with the patient throughout the entire case.

Medications are given pre-operatively to allay anxiety. Drugs also are given during anesthesia to control pain and to prevent postoperative nausea and vomiting. Patients are taken to the recovery room after surgery. The recovery room stay varies according to the type of surgery, type of anesthesia administered and the patient’s health status.

Perfusion Services

Manager: Keith Atwell
Location: 4 North

The Perfusion Department at the University of Tennessee Medical Center is a clinical department of skilled practitioners who are members of the cardiovascular surgical team. The perfusionist primarily is responsible for the selection, set-up and operation of the heart lung machine and other equipment used to support or replace the normal functions of the heart and lungs to maintain a constant physiologic state during adult and pediatric cardiac procedures and open-heart surgery.

The perfusion team also performs additional services utilizing blood conservation techniques involved in vascular, trauma, neuro, orthopedic and vascular surgical procedures. Perfusion Services are provided to patients in the Cardiac Cath Lab, operating room, Cardiac Intensive Care Unit and the Emergency Department.

The the medical center perfusionists are skilled professionals qualified by academic and clinical education and are credentialed via the certification process of the American Board of Cardiovascular Perfusion as Certified Clinical Perfusionists, and licensed by the State of Tennessee as Licensed Clinical Perfusionists.