Despite the great amount of factors to be controlled, errors are not admitted in a surgery. This is the report of what happens inside one of the most complete surgery rooms in Colombia. Fully coordinated controls, procedures and teams to assure that everything will work with total precision.
Marian is 39 years old and recently she was diagnosed a malignant tumor in the abdomen. Her doctor warns her that, despite some difficulties may happen, surgery is the only alternative. He provides her information about the type of incision and some procedure details. At the clinic where her doctor works there is a group of professionals in charge of evaluating the operation’s priority and complexity level according to the clinical diagnostic. The patients with cancerous lesions, immunosuppressive diseases, maternal diseases and children have priority.
After the doctor’s call to the Surgical Programming, Mariana’s operation is fixed in one week, at two o’clock at Clínica Universitaria Colombia. Immediately, a bed is booked for her in the Intensive Care Unit, as well as five blood bags (in case that a transfusion is needed), hematological exams, a kidney test, a chest X-ray and a pre-anesthesia consultation with a nutritionist who will provide her the corresponding recommendations. In Clínica Universitaria Colombia there are nine surgery rooms; 6 for scheduled interventions, 2 for emergencies during the 24 hours (one general and the other obstetrical) and other one for the exclusive use of patients with cardiovascular diseases.
The personnel check the provision of supplies and the required equipment for Mariana’s surgery, according to the protocols followed by the institution and the specific requirements of the surgeon. The programming sheet specifies the name of the treating physician, the surgeon assistant, the nurse chief of that shift, the assistant nurses, the medical and the anesthesiologist.
In the sterilization center the medical and 12 cleaning assistants will assure that the medical tools that the surgeon will use are not containing any microorganism. They will also prepare all the surgical clothing (uniforms, compresses, etc.), recipients and other materials that will be used during the operation. For this purpose, different methods are applied: vapor, dry health, chemical baths. In the storage everything is packed, perfectly folded, organized and hermetically sealed.
In total 133 workers compose the surgical area of Clínica Colombia: among them chief nurses, assistant nurses, medicals, cleaning assistants and secretaries, more than 25 anesthetists, administrative personnel and around 200 doctors
The nursing coordinator of the chirurgical area, Natalia Hendez, explains that these procedures never stop: 'Administrative and assistance procedures are basic in a surgery room. Consequently, these areas work 24 hours a day, 7 days per week. We work with a great team, focusing always on patients’ safety'.
The internal pharmacy that supplies surgeon’s rooms is also ready to respond to the requirements of the surgical program. Engineering and Maintenance and General Service teams are also ready to provide its permanent support. As well, medical imaging team is ready to verify with X-rays or an echography what is going on with the patient. Everything is prepared to guarantee Mariana’s safety. Mariana arrives punctual to her 11:00 a.m. appointment. Her mother and other few family members and close friends accompany her.
A general doctor completes the entry medical record, reviews once more the exams and the medical order. The nurses check the numbers of fasting hours, allergies and consumed medicaments. They also verify that the patient doesn’t wear any make up or nail polish, creams or perfume. They confirm that she doesn’t have any dental prostheses or any metallic object as earrings or perforations. If the patient has any artificial pacemaker or non-removal metallic prostheses this is indicated in the medical record and a colored ring is added in order to warn to surgical team. The same procedure is done to warn about allergies. Marina doesn’t tolerate penicillin, so they put a red ring on her right hand.
Óscar Pérez, the chief of the surgical room, indicates that flu, diarrhea, fever or a urinary tract infection may be some of the reasons to cancel and reschedule a surgery. In some cases, the operation can be delayed if the room requires a special preparation or if the duration of a previous surgery has been longer as expected. Mariana enters into a room where she has to leave all her things that later are delivered to her family. She puts on the blue disposable clothing. She doesn’t need any ring or earrings. Her long and curly hair remains hidden under the disposable ha and her feet covered by leg warmers. The hospital gown covers her undressed body. She says goodbye to her mother.
Germán Rojas Rodriguez is the scientific director of University Clinic Colombia and Oscar Perez is the chief doctor of surgery rooms. Both explain the details of the gear that they manage. Once the patient has entered into the corresponding room, one of the nurses and the anesthesiologist prepares new checking list to minimize the confusion possibilities. They check the name of the patient, the age, the treating doctor, the pathology and the procedure, allergies and piercings. In the Meantime, another nursing team checks every tool that is in the corresponding place.
In the surgery rooms everything is prepared to avoid any accident or event that may affect adverse to patient's health. The operating table includes some elastic bands help to assure that the best position for the patient according to the type of intervention. There are cardiovascular monitors, infusion pumps, air conditioning and a gas exhaust system; electrical insulation floors; a clock and equipment to cauterize, suction, vent and cut. There are some boxes also made of wood that serve as platform for doctors or nurses those that are not very tall.
Everything in the room has reason to be there. In the room there is a group of people ready for the operation: the chief nurse, the medical, the assistant nurses, the stretcher-bearer, the anesthetist, the overall physician as surgery assistant and the specialist physician as team chief.
In total 133 workers compose the surgical area of Clínica Colombia: among them chief nurses, assistant nurses, medicals, cleaning assistants and secretaries, more than 25 anesthetists, administrative personnel and around 200 doctors.
A puncture in the left wrist is the only pain that Mariana will feel in the surgical room. It consists on the venous cannulation in order to set direct communication with her vascular system. The rest will happen meanwhile she is unconscious. The anesthetist advices her to think about something that makes her happy and puts on her mouth and nose a transparent mask.
Before suturing the wound, the medical and nurse team makes a new inventory of disposable material and tools. They put in saline solution or formalin the organic residues that must be analyzed by pathology and in a red plastic bag those ones that must be discarded. Everything used in the operation, dischargeable or not, is got out through an exclusive door from which all used tools and materials are retired. This avoids that this material could mex with the sterile material that is going to be used in the next operation.
Mariana’s mother is in the waiting room. She sees the doctor who treats her daughter coming with another younger one. He opens his arms and smiles. Hugging her, he states: 'The operation has been a success. No unforeseen difficulties'. He leaves after giving her some indications. The mother of Mariana runs to tell her husband, Mariana’s sister, the boyfriend and the close friends the good news.
Mariana waits in the sterile area at the other side of the door. She is in the middle of the surgeon room, just three hours after that puncture on her left arm. She comes back from her deep sleep. She checks that she can move her feet and hands and she falls again sleep. Later, she is transferred to the recovering room where there are 24 boxes with personal and teams to monitor her vital signs. Once that she is conscious, an anesthetist follows the protocols of post anesthetic care and he sends her to a hospital room. 'As part of our institutional policy, the user should go out from the recovering area without any pain', explains Pérez.
After this surgery, Mariana received 25 radiotherapy sessions and a combined surgical and oncological treatment that will took the cancer to its end. Her story had a happy ending. One year and a half later, Mariana talks about this experience as an anecdote. She got married with the boyfriend that was waiting for her that day. She feels blessed.
Clínica Universitaria Colombia in numbers:
- In 2015 the number of surgeries reached 16.271. The average was 1.400 surgeries per month; 47 per day.
- Gynecology, General Surgery and Orthopedics were the specialties with more operations
- The 65% of the cases were prepaid operations and the remaining 35% came from emergencies.
- The 80% of those procedures were financially supported by EPS and a 20% by prepaid medical systems.