CRNA Pays It Forward During National Public Health Crisis

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By Melissa Ramirez Cooper
Director, AANA Public Relations and Communications

When Hurricane Katrina ravaged New Orleans, Tanya Smith, DNP, CRNA, SMP, said it took a long time to recover. “My kids were young, and we had nothing,” said Smith, a member of the American Association of Nurse Anesthetists (AANA).

It was the kindness of others that aided in her recovery. “Everyone needs help at some point in their life,” said Smith. “And I knew that, one day, I would want to pay it forward.”

That opportunity came earlier this spring when Smith was extended an opportunity to work on the COVID-19 pandemic’s frontline of care in New York. Through her contract with AMSURG, a division of Envision Healthcare, Smith joined the national medical group’s travel team and was assigned to work in New York’s Mount Sinai Hospital in the upper West Side.

“My kids were on board with me going. I had the means and the opportunity to go. I was equipped with personal protective equipment and the appropriate resources, and I was ready.”

When Smith arrived at the hospital, she hit the ground running. “My first two weeks were very busy. I ran ventilator management and tended to the oxygen needs for patients in the COVID-19 unit. I did whatever needed to be done, working in the ER and ICU. Some days, I had 25-26 patients. That’s a lot of patients. I had never seen anything like it.”

In the beginning, little was known about the virus, and medical care was based on evolving knowledge. “We had to work to prevent the spread, protect patients and healthcare workers. We did everything to care for patients —I would go six to eight times a day from changing bipap to high-flow nasal cannula,” said Smith,” working to keep patients off ventilators and get them back to baseline to prevent damage and lung trauma.”

“Patients only have you to care for them and be at their side.  Some patients could not communicate. The enormity of the situation was overwhelming,” said Smith.

To help her through, Smith had a support system. “I had a lot of people to help keep me going.”

“It’s great that we have received so much support and that nurses are being recognized. But it’s hard for people to truly understand all the work that we do. We gave our all, and when a critical patient was able to leave the hospital, it was an accomplishment.”

As hospitals across the country continue to deal with the pandemic, CRNAs continue to care for critically ill patients. Their unique skills and expertise have allowed them to step forward in a way only a few others can, leading the way in advanced airway and ventilation management that has been essential in addressing the virus. During state emergencies federal and state governors temporarily removed barriers to CRNA practice, further reinforcing the need to utilize CRNAs at the full extent of their education and training.

During her time in New York, Smith admitted to being concerned for the public’s health and safety. “The virus does not discriminate and impacted people differently. But it was important to help. It’s important for everyone to help. You don’t necessarily have to go to the frontlines; it can be in so many other ways, but it’s important to help people.”

Smith completed her work in New York mid-May. While the experience will remain with her, one thing the pandemic has shown her is that, “There is good in everybody.”

CRNAs’ Expert, Diverse Skills Indispensable During Public Health Crises

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By Melissa Ramirez Cooper
Director, AANA Public Relations & Communications

Samantha Heavrin, CRNA, MBA, was among one of the first to arrive in New York City to serve on the COVID-19 pandemic’s frontline of care. Assigned to work at The Mount Sinai Hospital on Madison Avenue, Heavrin had three “identities” for her computer sign-in: nurse, advanced practice nurse practitioner, and Certified Registered Nurse Anesthetist (CRNA).

“Later in my deployment, I was also given a fourth identity as respiratory therapist,” said Heavrin, a member of the American Association of Nurse Anesthetists (AANA) who is chief of anesthesia at an ambulatory surgery center in Louisville, Ky. Through her contract with AMSURG, Heavrin was part of about 200 Envision clinicians who deployed to the greater New York City area to provide care.

“At Mount Sinai, we did whatever was needed, and that was true for all healthcare workers across New York City,” she said. “Whether it was changing drips, running labs, getting materials, or turning a patient, all of us worked outside of our traditional roles.”

Heavrin said her entire anesthesia team took on multiple responsibilities. “There was so much to be done to care for patients impacted by COVID-19,” she said. “We also served on ‘proning’ teams, which is a process of turning patients onto their stomachs so they can take in oxygen better. It can be a difficult process to have intubated patients move onto their stomach, but it made a huge different for patients to oxygenate, and our proning teams were great.”

Throughout the pandemic, tens of thousands of CRNAs like Heavrin were readily available to serve. CRNAs are expert clinicians with advanced specialized skills in airway management, ventilator support, vascular volume resuscitation, and advanced patient assessment. Because of their diverse and unique skillset, CRNAs have been utilized as advanced care providers and regarded as vital members of the nation’s critical care workforce. During the COVID public health crisis federal and state governors have temporarily removed barriers to CRNA practice, enabling them to practice to the fullest extent of their education and training.

Alongside her colleagues at the hospital, Heavrin had friends deployed in other parts of the city. “One of my nurse practitioner friends worked in tents set up in Central Park. When we looked out the window, we could see these MASH-type units set up by the military to triage patients.”

Heavrin is thankful to her employer for the support services extended to clinicians, which included, among many things, traveling logistics, supplies of personal protective equipment, and mental health and wellness resources.

“When we left New York, we had to go into quarantine for two weeks. We were encouraged to do video calls and talk about our experiences with our clinician peers. We were also provided resources and information. It was during quarantine when we really processed our experience, talked and cried.”

Since returning home to Kentucky, Heavrin and her friends journaled about their time in New York and wrote a book chronicling their experiences.

“It Was Like Going Off to War”: CRNA Shares Experience of Working in NYC During Pandemic

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By Melissa Ramirez Cooper
Director, AANA Public Relations & Communications

When Jeremy Carlisle, CRNA, flew from Springfield, Ore., to New York City, he was struck by how few people were on his flight. “Maybe there were 15 of us on a 200-seat airplane.” Carlisle, a member of the American Association of Nurse Anesthetists (AANA), was on his way to serve on the COVID-19 frontlines of care.

With elective surgeries on hold, Carlisle was one among many Certified Registered Nurse Anesthetists (CRNAs) in the Portland area without patients. Still credentialed with AMSURG, a division of the national medical group Envision Healthcare, Carlisle received an opportunity to work in New York. Within three days of that call, he was en route to New York’s Mount Sinai Beth Israel Hospital, located in Manhattan's Lower East Side.

When Carlisle arrived, the hospital was determining the roles of each healthcare provider tending to patients impacted by the virus. “Given my experience in anesthesia and critical care, I was able to help provide care in the ICU.”

Since the start of the pandemic, tens of thousands of CRNAs have cared for critically ill patients. Their unique skills and expertise have allowed them to step forward in ways essential to addressing the virus that few others can, particularly in advanced airway and ventilation management, vascular volume resuscitation, and advanced patient assessment. During state emergencies, federal and state governors temporarily removed barriers to CRNA practice, further reinforcing the need to utilize CRNAs at the full extent of their education and training.

“When I first arrived, New York was experiencing some of its worst weeks statistically with the number of admissions and deaths,” said Carlisle. “Almost all of the patients at Beth Israel were COVID-19 patients.”

While healthcare teams were working relentlessly, “doing everything possible to care for patients,” said Carlisle. For him, the hardest part was “that patients didn’t have their family members to visit them or be with them at their bedside. We set up video calls and made other connections for patients and families.”

“I was in the military, and the situation in New York was somewhat like going off to war. It was going to the battlefield and wondering if you were going to come back,” said Carlisle. “The scale and intensity of the situation was different and unlike anything I had experienced,” he said.

“I asked God every day to help me, my family and my patients.”

“One story that continues to stay with me was a patient and her granddaughter, with whom I built a friendship. The granddaughter shared with me how grateful she was for the care we provided her grandmother,” recounts Carlisle.

“On one of the last days before I left, the granddaughter came to me and [offered to buy me] breakfast. I told her that it wasn’t necessary, but she told me to go have breakfast and to think about her and her family. I will never forget that. I will never forget the love she had for her loved ones.”

Patient Safety a Top Priority Amid COVID-19 Pandemic

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COVID-19 has had far-reaching impacts on our lives, with medical procedures and surgeries deemed “elective” and postponed in order to slow the virus’s spread. In reality, these procedures are far from optional: delaying medical interventions can result in increased health problems, such as later-stage cancer diagnoses.

Increased Patient Safety Measures to Combat COVID-19

In recent weeks, our ambulatory surgery centers (ASC) have resumed elective cases and implemented a number of protocols to ensure patient safety. These measures include:

  • Screening everyone who enters our surgery centers for COVID-19 symptoms
  • Taking the temperature of every person who enters our surgery centers
  • Requiring masks for all employees and patients
  • Enforcing social distancing guidelines
  • Requesting patient escorts remain in the car until patient is ready to go home
  • Increasing cleaning of high-touch surfaces throughout the day
  • Providing hand sanitizer and tissues

Learn more about all of the steps our ASCs are taking to keep patients safe.

Patients Feel Safe at Our Surgery Centers

Patients who have already returned to our ASCs have first-hand experience of the new protocols in action. Their feedback has been extremely positive, with reactions like:

“During this COVID-19 time, I was especially nervous about my procedure but was immediately greeted by the friendliest nurse around. She was very courteous and kept asking if I was fine. She prepared me for the procedure by carefully doing everything that needed to be done and listened to me. The rest of the staff was also very professional and took great care of my needs. Thank you all for a great experience that I hopefully won’t have to repeat for a while.” – San Antonio, April 2020

“Even during these crazy times, I was treated with the utmost respect, courtesy, and care. My doctor and her amazing team took the necessary steps to make sure I wasn’t put at greater risk during my procedure. They ensured all my questions were answered, and I was 100% ready going into and out of the procedure.” – Escondido, April 2020

“Every social distancing precaution that I have learned was practiced from the front entrance to the check-in desk to the exam rooms to my time with my doctor and my exit. They were all efficient and caring before the virus and that certainly was the case at this visit also.” –  Knoxville, May 2020

We All Have a Role to Play

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NASHVILLE, Tenn. – This week, Envision Healthcare sent the following communication from CEO Jim Rechtin to all employees about the death of George Floyd, the protests taking place across the country and how we all have a role to play in building a more just society.

Read the full letter here.

AMSURG Develops Toolkit to Guide Ambulatory Surgery Centers in Providing Safe, Quality Patient Care

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NASHVILLE, Tenn. – AMSURG, a division of Envision Healthcare and national leader in the management of ambulatory surgery centers (ASC), has developed guidelines to support the delivery of safe, quality outpatient care as communities begin resuming elective procedures during the COVID-19 pandemic.

“Quality patient care is always our top priority, and following clinical best practices, along with federal and local guidance, will help ensure the safety of our patients and clinicians as we resume elective procedures during this public health crisis,” said Dr. Chan Chuang, Chief Medical Officer of Envision and Co-President of AMSURG. “Ambulatory surgery centers are an integral part of the healthcare delivery system, providing quality care at a significantly lower cost and in a more convenient setting than many alternative care sites. The services we provide are essential in helping patients maintain their health and quality of life, and these procedures can be resumed safely in some communities.”

The guidelines developed by AMSURG clinical and quality leaders provide the organization’s network of more than 3,700 physicians and more than 250 ASCs with recommended processes to ensure clinician and patient safety. The best practices include:

  • Screening patients diligently. In addition to conducting a thorough patient screening for the appropriate elective procedure, ASCs are screening patients for COVID-19. All clinical staff members are also screened daily.
  • Educating patients. In addition to traditional pre-procedure education, AMSURG ASCs are educating patients on precautions the center is taking to protect patients and staff. Education also includes information about patients’ role in their health and well-being.
  • Implementing social distancing precautions. ASCs are scheduling more time between procedures to enable appropriate social distancing during patients’ care journeys and thoroughly clean treatment rooms and equipment.
  • Continuing to adhere to high clinical quality and safety measures. Clinicians and clinical staff are following strict clinical guidelines, including screening for COVID-19, using appropriate personal protective equipment and following stringent cleaning protocols.

Since the outbreak of COVID-19 in the U.S., AMSURG ASCs have complied with all local and federal guidelines and been a part of efforts to mitigate the spread of the virus and support patient care. Some centers have aligned with hospitals and state agencies to distribute critical resources like personal protective equipment and ventilators to areas of greatest need. Other centers have continued to provide essential care to patients – when it was medically necessary not to delay a procedure – including a colonoscopy to detect and remove cancerous polyps and urgent orthopaedic and retina procedures to improve patients’ quality of life.

Envision, along with AMSURG, has taken a leading position in responding to America’s call for COVID-19 care. The medical group’s actions to support clinicians, healthcare partners and patients include:

  • Mobilizing to meet the need for more physicians and advanced practice providers across the nation. Envision is providing support to 55 medical sites by deploying more than 500 clinicians to care for COVID-19 patients. Anesthesiologists and certified registered nurse anesthetists from the anesthesiology provider team are already on the ground to meet unprecedented demand for care. Clinicians will continue to be deployed to address surging hot spots across the country.
  • Securing more than 5 million items of PPE, including masks, face shields, gowns, and goggles to support Envision’s clinicians and hospital partners. This PPE is being delivered to areas of greatest need.
  • Treating every patient regardless of their ability to pay. Envision has committed to working with all parties to ensure no COVID-19 patient is burdened with unexpected costs. We will not send patients surprise medical bills and will work to ensure patients are only responsible for in-network cost-sharing.
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About AMSURG

AMSURG acquires, develops and operates ambulatory surgery centers (ASC) in partnership with physicians throughout the United States. As of January 1, 2020, AMSURG owned and operated 257 ASCs and one surgical hospital in 34 states and the District of Columbia with medical specialties ranging from gastroenterology to ophthalmology and orthopaedics. To learn more about AMSURG, a division of Envision Healthcare Corporation, visit www.amsurg.com.

About Envision Healthcare Corporation

Envision Healthcare Corporation is a leading provider of physician-led services and post-acute care, and ambulatory surgery services. The Company delivers physician services, primarily in the areas of emergency department and hospitalist services, anesthesiology services, radiology/tele-radiology services, and children’s services to more than 1,800 clinical departments in healthcare facilities in 45 states and the District of Columbia. Post-acute care is delivered through an array of clinical professionals and integrated technologies which, when combined, contribute to efficient and effective population health management strategies. As a market leader in ambulatory surgical care, the Company owns and operates 257 surgery centers and one surgical hospital in 35 states and the District of Columbia, with medical specialties ranging from gastroenterology to ophthalmology and orthopedics. In total, the Company offers a differentiated suite of clinical solutions on a national scale, creating value for health systems, payers, providers and patients. For additional information, visit www.envisionhealth.com.

Colonoscopy Aids Patient’s Health Outcome as COVID-19 Crisis Ensues

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On Friday, the Florida governor ordered all hospitals and ambulatory surgery centers to cease all elective surgeries due to COVID-19, leaving surgery centers like ours to decide which procedures are considered an emergency. Making these decisions are not easy for our physicians. Each decision is painstaking, having to determine the medical necessity of each procedure on a case-by-case basis.

COVID-19, the new invisible disease, arises in addition to another daily invisible disease – colon cancer. March is Colon Cancer Awareness Month and although this fight is understandably taking a back seat in its importance, it is still a very real killer.

Earlier this week, at Space Coast Endoscopy Center in Rockledge, Florida, a 37-year-old woman began showing somewhat benign symptoms of possible rectal cancer. Feeling that overlooking her symptoms and delaying a colonoscopy could mean dire consequences, our physician performed the procedure. Upon completion, our physician diagnosed her with rectal cancer. If our center were not open to proceed with her procedure, it may have been months before she had her colonoscopy, drastically changing her life story.

Colon Cancer Kills, Too

Colorectal cancer is the second-leading cause of cancer death among men and women combined in the U.S. There will be an estimated 147,950 new cases of colorectal cancer in 2020. 1 in 20 people will be diagnosed with colorectal cancer. 1 in 3 people are not up-to-date with colorectal cancer screening.

Symptoms of colorectal cancer may include

  • A persistent change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
  • Rectal bleeding or blood in your stool
  • Persistent abdominal discomfort, such as cramps, gas or pain
  • A feeling that your bowel doesn’t empty completely
  • Weakness or fatigue
  • Unexplained weight loss

If you believe you are experiencing any of the following symptoms, it’s important for you to schedule an appointment with a gastroenterologist immediately.

How Our Center is Protecting Patients from COVID-19

Our staff continues to be diligent in keeping patients safe during this pandemic. Our center has implemented the following standards:

  • Prescreening Patients via the phone and text message
  • Screening our staff
  • Asking all patient caregivers to wait outside
  • Reassessing our patients and taking their temperatures upon entering our facility
  • Social distancing our patients in our pre/post procedure area
  • Wiping down our facility twice a day or more per the recommended CDC guidelines
  • Wearing N-95 masks per recommended NETEC and CDC guidelines
  • Waiving up-front payments for procedures unless a patient wants to pay

Yes, procedure numbers are approximately a quarter of our usual caseload, yet we continue to play a vital role in our community as we abide by local/state health department guidelines while readying ourselves to assist however we can. We remain connected with the local police and fire marshal, assuring them of our support as they are truly on the frontlines of this pandemic. We have also reached out to a local nursing home, where one of our staff members works aside from our center, providing an encouraging note and a prepackaged goodie for their patients if their diet permits. In continuing to give, we all feel truly blessed.

On National Doctors’ Day, AMSURG Celebrates the Role of ASCs During the COVID-19 Crisis

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March 30 is National Doctors’ Day, and AMSURG would like to thank the 3,700 physicians who practice in our more than 250 partner centers across the country. Every day, you partner with patients to prevent colon cancer, repair vision or improve their quality of life with orthopedic solutions. The important work you do to deliver high-quality, patient-centered has never made a bigger impact in the communities we serve than now in the midst of the COVID-19 crisis.

Ambulatory Surgery Centers (ASCs) play a valuable healthcare delivery role in this pandemic. As hospitals care for critical patients, ASCs can offer safe, high quality surgeries to patients who need emergent and urgent procedures.

AMSURG values its partnership with you and the work we do to ensure the continued safety of patients and physicians alike. With communities on high alert due to COVID-19, AMSURG is leveraging its resources to equip its center partners with clinical best practices to prepare for and protect patients from the virus.

“The commitment you show to your patients is awe-inspiring, but as your partner, we are equally committed to supporting our physicians,” Chan Chuang, AMSURG Co-President, said. “You do incredible work every day, and we will continue to support that work and ensure the safety of both physicians and patients,” added Teresa Sparks, AMSURG Co-President.

Happy Doctors’ Day. You are our Healthcare Heroes, and we are so proud to partner with you.

Help Us Celebrate Healthcare Heroes

We invite you to join us in celebrating Healthcare Heroes by posting a video of yourself thanking physicians for all that they are doing to maintain our country’s healthcare safety net during the COVID-19 crisis and use the #HealthcareHeroes hashtag.

Our organization is honored to celebrate the work of these men and women as they demonstrate a willingness to stand united in their commitment to patient safety and well-being. We thank you for everything you do to care for communities and help contain the spread of COVID-19.

GI Nurses: Advocates for Population Hesitant to Care for GI Health

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GI Nurses and Associates Week is March 22-28, and AMSURG is proud to recognize the work of GI nurses and associates at partner centers around the country.

Jimmy Dottolo, MSN, RN has served as center leader for the Louisiana Endoscopy Center in Baton Rouge, Louisiana, since 2010. Dottolo manages operations for a staff of more than 80 employees responsible for nearly 33,000 procedures a year.

A former emergency department nurse, Dottolo said his transition to GI nursing and the important role GI nurses play caring for the general population provided an eye-opening education. “GI nurses are advocates; we work with a population that is hesitant to take care of their GI health, so we are constantly working to educate and increase awareness that the GI diseases we see are detectable and preventable.”

GI nurses are vital to the delivery of quality care at AMSURG partner centers. “They are the first wave for patients at our centers; GI nurses prepare patients physically and emotionally for procedures, and it is their passion and knowledge that helps patients through the process,” AMSURG Regional Vice President, Operations Erik Hamnes said.

Passion is a shared trait among GI nurses and associates, many of whom have dedicated their lives to advocating for the necessity of potentially life-saving colorectal cancer screening procedures. Last year alone, AMSURG’s more than 180 endoscopy partner centers performed more than 600,000 colonoscopies.

Robi Rhodes, MSN, RN, is Director of Nursing for MGA GI Diagnostic and Therapeutic Center in Marrero, Louisiana. With three locations in the New Orleans Metropolitan area, MGA and its clinicians are responsible for over 2,000 colonoscopies a month.

Rhodes, who is responsible for overseeing the daily operations of 70 nurses and support staff, said misconceptions regarding digestive health – and the role GI nurses play – persist. “When I tell people that I’m a GI nurse, I still sometimes get that sort of ‘Wow, why did you go into that specialty?’ response,” Rhodes said. “But being a GI nurse, I understand how important the work we do is and how important gastrointestinal health needs to be for our population.”

“A lot of people still don’t understand the reality of things like colorectal cancer, so I’ve been able to use my profession as a conversation starter for discussing GI health with my friends and family,” Rhodes explained.

As a center leader, Rhodes works closely with AMSURG to ensure MGA meets the needs of its community. The operational and strategic support AMSURG provides, Rhodes said, has allowed both he and his clinicians to better focus on their patient population.

“I've talked to directors who operate independent centers, and something I always hear is that the responsibility is all on their shoulders,” Rhodes said. “But having AMSURG as a partner means they’re here to help me – whether it be with day-to-day operations, clinical questions or administrative support, you name it.”

Dr. Edward Esber and a Patient’s Family Promote Colonoscopies in the Battle with Colon Cancer

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AMSURG Partner Gastroenterologist, Edward Esber, M.D., FACG, FASGE, and the McCool family recently shared their story of battling colon cancer. Tracy’s husband, John, was diagnosed with stage four colon cancer in the fall of 2018. In hopes of encouraging others to take action now before it’s too late, Tracy is sharing the message of early screening. “Don't put off that colonoscopy… It’s not complicated, it’s a simple procedure and it really does save lives.”

Click here to view the complete video interview.

To learn more about Dr. Esber and the Digestive Health Center in Akron, Ohio, visit dhcakron.com.