Metabolic Surgery Center at Baptist Hospital: Nashville, Tennessee

TELL US ABOUT THE ROLES AND RESPONSIBILITIES OF THE LEAD STAFF AT YOUR FACILITY.
The Metabolic Surgery Center at Baptist Hospital currently has four surgeons, four nurses, and 11 staff members. Surgeons include Albert T. Spaw, MD, and Charles E. Morton, III, MD, who serve as co-medical directors, and George B. Lynch, MD, and James G. McDowell, Jr., MD. Each surgeon has a nurse who practices with them out of the center. The center is led by Director of Bariatric Services, Cylinda V. Phillips, RN, MBA, who is responsible for operations of the practice, strategic planning, business development, marketing, community outreach, patient education, consultation, and support group facilitation.

A registered dietitian and licensed, registered dietitian provide patient consultation of dietary needs and diet recommendations for patients undergoing surgical and non-surgical weight management programs. They also assist with community education outreach and support group facilitation. A wellness specialist is responsible for patient counseling, exercise training, and facilitating a 12-week SUCCEED preoperative education course. Three bariatric insurance specialists handle patient consultation, insurance verification, precertification, authorization, and surgery scheduling. The center’s staff also includes an office manager and secretary/receptionist.
Baptist Hospital has a 34-bed medical surgical unit comprised of 25 registered nurses, six licensed practical nurses, and 16 patient care technicians who are trained in the care of bariatric patients. About 75 percent of staff has been providing care to this patient population for 10 years, since the hospital began providing bariatric services. The unit also has a dedicated pharmacist, nutritionist, physical therapist, care manager, and social worker. The hospital’s Comprehensive Surgery Center team has extensive experience in assisting the four surgeons in the operating room.

Please describe your bariatric facility.
For nearly 90 years, Baptist Hospital has provided faith-based care to the greater Nashville, Tennessee area. Baptist Hospital is the largest not-for-profit hospital in middle Tennessee with 683 beds and is a member of Saint Thomas Health Services.
The hospital has provided bariatric services for 10 years and in 2005 opened the Metabolic Surgery Center, which was designed to accommodate the bariatric patient in every respect. The entrance of the clinic has a front door 48 inches wide, the waiting room has oversized bariatric chairs, and the patient rooms are fully equipped with benches, tables, chairs, and equipment to accommodate bariatric patients.
The hospital has also invested in serving patients of size, from the emergency room and operating room to medical imaging and patient care unit. Surgical procedures are performed in Baptist Hospital’s Comprehensive Surgery Center, an 18,500-square foot, state-of-the-art center remodeled in September, 2005. This is where the majority of outpatient and minimally invasive procedures, including bariatric, are performed. The surgery center features nine operating rooms, including two Stryker i-Suite operating rooms that provide real-time connectivity to hospital-networked data, image archives, live consultations, and a cutting-edge high-definition medical video system. Operating room tables hold patients who are up to 1,000 pounds. The hospital invested more than $540,000 in a medical imaging suite with the nation’s first dedicated bariatric imaging system that provides high quality digital images and holds patients up to 700 pounds. In addition to the imaging device, the i-Suite has been customized so it has more space, an enlarged restroom, and entryway for bariatric beds and wheelchairs. All equipment, including gowns, bariatric beds, wheelchairs, walkers, commode chairs, stretcher chairs, and lifts, on the medical surgical patient care unit accommodate patients up to 1,000 pounds. The staff is trained on protocols, safety, nutrition, and sensitivity in serving patients of size.

How many patients are treated annually at your facility?
The Metabolic Surgery Center is a regional facility serving patients in middle Tennessee and surrounding counties and southern Kentucky. Most patients are female, ages 30 to 45. Approximately 125 patients walk into the facility each month inquiring about weight loss surgery, and more than 800 patients are currently in the precertification process for surgery awaiting approval. Approximately 50 bariatric surgeries are performed at Baptist Hospital each month and we continue to grow.

Was the process of attaining the ASMBS SRC Center of Excellence certification difficult?
The process of ASMBS certification is an ongoing opportunity to provide the best possible care to the bariatric population. Since the Metabolic Surgery Center at Baptist Hospital is a designated ASMBS Center of Excellence facility, we strive to uphold the standards and requirements that are set forth. Quarterly updates are set by the ASMBS and issued to us so that we can implement them in our practice. In addition to ASMBS, our center has been recognized as a Center of Excellence by Cigna and named to the Bariatric Centers of Excellence network by United Resource Networks. A handful of patients occasionally ask about certification. Most of them tend to be Medicare patients who are looking for a facility that can perform their surgery. Patients can research centers that are certified by going to
www.surgicalreview.org.

How do you handle patient compliance and long-term follow-up?
When a patient has an initial consultation with one of our staff members, we stress the importance of lifetime compliance. Many people feel that weight loss surgery is an easy fix and that they do not have to accept responsibility for their actions. We strive to educate our patients and encourage them to analyze their habits preoperatively. Every one of our patients consults with a dietician prior to surgery. This consultation is focused on changes that need to be made for lifetime success. The patients also receive a psychological evaluation preoperatively to assess their readiness for change and/or any issues that may hinder them from becoming successful. We do offer support groups to all pre- and postoperative patients, as well as additional wellness programs for patients. Patients are followed by a dietician postoperatively at each visit to aid with compliance. Each physician can refer to one of our dietitians at any time.
One of the biggest compliance issues with our patients is that many patients find the pureed stage very hard to handle. Our dietitians try to work with patients preoperatively to prepare them for this stage of the process and to help them find palliative foods that they can enjoy. Patients are required to make a long-term commitment for follow-up. We ask each patient to follow up for a minimum of five years.

Please give a general synopsis of how your patients are treated while under the care of your center, including patient education and HIPAA compliance.
Once a patient walks in the door to start the process with us, he or she is given a privacy statement and we go over our HIPAA policy. All patients are taken to a private consultation room where they are educated, counseled, and allowed to ask questions freely. We frequently offer educational seminars at the center and locations in surrounding counties. In addition, patients have the choice of taking an online seminar via Emmi, an Internet-based, multimedia program that gives patients a clear sense of what to expect before and after surgery. It allows patients to learn about weight loss procedures at their own pace and type in questions during the seminar specifically for their physicians. Patient education also includes sessions with the physician, nurse, and dietitian before and after surgery. An Ambassador Program gives patients the opportunity to speak to former patients, allowing them to ask questions to someone who has “been there before,” which helps ease concerns and any anxiety.

WHAT ARE SOME OF THE NEW EQUIPMENT, DEVICES, AND PRODUCTS INTRODUCED AT YOUR FACILITY LATELY?
We utilize a variety of vendors and are always looking for new technologies and products that can improve safety, outcomes, patient care, and patient satisfaction. All of our physicians are trained in advanced laparoscopic surgery. We offer laparoscopic procedures for the laparoscopic adjustable gastric band as well as gastric bypass.
In the operating room, we recently installed a high-definition medical video system for minimally invasive surgeries. The system includes 1188 HD 3-Chip Cameras and 21-inch monitors from Stryker Corporation. The cameras offer superior picture quality, enhanced clarity and more intuitive user controls, giving surgeons more precise visibility during endoscopic procedures. Surgeons can see very detailed images of a patient’s anatomical structures, such as capillaries and veins. In addition, the new technology generates a greater depth of view than traditional equipment, which some surgeons call the “3-D effect.”
We were the first in the nation to install the Sonialvision Bariatric R/F manufactured by Shimadzu. The Sonialvision Bariatric R/F has an imaging table that can hold a patient weighing up to 700 pounds and has a large view fluoroscopic (dynamic exam) and radiographic (static exam) image field with head-to-toe coverage to minimize the need for repositioning the patient. The patient support table can be raised or lowered to accommodate patient loading and unloading, thus minimizing the risk of falls and allowing physicians to operate at comfortable heights. The system also features a one million pixel ccd camera, which produces high-definition, high-contrast photographs that are extremely valuable for gastrointestinal examinations. To ensure no detail is missed during imaging, images are captured at up to 15 frames per second.

How do you perform patient assessment to determine who is appropriate for surgery?
Immediate patient assessment is performed at initial consultation based on BMI and comorbidity screening. If additional questions arise, each individual physician determines appropriateness. The Metabolic Surgery Center at Baptist Hospital offers three weight loss surgery options—laparoscopic adjustable gastric band (Lap-Band), laparoscopic Roux-en-Y gastric bypass, and open or laparoscopic duodenal switch. We are currently the only hospital in Tennessee to offer the duodenal switch procedure.
By providing a variety of options, the patient and physician can decide which procedure is most appropriate. For those patients who may not be candidates for surgery, we offer them the option to enroll in a non-surgical weight management
program.

HOW IS INVENTORY MANAGED IN YOUR FACILITY?
Inventory is handled by the center’s director of bariatric services, as well as the office manager. Since we are a part of a health system, Saint Thomas Health Services, we work with the purchasing department to order our supplies and equipment.

How has managed care affected your facility and the care that it provides patients?
Managed care tends to have stringent requirements for bariatric procedures. Each of our bariatric insurance specialists works diligently with the patient, insurance company, and primary care physician to meet the criteria that the insurance company demands. Our designation as a Center of Excellence with Cigna and United Resource Networks is helpful for patients who are insured by these carriers.

What measures has your facility implemented in order to cut or contain costs and improve efficiency?
One action that has increased productivity is our ability to allow anyone interested in weight loss surgery to walk in off of the street without an appointment and start the process of undergoing weight loss surgery. We have an insurance specialist on call daily for consultation. This gives potential patients freedom to come to our center at a time that is convenient for them. It also saves time for our secretary, so she does not have to book appointments for those who are inquiring about weight loss surgery.
We have also improved efficiency in the operating room for our physicians. We have a dedicated bariatric operating room team and have blocked times in the operating room for our physicians to conduct procedures. As a Center of Excellence, we follow clinical pathways with all of our patients, which help with efficiency, so we can clearly see the next step that needs to be taken with each patient.

How does your facility deal with the issue of patient safety and staff safety?
Each employee is trained on the lift and transfer of bariatric patients when they are hired and on an annual basis. We have equipment, including ceiling, stand, and chair lifts, that are designed to assist in transfer and mobilization of bariatric patients up to 1,000 pounds. A dedicated skin care team ensures patients change positions on a regular basis to prevent pressure ulcers.

How are employees oriented and trained for working with the bariatric patient?
Employees are trained on lifting, sensitivity, and other issues regarding the bariatric patient upon hire and in monthly staff meetings.

What trends do you see emerging—including new technologies as well as what patients seem to be looking for?
Patients seem to be looking for a center that is caring, sensitive, and takes the time to work with them, answering their questions and being there as a resource for them. Patients are more knowledgeable about the procedures that are available and are researching what facilities in their market have to offer. We are beginning to see more men who are interested in weight loss surgery.
Describe one of your most interesting patient cases.
Weight loss surgery at our center has helped three sisters and a brother. Two of the sisters decided to explore their options together and spent a great deal of time researching Lap-Band surgery online and reading about testimonials. They attended one of the Metabolic Surgery Center’s free informational seminars. One of the sisters had her surgery in October, 2005, and lost nearly 90 pounds. The other was sidetracked a bit because of some health problems that needed to be resolved prior to surgery, but underwent surgery in May, 2006, along with the third and youngest sister. Nearly one year later, their brother decided on weight loss surgery. All of them make it clear that weight loss surgery is not an easy fix or for everyone—but it has worked for them, helping them lead much healthier, active lives.

What makes your facility unique?
We are a faith-based organization that is dedicated to serving the bariatric population on a physical, emotional, and spiritual level. Patients are drawn to our facility because of our people and the compassionate care they provide. The medical surgical unit that is dedicated to taking care of bariatric patients has also been involved in a spiritual care pilot program. The goal of the program is to “create a healing environment” by integrating workplace spirituality, our mission and values, holistic care, and reverence, and to increase associate and patient satisfaction. The unit staff takes a moment at shift change to pray together for the health of patients, their families, and coworkers. A sign marked “Sacred Place” has been placed on every patient’s door and tent cards in reach room explain, “Those who are caring for you are dedicated to your physical, emotional, and spiritual wellbeing. During your stay we are praying for you.” Implementation of the program has been met with encouraging feedback from patients and associates.

Tags: Bariatric Center Spotlight

Category: Bariatric Center Spotlight, Past Articles