El Camino Surgery Center

caliotter3 · Dec 25, 2007

Didn't work there but was a patient there a little over a year ago. They were very efficient and professional. My only complaint was that I should have been told by my surgeon or somebody before the time of the procedure that they do not accept advanced directives. The time of the procedure is not the time to be looking for a different provider. Good luck finding a job in that area!

qtRN · Dec 27, 2007

Thank you for your response caliotter3. Different institutions have different systems and I just don't go for those who do not accept the patients' wishes.

caliotter3 · Dec 27, 2007

I agree with you. You would have thought that they would have been happy to get a copy of my advanced directive since I'm DNR. "Let er die!" They told me no matter what, they code everybody. I would think that would pose more liability issues. At the time, I had no opportunity to call it off and look elsewhere. I was very disappointed at this.

suzanne4, RN · Dec 29, 2007

Actually in almost every hospital facility, the DNR is not in effect in the surgical suites. This is not specific to this facility, but everyplace.

Advanced Directives are not the same as an DNR either. It is what you would want done in certain situations where there is no hope for returning to your previous status, and essentially not needing life support, and multiple other tubes to keep you alive. Anything goes wrong in the OR, and that is an acute situation that can hopefully be treated.

The only time that you may see a DNR continue in the OR is if the patient is going for a debridement of a wound, is terminal to begin with before going for a palliative procedure in the OR, or something else similar.

Even an 80 year old patient would have the DNR reversed if they went to the OR to repair a fractured hip in most cases.

In the world of ambulatory surgery, they do not do any surgeries on those that are not in reasonably good health to begin with, or you would have been required to go to a full-service hospital in the first place. They are not permitted by law to do so.

qtRN · Dec 31, 2007

In the hospital that I work in, they recognize the advance directives but one of the nurses stated that DNR is not being recognized because every patient in the OR is to be revived by all means. I have to check the hospital's policy about that. I think Suzanne is right too about DNR in the ambulatory surgery because we do not accept patients who are unstable and it is the anesthesiologist who give that call.

caliotter3 · Dec 31, 2007

As happens often, I've learned something on this site. I still wish this could have been appropriately explained to me in enough time that I could have made changes to my plans if necessary and possible.

lcooper · Aug 15, 2008

Hi,

I'm Lisa Cooper, the CEO at El Camino Surgery Center. I stumbled upon this post through a google search. I'd like to respond to the concern regarding DNR advance directive, which is very legitimate concern.

Federal law requires that hospitals participating in the Medicare or Medicaid programs provide information regarding the right, under state law, to formulate advance directives concerning health care decisions to all adult (and emancipated minor) hospital inpatients. This requirement does not pertain to surgery centers. The reason most surgery centers will not accept a DNR order is not because they do not want honor a patient's wishes; it is more to do with the scope of practice and how they operate. One of the benefits of coming to a surgery center as opposed to a hospital is the manner in which we run our business. The process from registration to discharge ideally runs very smooth and efficient. Patients are able to spend less time in our facility - which is one of the reasons why there are less surgical site infections from surgery centers as compared to hospitals. If we were to accept a DNR advance directive from a patient, we would need to have the resources to manage those directives. i.e. once a directive is accepted, a facility needs to accomodate the patient's verbal request to make changes to that directive - which many patients with DNR do when under anesthesia. We'd also need to document the process throughout the stay. Given our patients are coming in for elective surgery, and given the majority would place their DNR directive on hold for the majority portion of their stay with us, we have opted not to accept DNR advance directive. Any other type of advance directive is honored and placed in the chart.

I regret your physician did not inform you of this prior to your surgery. We have communicated with our physicians several times on this issue. If you feel comfortable, please email me your physician's name so I can contact his or her office to remind them of our policy. My email is [email protected]. In the meantime, as a management team we will relook at our process and see how to get this policy - along with the rationale - to our patients in a better manner.

Regarding employment at ECSC, of course I am bias, but I find it to be a very nice place to work. We have several hosted social events throughout the year, provide hearty breakfasts daily and lunch on Fridays for all staff, offer profit-sharing and 401K match, and are competitive with our salaries. Our average tenure of our staff is 9 years, with some of our nurses having been here since we opened in 1991.

Thank you,

Lisa