When the Parnassus Outpatient Surgery Center (POSC) opened in September 2021, it revived a location that had been closed since 2015 due to declining volumes. “Medical advances have enabled us to do so much 
more in the outpatient setting and UCSF Health leadership realized we have a huge opportunity,” says Co-Medical Director Tyler Chernin, MD, from the UCSF Department of Anesthesia and Perioperative Care.
Chernin, along with Co-Medical Director Thomas Chi, MD, a urologist, and Executive Director Debbie Gee oversaw the effort to modernize the space with the backing of UCSF Health Senior Vice President and Chief Operating Officer Sheila Antrum, RN, MHSA. Today, four operating rooms, two procedure rooms, up-to-date surgical equipment, and a joyful culture have generated a dramatic uptick in volumes and sky-high patient satisfaction scores.
Growing Volumes Reflect Safety, Efficiency
Though UCSF’s surgeons and other perioperative clinicians have long wanted a dedicated outpatient facility, getting the center up and running required that people change their established practice patterns. In addition, the COVID-19 pandemic has periodically suppressed volumes.
“But we did a lot of outreach and learned from the first [COVID] wave that we can continue doing elective surgeries as long as we’re smart about it,” says Chernin. After doing 28 surgeries in its September 2021 opening, in April 2022 the POSC completed 188 surgeries, 49 procedures and 11 liver biopsies. Ophthalmology, general surgery, urology, gynecology, otolaryngology, neurosurgery, and plastic surgery make up the majority of those procedures.
“We’ve also started providing anesthesia for electroconvulsive therapy, bone marrow biopsies under anesthesia and liver biopsies without anesthesia,” says Chernin, who in his first stint as a medical director, has participated in everything from planning through purchasing equipment and consumables and defining patient criteria. “Because UCSF is a quaternary center that services a medically-complex patient population, one of our main challenges has been developing realistic patient selection criteria for the outpatient setting without compromising patient safety.”
Written guidelines for the POSC’s surgical partners combined with a dedicated preoperative screening process through PREPARE and the usual day-of-surgery check by the anesthesia team ensure the appropriate screening processes are in place for an expanding list of potential patients. Chernin says, “I’m proud that we have been able to move the needle a bit towards providing safe anesthetic and surgical care to a more complex patient population than is typically seen in outpatient centers.”
Much of the POSC’s success depends on moving its complex patients efficiently through all stages of their procedures so they can get back home quickly and comfortably. To that end, anesthesiologists and CRNAs at the POSC deploy a variety of techniques – including aggressive anti-nausea prophylaxis, total intravenous anesthesia, local anesthesia and optimized, multi-modal pain control.
A Focus on Culture
Another contributor to safety and efficiency is a collaborative, well-trained staff that has broken down some of the traditional operating room hierarchies. “Everybody helps out, no matter our role – opening doors, bringing in stretchers, putting on blood pressure cuffs. Everyone here – nurses, CRNAs, environmental staff, everyone – has been fully invested from day one and we frequently hear how happy and engaged our staff is,” says Chernin, noting that staff engagement is typically tied to improved clinical outcomes and patient satisfaction. “When surgeons come here it’s what they notice.”
So do patients. The attentive staff has combined with a clean facility suffused with natural light and ample patient privacy to garner impressive Press-Ganey scores: almost 90 percent of patients say they would recommend the facility.
It all speaks to the culture Chernin and his colleagues have created, perhaps his proudest achievement. “We really set out to make it a delight to come to work,” he says.
Written by Andrew Schwartz