Coronado Surgical Recovery Suites, known as CSRS, is located in Henderson, Nev. It is an outpatient surgery overnight stay and recovery facility recently developed and designed by Michael Crovetti, DO, the facility's owner and operator who is an orthopedic surgeon and sports medicine physician, and also a co-owner of Coronado Surgery Center. Assisting him with this undertaking was Deborah Munoz RN, MHA, who serves as the administrator/CNO for both the ASC and the recovery suites. Dr. Crovetti performs orthopedics procedures in two local Las Vegas/Henderson hospitals with the majority of those procedures being joint replacements.
Dr. Crovetti's ASC and recovery suites facilities cater to medically cleared patients who undergo hip and knee joint replacement surgery in the ASC, are discharged per ASC criteria and then admitted to spend a few days recovering at CSRS, which is located next door to the surgery center. This program provides for the surgery to be performed on Monday in the ASC, admission into the recovery suites for intensified patient-center physical therapy and personal nurse attention for recovery and then discharge home on Wednesday. Prior to discharge, home health services and physical therapy visits are coordinated with companies authorized by the patient's specific insurance provider.
"Minimally invasive techniques in hip and knee replacement have made it possible for healthier patients to have an 'out of hospital' experience with less exposure to infections, dedicated physical therapy for early ambulation, and shorter length of stays," says Dr. Crovetti about the program. "We hear about negative events and outcomes during and following hospitals stays across the country: hospital acquired infections and patient falls. In addition, patients complain about feeling like they did not get everything they should have due to staffing ratios and in general, too much is paid by the insurance companies and patient out of pocket payments that are required to be paid prior to surgery".
Here are six things to know about CSRS.
1. State license challenge. When Dr. Crovetti and Ms. Munoz were researching development of CSRS, they first contacted the Nevada Bureau of Licensure and Certification to inquire what type of license would be required for the recovery suites. The Bureau informed them that the program for the recovery suites would not need licensure since it fell "in between" current regulations.
"No one has ever done something like this before," Dr Crovetti says. He presented his idea to the City of Henderson, which approved the business facility license as a home for less than 10 people staying less than five nights. The state licensure bureau later returned a revised opinion and the facility opted to apply for a license as an Intermediate Care Facility. Although these regulations did not meet the program's medical intent and business needs of the suites, Ms. Munoz worked closely with the license bureau and requested variances from the Nevada State Board of Health which were granted. The first patients were admitted to the suites following their joint replacement surgery in early Dec 2010.
2. Physical therapist and tech work directly with each patient to develop recovery plan. A patient's recovery plan begins immediately after surgery. Within three hours of joint replacement, the patient is up and walking with the physical therapist. CSRS uses Secure Track, a ceiling mounted patient support system designed to assist in fall prevention and stress to the therapist or nurse needing to hold up the patient. The system allows patients to aid their recovery by walking safely and comfortably. CSRS was the second facility in the United States to have this system installed in an outpatient environment.
The harness device is brought to the door of the patient's suite and the patient is assisted into a padded U-shaped device. Patients rest their hands on adjustable handholds and are secured by belts around their upper arms. They walk as the device moves along an overhead track mounted to the corridor ceiling. Patients have the freedom to move forward, backward or turn around while following the track. The device slides on a trolley. Additional assistance from the therapist or nurse is minimal as the support device holds the weight of the patient.
3. Suites are designed for physical therapy, comfort, and positive well-being for recovery. CSRS has private suites providing the patient with a large ADA-approved bathroom and a Murphy wall bed. Wall beds are closed most of the day and allow for full room floor space for physical therapy exercises and ambulation. Open floor space allows for minimal chances of falling or tripping. There is also space allocated for guests to visit. At night the wall bed is open and the suites still provide adequate space for a sleeper chair, allowing a family member or friend to stay with the patient.
The suites also feature Tempurpedic mattresses, telephones, flat-screen televisions with DVD players and wireless access for smartphones and laptops.
4. Medication plan helps keep costs down; pain is controlled with nerve blocks and pain medications. Patients are advised to bring their home mediations on the day of admission. Medications are stored in a bottom drawer of the wall unit in the suite and is kept locked. The nursing staff maintains a medication record for each patient. When it is time for routine mediation or the patient asks for pain medication, a nurse unlocks the drawer and assists the patient in taking their medication. This security allows the patient to keep their own medications close at hand and also prevents additional costs for the facility needing an in-house pharmacy and a pharmacist. The nurse monitors the effectiveness of pain mediation and, when needed, contacts the surgeon for changes to medications or additional medications for control of nausea or other post-anesthesia reactions.
Prior to surgery the anesthesiologist consults with the patient in pre-op regarding post-op pain. The availability of a nerve block procedure, especially for hip replacement procedures, is discussed and if the patient consents, the block is given. During the next 48 hours, the nursing staff monitors the effectiveness of the block as it diminishes in strength and provides oral pain medications as ordered.
5. Not your typical hospital food. Patients at CSRS choose and receive their breakfast and lunch from the Skeletal Metal Café menu, a small café built along with the suites in the same building. The café is contracted and business is run daily by a local vendor called Tropical Smoothie (managed by Southwest Business Management). Dinner is provided by local restaurant favorites within a few block radius of the facility. Patients choose from the restaurant menu, orders are placed by phone or online and are delivered by the restaurants.
6. Fully stocked kitchen and more. Patients and family have access to a multipurpose lounge with a refrigerator, microwave, coffee maker, popcorn maker, snacks and drinks. For those who may wake up during the night and find themselves hungry or for daytime snacking, patients and family can help themselves. Leftovers from dinner can also be stored in the fridge to help with those nighttime munchies.
To provide even more comforts of home, each patient is called prior to surgery and asked about their favorite snacks and drinks, any particular magazines they enjoy or movies they would like to watch. CSRS provides these items for the patient to help them remain comfortable during their stay and ensure maximum focus on physical therapy and discharge goals.
Learn more about Coronado Surgical Recovery Suites.
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