Over, under, around: Know where patients can go

Facility addresses pediatric safety concerns

Evaluating your same-day surgery space as you sit or crawl around the floor doesn’t sound practical or necessary, and it is definitely not dignified, but it is essential when you’re designing space to be used for pediatric patients. In fact, while setting up one of the nation’s first freestanding pediatric surgery centers, the staff at Children’s Surgery Center in Columbus, OH, had to consider several issues important for any program that has pediatric patients.

"Not only did we have to evaluate the level of countertops, safety of electrical outlets, position of televisions in the waiting room, and types of window coverings used, but we also had to make sure there are no sharp corners, and no water cooler in the hallway of which an NPO [nothing by mouth] child will make use," says Annette R. Svagerko, RN, CNOR, OR clinical coordinator for Children’s Surgery Center. If your state requires water coolers in public hallways, be sure to place them in locations that can be seen by nurses, such as next to the nurses’ station, sources suggest.

"We have to think like children when we evaluate a pediatric facility because we have to be able to identify everything that can be climbed on, crawled under, pushed over, tripped on, and put in a mouth," she adds.

Programs that serve large numbers of pediatric patients have to consider that these patients will chew on furniture, lamps, magazines, toys in the waiting room, or anything else that will fit into a mouth. Thus, managers have to think about how the items can be cleaned, Svagerko points out. "We have to make sure that we can clean everything to remove germs before the next child chews it and make sure that the cleaning agent we use won’t harm the child," she says.

Children’s Surgery Center opened five years ago and now handles 350 to 450 cases each month in four operating rooms and one procedure room, Svagerko says. The center is a limited liability corporation owned jointly by Children’s Hospital and a group of physicians. The center was built to meet the growing needs of surgeons who were looking for more operating room time as the numbers of outpatient pediatric procedures grew, she says. Physicians also wanted a facility that was not as intimidating to children and parents and did not require the red tape and myriad hallways that going into the hospital for surgery requires, she adds.

"We have an ocean theme that appeals to children throughout the center," Svagerko says. A front desk that looks like a boat greets the children, and all artwork and decorations carry the theme throughout the child’s visit, she explains.

Beyond decorating for pediatric needs, staff also have to make sure their supply inventory contains the wide range of sizes needed for pediatric patients who range from infants to young adults, Svagerko explains. Safety issues require more diligence in a facility that serves a large number of pediatrics, she says. "State requirements mandate that a pediatric advanced life support (PAL)-certified staff member be in the building whenever we have a patient," she says.

Rather than have four or five staff members with PAL certification juggle schedules to make sure one is always in the building, the center administrator and physician board members opted to require PAL certification for all staff members. The surgery center pays for the certification and gives employees the time off to attend the classes, Svagerko says. The certification helps keep patients safe, she emphasizes.

"We also have special doors throughout the building that have a 15-second delay," she adds. When the bar to open the door is pushed, an internal alarm beeps, and the door doesn’t open for 15 seconds, which gives staff members a chance to stop a wandering child, she explains. There is an override button that staff members can push if there is an emergency requiring evacuation of the building, she adds.

Another issue to consider for pediatric patients is legal guardianship. "We have to make sure we have the proper identification for parents or guardians," Svagerko says. The center’s computer system does have pop-up screens to alert staff of missing or abducted children, she adds. "At this time, we are not tied into a national alert system, but we are working with the state of Ohio to bring this to fruition," she says.

There is one door in the center that serves as a marketing tool to alleviate parent concerns about safety, Svagerko says. "Even though we are independent of the hospital, we are located on the hospital’s campus and our center connects by a door to the hospital," she says. "This enables the staff to reassure parents that if their children need more care than the same-day surgery center can provide, there is no need to transport by ambulance across town."


For more about pediatric same-day surgery, contact:

Annette R. Svagerko, RN, CNOR, OR Clinical Coordinator, Children’s Surgery Center, 660 Children’s Drive, Columbus, OH 43205. Telephone: (614) 722-2920. E-mail: svagerka@chi.osu.edu.