The Importance of Support Staff In Laparoscopic Surgery

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Dr. Mark Smith:  “Good morning and welcome to the AAGL, it’s actually our final day here but we’re fortunate to have with us Wendy Winer.  Wendy’s given numerous lectures that I’ve heard over the years and has been a proponent of building a strong operating room team to team concept to facilitating the surgery.  Wendy’s a registered nurse and first assistant, she works with Tom Lyons in Atlanta and has worked in this area for a few years anyway.  Wendy, thanks for joining us today.”

Wendy Winer, R.N.:  “Thank you very much for having me, and thank you very much for including a section specifically for O.R. personnel.  I think that all of us, physicians and O.R. personnel alike, all have the same goal and that is we’re trying to give our patients the best possible care as a result of all this new technology and these potentially wonderful endoscopic procedures.  The key question is what we can do to really give the patients the best possible care, and the first thing that we all look at is how we can get our O.R. team motivated and well trained so that they can do the best possible job as part of the team and work with the physician to facilitate them during these procedures.  I think that the O.R. personnel themselves have to read everything they can and attend meetings such as this AAGL meeting.  Unfortunately, a lot of O.R. personnel don’t have that opportunity so I think we really need to look at in-house training where the physicians themselves do a session like a grand rounds or an in-service with the staff and talk about particular procedures that they do on a regular basis and tell the staff what they can do that would really help them out.  At the same time, give the staff a review of the anatomy, of the procedure, of the instrumentation, and anything that the physician may have learned at a meeting such as this or that they have read recently in journals.  In addition, physicians can help by bringing any journal article that they’ve ever read that they think would be of help to their O.R. staff and bring it to their O.R. Director to have it available in the lounge so that the O.R. staff, nurses, techs, and everyone can read it.  Another thing that I think is very important is this is obviously a team approach, we really need to all work together - the physicians, the nurses, the techs, anesthesia, the person who cleans the instruments, every single person really plays an integral role in the success of these procedures.  So I think it’s really important that you have good communication and that you really do work well together as a team.  For starters, the physicians really need to develop a relationship with the O.R. Director and really sit down with them.  Everyone has the same goal, everyone’s really trying to give our patients the best possible care so sit down with the O.R. Director and encourage them to come to you to see what you can do to participate as well as ask them if there is any way possible that you can work towards the goal of having a dedicated team.  Have at least a dedicated nurse, tech, or somebody who scrubs with you even on a regular basis to kind of keep an extra eye out for your instrumentation and equipment so really the idea is to have some type of a dedicated team and some people who work with you on a regular basis.  I think the first place to start is having a good relationship with your O.R. Director and from there work with the people who, hopefully, will make up your team.  Do everything possible to aid them in the education process and to have a good relationship and communication.  Just like the basic of any good relationship is communication, I think that your O.R. staff can really, really help you.  The most frustrating thing is for a physician to go to AAGL or to a meeting where they come back to their hospital or surgery center and they’re so excited about what they’ve learned and they can’t wait to put it into practice.  Then they go and they do a case or two and they are so frustrated because the nurses and everybody in the room is either disinterested or doesn’t know anything about what your doing.  You feel like you’ve learned all these wonderful things and you can’t put it into place.  In the last couple of weeks and on a regular basis, I get e-mails and phone calls from physicians all over the world saying to me, “I am so frustrated, what can I do to get the staff interested, motivated, and get them to really follow these procedures?”  One of the most wonderful things about laparoscopy these days is that we have a video camera.”

Dr. Mark Smith:  “Everyone can watch.”

Wendy Winer, R.N.:  “So everybody is part of the procedure and it’s no longer the days where there’s a big incision and only the people who were actually scrubbed could see what’s happening.  You can be the person standing at the door and you can look at the TV monitor in the room and see what’s going on.  The next key is the staff really needs to try to anticipate what the surgeon is going to be doing and once they really know the anatomy, understand the procedures, and know the instrumentation and equipment, they should really be able to follow on the monitor and be two or three steps ahead of where the physician is going.  Ultimately, this is going to save money.  It will cut down on operating room costs, operating time, and hopefully on complications and on a number of laparotomies as a result of not being ready with the right equipment or instrumentation if you encounter a bleeder.  All of these things I think is just being prepared and anticipating, and a lot of it’s just human nature and having an enthusiastic motivated team.  I think if they’re well educated and if the physicians can make the staff really feel like they are an integral part and it should…”

Dr. Mark Smith:  “Yes, they are.”

Wendy Winer, R.N.:  “Yes, and that you really appreciate them and work together.  It’s really just like a marriage.  I think a lot of us spend more time in the operating room than we do at home so it’s important to like what you’re doing and at the end of the day for all of us - physicians, nurses, and everybody to feel good about what we’ve done and to really feel like we are giving the patients the benefit of these procedures.”

Dr. Mark Smith:  “Absolutely, I was thinking when you were discussing that that I use to give inservices to the operating room staff about laparoscopy, and it was amazing that for the next six months cases would go so smoothly.  Doctors very commonly walk in and expect the O.R. staff to know everything and they’ve never told them anything.  Yet, they say they don’t have an hour to go give an inservice – well, if you save thirty minutes on your next twenty cases for spending that hour do the math.  It’s very simple.”

Wendy Winer, R.N.:  “I was just going to interject real quickly, a simple thing to do is to encourage your O.R. staff to update your prevalence cards regularly and to use them so that will cut down on opening unnecessary things and, hopefully, cut down on the waste and being better prepared for what you’re going to be doing.”

Dr. Mark Smith:  “Wendy, thank you very much for joining us today.  We hope to see you back here soon.”

Wendy Winer, R.N.:  “Thank you for having me.”

Dr. Mark Smith:  “Work hard in Atlanta, you guys usually do.”

Wendy Winer, R.N.:  “You need to come to Atlanta and visit us.”

Dr. Mark Smith

:  “Maybe I will.  Thank you very much.”