Thanks to technological advances and the expertise of Memorial Sloan Kettering’s doctors and staff, many more surgeries that typically required hospitalization in the past can now be performed on an outpatient basis. And with the opening of an extraordinary new facility in 2016 specializing in high-quality outpatient cancer surgery, more MSK patients will be able to return to the comfort of their homes quickly after procedures — often within a matter of hours.
The Josie Robertson Surgery Center (JRSC), a 16-story building housing 12 operating rooms, will be equipped to provide sophisticated surgical care, including the very latest in minimal-access surgery, such as laparoscopy and robotics, as well as traditional open surgery.
Located on Manhattan’s Upper East Side just a few blocks from Memorial Hospital, the JRSC is the first-of-its-kind freestanding outpatient facility for short-stay (also called ambulatory) cancer surgery. The operating rooms and patient-care areas are designed for these specialty procedures, which include surgery for breast cancer and reconstruction as well as head and neck, gynecologic, and urologic cancers.
A certain percentage of patients may require a single overnight stay at the JRSC, but all patients will be able to leave the building either the day of or the day following their procedure.
“We recognize that surgery patients are better off recovering at home, so designing a way to get them there safely and quickly represents a significant advance in cancer care,” says anesthesiologist Brett Simon, Director of the JRSC.
Managing Patients “End to End”
The advanced methods and patient care procedures to be employed at JRSC were pioneered in recent years by MSK teams at Memorial Hospital. Dr. Simon explains that the innovations go beyond enhanced medical techniques such as minimal access surgeries — which are less invasive than traditional open surgeries — or better ways of delivering anesthesia.
“What’s unique about what we will be doing at Josie Robertson is the careful management of patients from end to end, starting the moment the surgery decision is made,” he says. “This involves an increased effort to prepare patients before surgery, set clear expectations through education, manage their medical conditions, and then — once the procedure is complete — monitor their conditions and actions very closely. We want to engage them in their own care and empower them with knowledge to speed their own recoveries.”
New technologies, including an online patient portal and mobile device app, will enable patients and medical staff to stay in constant communication. Leading up to the day of surgery, patients will receive frequent notifications from MSK staff to help familiarize them with the facility and prepare for the operation. These may include directions about which medications to take, how to sanitize their skin to reduce infection, and what to eat or drink.
For example, Dr. Simon says it is now known that drinking complex carbohydrates (fluids similar to Gatorade) eight hours before surgery can help patients regain normal functions more quickly after awakening.
And following surgery, patients fare much better if they get out of bed and begin walking as soon as possible. “Walking around is the best thing for them,” Dr. Simon says. “It’s better for circulation and breathing, and it helps reduce infection.”
The JRSC building is designed to encourage this activity, providing spaces outside private recovery rooms for patients to meet with family members. In addition, visually interesting and engaging graphics on the walls will serve as walking milestones for patients.
“We have mapped out in detail what they’ll be doing almost hour to hour after surgery, and we’ll be tracking their progress — pain control, walking, eating and drinking, physical therapy — and we’ll know whether they are on the right path or not,” Dr. Simon says. “It’s very important for us to know if patients are not hitting their milestones because we have limited time to intervene and get them back on track so they are ready to go home.”
A real-time location system will enable patients and caregivers to move freely throughout the JRSC, while assuring that medical staff will always know where they are in their surgical journey. All of the communication and tracking technologies will also help JRSC staff compile data that will allow them to constantly evaluate procedures and processes in order to further improve patients’ experience.Back to top
Continuous Feedback to Improve Outcomes
Vincent Laudone, Chief of Surgery at the JRSC, explains that this constant reevaluation is a primary mission of the new center.
“We all know that 20 years from now we’ll look back at medicine today and say, ‘Why did we do things that way?’” he says. “The surgical field is continually evolving, and our goal at the JRSC will be to drive that process. We’ve set up the facility to critically examine everything we do and ask what should be done differently — always with the aim of improving outcomes. Everyone involved shares in this mission.”
Rebecca Twersky, Chief of Anesthesia at the JRSC, says that the wealth of information generated from closely monitoring patients — particularly after surgery — will be invaluable.
“What really stands out with Josie Robertson is the increased attention to follow-up,” she says. “Ambulatory surgery is generally fast paced, involving high numbers of patients passing through the facility. In most places, there isn’t much focus on what happens after the patient goes home. But we’ll be checking in with our patients frequently and then using data from these interactions to see how we can improve the process.”
This feedback loop is critical, Dr. Simon emphasizes. “Looking at the data, for example, we might learn that a subset of patients had problems on day three following a particular procedure. So we’d look at everything from the specifics of the surgery to the anesthesia care they received to how we managed the immediate post-surgery hours before these patients left the building. We’ll compare who did well with who didn’t and, using that information, figure out what needs to change.”
Dr. Laudone said one innovation already in the works is eliminating the traditional method by which patients move throughout the process: first to a pre-op room, then to a recovery room after the operation, and finally to a third room — with different teams of nurses at each stop along the way.
“We will skip the traditional recovery room and send patients directly from the OR to their post-op room, where they will go through the traditional PACU ‘acute’ recovery and transition directly to their ‘extended’ recovery with the same nursing team,” he says. “This type of continuity should not only be more efficient, reducing hand-offs and transports, but also can enhance patients’ well-being because the nurses have a comprehensive understanding of all phases of each patient’s surgical preparation and recovery.”Back to top
Enhanced Comfort for Patients and Caregivers
At full capacity, the JRSC will accommodate 60 surgeries a day, of which 25 to 30 percent are expected to include an overnight stay. The facility is designed to keep patients and their families as relaxed and comfortable as possible. Special areas throughout the building will give family members and caregivers places to rest, eat, use technology, exercise, or just sit in private or in a group “campsite.”
No patients will be discharged until they are comfortable leaving the JRSC and have the OK of their MSK care team. A small percentage of patients who need more time to recover will be transferred to Memorial Hospital just a few blocks away. But the overriding goal is to enable patients to go home safely in the shortest time possible so they can take control of their own well-being.
“We believe that Josie Robertson is the model for the future of outpatient cancer surgery,” Dr. Simon says.Back to top