You've come a long way, baby!

1-page charts, typewriters replaced by scopes, MAC

The year 1976 was a leap year that saw Rocky win the Academy Award and the Golden Globe Award for best picture, the first flight of the Concorde, the formation of Apple Computer Co., and the first issue of Same-Day Surgery.

That year, the surgery center that is now HealthSouth Surgery Center in Belleville, IL, opened its doors.

Although the surgery center has seen a lot of changes throughout the years, staff changes are not a problem, says Diana Geoghegan, administrator of the center. "I'm the new person on staff, and I've been here three years," Geoghegan says. "I've not had to hire anyone since I arrived." Although no one on the current staff was at the center when it opened, one employee has been here 25 years, she adds.

While she's not the employee with the longest tenure, Janice Schepers, RN, nurse manager, a 22-year veteran of the surgery center, has noticed dramatic changes at her center and in outpatient surgery in general. The changes aren't limited to more procedures and new technology, Schepers says. "When I started, our charts were one page. Now, we have multiple forms and pages that must be included according to accreditation and regulatory requirements," she says.

Small and large changes noticed

Advances in anesthesia are responsible for the most significant changes in outpatient surgery centers, says Schepers. Monitored anesthesia care (MAC) is the most common anesthesia, with less use of general and local anesthesia, she points out. "This means that patients recover more quickly and have fewer after effects such as nausea and vomiting," Schepers adds.

"I've also noticed that patients are much better informed," she says. "Patients used to ask us why we wanted to know if they had allergies and why that was important for their surgeon." Now, patients volunteer information about allergies and medications before the staff can ask, Schepers says.

The Belleville center was owned by physicians until HealthSouth purchased the facility in 1998. "Being owned by a publicly traded company is very different because there are more financial controls and compliance issues to address," says Geoghegan. "It is also beneficial because we have more resources as part of a larger company than we would have if we were owned locally."

Hope Mangum, RN, director of the Davis Ambulatory Surgical Center in Durham, NC, also has seen significant differences between outpatient surgery 21 years ago, when she was a member of the original staff, and today. For example, today outpatient surgery is well known to be safe.

"All of the [original] staff came to the surgery center from the hospital operating room, and we found it hard to believe that we were sending patients home the day of their surgery," says Mangum. "The challenge was to reassure patients at the same time we were having our own doubts about the safety of outpatient surgery."

Scopes greatly changed the field

What has had the greatest effect on outpatient surgery? The development of laparoscopes and endoscopes, says Mangum.

"Scopes enable us to perform hysterectomies, cholecystectomies, shoulder ACL [anterior cruciate ligament] repairs, gastric bypasses, and carpal tunnel procedures, on an outpatient basis," she says. Not only does this technology mean more business for the surgery center, but also patients don't have to face weeks of slow recovery, she adds.

The technology can be a challenge, particularly for new staff, says Pam Neiderer, RN, BSN, nurse manager at the Surgical Center of York (PA), a 14-year veteran of outpatient surgery. "I'm glad that I'm not starting out today as an outpatient surgery nurse because I would hate to have to learn about all of the equipment and other technology in the surgery center at one time," she says.

Like the HealthSouth Center, Mangum's facility has changed ownership throughout the years, starting as a physician-owned center, then becoming hospital-owned and now owned by a health system. Even with increased competition in the area, Mangum's facility has grown steadily, performing 8,000 procedures each year, she says.

"My staff has quadrupled since we opened, and I now have 68 employees and 50 physicians," says Mangum. Because patients want a warm reception and a comfortable environment, it is important, even with a large staff, to foster a sense of community and family, says Mangum. "I start by hiring the right people with the right attitudes," she explains. "I can teach someone how to do a job, but I can't teach attitude if it's not already there," she adds.

Staff members are kept up-to-date with staff meetings and they are involved in committees that handle activities such as performance improvement, says Mangum. It also is important for the manager or director to stay visible and accessible, she adds. "I'm like a mother who is always there to listen to problems and help my family," she explains.

"It is also critical today to develop leadership within your outpatient surgery staff," says Neiderer. Involving nurses in performance improvement projects and other projects that affect the operation of the center improve staff members' accountability, she says. "I even have my nurses evaluate each other as part of annual employee evaluations, and I always have peer interviews where members of my current staff interview potential new employees," she adds.

Future changes for the Davis center include the introduction of electronic medical records, says Mangum. "When I started, we didn't have computers, e-mail, or fax machines," she points out. She laughs and says, "When I wrote policies, I used a typewriter and tried not to change the policy often."


For more information about changes in outpatient surgery, contact:

  • Diana Geoghegan, Administrator, HealthSouth Surgery Center, 28 N. 64th St., Belleville, IL 62223. Phone: (618) 398-5705. E-mail:
  • Hope Mangum, RN, Director, Davis Ambulatory Surgical Center, P.O. Box 15727, Durham, NC 27704. Phone: (919) 470-1000. E-mail:
  • Pam Neiderer, RN, BSN, Nurse Manager, Surgical Center of York, P.O. Box 290, York, PA 17405. Phone: (717) 843-7613.