A helping hand: patient need prompts creative, cost-saving solution at Confluence Health

MOSES LAKE - Necessity is the mother of invention and oftentimes the great difficulties that arose during the pandemic gave rise to creative and innovative solutions.

In addition to the more readily apparent challenges of COVID-19, staffing shortages and procedure backlogs were another difficulty facing hospitals and clinics. Testing requirements, delays due to shutdowns, and increased demand led to a lack of available operating room (OR) hospital space in Moses Lake, making it difficult for patients to have access to needed, but non-life-threatening, surgeries. For Dr. Matthew Kai Elliott and Wendy Weston, this wasn’t something they were willing to accept.

“I was motivated to do office-based hand procedures because we were only able to do half the procedures we were previously doing because of a staffing shortage,” commented Dr. Elliott, an orthopedic surgeon with Confluence Health. “I knew hand procedures like carpal tunnel release and trigger finger release were done in-office in many places. In addition to helping these patients get access faster, this would also allow the limited time in the operating room to be reallocated for diagnostic procedures and joint replacement surgeries that really need an OR.”

Rather than having patients undergo general anesthesia, these procedures would be done in an office-like setting with local anesthesia, allowing patients to be awake the entire time, which made it possible to utilize fewer staff in an outpatient setting. This change allowed patients to have the same procedure without having to endure the many difficulties that accompany surgery under general anesthesia. Patients could skip pre-operative testing, wouldn’t have to fast, and could drive themselves home afterwards. Normal surgeries in an OR would require hours of pre-operative preparation, the surgery itself, and then recovery time from anesthesia. This new method eliminated all those additional needs in time, space, and staffing. All in all, procedures could be done in as little as an hour.

“Additionally, this leads to significant cost-savings for the patient and the healthcare system,” continued Dr. Elliott. “I could perform the surgery exactly as I was previously in the hospital, resulting in the same great outcomes with no additional risks.”

That is not to say that this creative solution did not come with its own set of challenges. After observing similar procedures and seeing how it could be done, there was the challenge of finding an appropriate space, trained personnel, and the right tools.

“Initially, we didn’t have a procedure room, but eventually we were able to share some space with our general surgery team at the Confluence Health Moses Lake Clinic,” explained Wendy Weston, practice manager for general surgeons at Confluence Health. “Staff trained with the team in Wenatchee. On our end, we worked to get our space set up, meet the licensing requirements, and collaborate with our health and safety teams. We were lucky in that we have an RN – Tristan Leeder – who has operating room experience, allowing her to take the lead in getting things set up. With the supply chain issues during the pandemic, however, ordering instruments took several months to get some of the items.”

Despite the challenges and hurdles, the group persisted and, in March 2022, the first patient had their surgery performed in a procedure room, returning home an hour later with significant time and money savings in their pocket. Since then, Dr. Elliott and his team have performed nearly 40 of these operations.

“One of the happy additional benefits of these types of procedures is that, since patients are awake and not fully under, the staff get to visit and talk with the patients while they have their procedure, which the staff really enjoy,” reflected Weston. “And most of the patients I have followed up with have been very happy with the overall process. Patients are happier, surgeries are performed more promptly, and OR space is more readily available for major needs.”

“Looking back, the most important take-away for myself was a realization that, even in trying times such as the unique restrictions and challenges of the COVID pandemic, my drive as a physician is to provide care for my patients and to be able to provide procedures that help with their pain and dysfunction,” concluded Dr. Elliott. “And really, that’s what we’re here for.”