Since Johns Hopkins Medicine opened its ambulatory surgery center at Green Spring Station in 2019, the pediatric anesthesia division has made it possible for young patients to undergo a variety of procedures as outpatients.
Patients appreciate that they don’t have to go to the hospital and be admitted, says Johns Hopkins anesthesiologist Joanne Shay. They can come in, get their procedure and go home.
“We’re definitely pushing the edges of what can be done for pediatric patients in the ambulatory setting,” says Shay, director of the pediatric ambulatory anesthesia group within the Division of Pediatric Anesthesiology, Critical Care and Pain Management. “The real strength of it is the pediatric anesthesia team, working closely with our pediatric surgeons to determine the right patients and the right procedures, and how we can make it successful.”
Subspecialty board-certified pediatric anesthesiologists and certified registered nurse anesthetists now participate in about 100 cases a month, assisting in procedures in general pediatric surgery, urology, otolaryngology, orthopaedics and gastroenterology, along with some plastic reconstructive or gynecological surgeries. They are skilled in offering anesthesia during laser surgeries for patients with burns, and they perform lumbar punctures for pediatric patients who have spinal muscular atrophy and come in for periodic intrathecal infusions of Spinraza, a lifesaving specialty medication.
“It has opened up a huge swath of opportunity for us in pediatric ambulatory care, where before these children might have gone to community hospitals or places a bit farther away,” says anesthesiologist Samuel Vanderhoek.
Pediatric regional anesthesiologists such as Tricia Vecchione work alongside orthopaedic surgeons to perform regional nerve blocks, offering the same quality of services available at Johns Hopkins Children’s Center in East Baltimore. “It’s nice when you have young teenagers who come in super anxious about their surgeries and the pain postoperatively, and we can tell them, ‘Hey, we can make sure you wake up feeling comfortable,’” she says. When Vecchione sees patients using their cellphones within a few minutes of waking up, she feels heartened.
The tight-knit team spirit at the surgery center started even before the building opened, explains Kate Vaughn, the lead certified registered nurse anesthetist. Pediatric and adult anesthesia staff members scheduled at Green Spring met together in leadership workshops. Vaughn and her colleagues, along with anesthesia technician Willie Williams, helped organize pediatric supplies and medications for the center.
Vaughn, Shay and others helped design work processes, organize anesthesia carts, order medications and implement a process to track inventory. While it was a bit of a challenge, Vaughn says, “it was a unique opportunity.”
Vaughn, Vanderhoek and nurse coordinator Linda Ellwood are among team members who review patient charts a couple of weeks before surgery, making sure those pediatric patients who are scheduled are appropriate for the ambulatory setting and have completed any preoperative tests.
Patient comfort also was taken into account during design. Shay asked to supply the preoperative area with toy cars for children to ride as a distraction before surgery. The cars make it easier for young children to separate from their parents, and allow anesthesia team members to direct the cars right into the operating room, avoiding preoperative sedation and decreasing wake-up time.
Sometimes, Shay can administer anesthesia while the children are still in the cars, she says, “and we just scoop them up, placing them on the OR table once they are asleep.”