Nurse, hospital administrator reminisce about advances in Cape Girardeau medical community

Health care is a major business in Southeast Missouri with hospitals, complexes of doctors' offices, nursing services, home health care providers, laboratories, and a host of ancillary businesses.

Most of it is fairly recent, with medical strides growing rapidly throughout the past few decades.

Dottie Worley, a nurse and surgical project director, has been at Saint Francis Medical Center since 1968. Worley started at Saint Francis as a staff nurse in the operating room at the old hospital building. She was very involved in the relocation in 1976 from the building on Good Hope to the current location. After the move, she became the assistant manager in the operating room, and from there, the director of surgical services, where she stayed for about 17 years. Four years ago she was promoted to surgical project director.

In her years at the Medical Center, Worley has seen Saint Francis undergo massive changes, Sikes said. She was involved in bringing retinal, open heart surgery and neurology into the medical center, as well as the addition of 14 new operating rooms.

Worley provided a list of the changes she has seen in the medical profession.

Medical scene

Thirty to 40 years ago, many physicians took care of everything the patient needed: from the common cold to surgery and even the delivery of a baby. In today's world of medicine, many physicians are much more "specialized" in their care.

Today's physicians have more individuals and better technology to assist them in caring for their patients — nurse practitioners, assistants and technologists, along with MRIs, CT Scans and others.

Nurses used to care for many types of patients on the nursing units. Today, many of the units are much more specialized and many of the caregivers are required to achieve certification or additional education in their field of practice.

Patients used to be hospitalized for a week or more just for testing and procedures. Now, most of these routine procedures are performed on an outpatient basis.

Major procedures, such as a total joint replacement or an abdominal aneurysm, required the patient to be hospitalized two or three days prior to the procedure for preparation. Today, most patients come for pre-admission testing and are admitted for their procedure the same day.

Forty years ago, patients were hospitalized for a week to 10 days after a surgery. Today, when these same surgeries are performed, the patient goes home the day of or within a day or two of the procedure.

When performing surgeries 30-40 years ago, staff was not required to perform the number of quality checks for patients that they do today.

Technology has changed greatly

We have come a long way from having large open incisions, to performing these same surgeries thru laparoscopic ports (openings) using cameras to allow the physician to see and complete the procedure.

Today's technology has taken this another step by using robotics to perform surgery. This technology allows physicians to work through small openings and in tight areas by using very precise instrumentation.

Thirty to 40 years ago, surgical drapes that covered our patients during procedures were all cloth sheets. With technology changes, these drapes now are either disposable or made of special material — both of which are impervious and protect the patient.

Forty years ago, surgeons owned their own set of instruments and used them for all their surgeries. They also brought the implants needed to the hospital. Today, Saint Francis Medical Center is responsible for purchasing the instrumentation and ensuring the correct implants are available for the surgical procedures when needed.

Implants used to arrive at the hospital and would have to be sterilized prior to or during the procedure. In today's world, many of the implants are delivered in a sealed package, sterilized prior to delivery. These packages are double sealed and have information on them including the date there were sterilized and the lifetime of the sterility.

When we talked about flash sterilizing an item 35 years ago, it took a minimum of 30 minutes to perform this function. Today, we are able to accomplish this same process in four minutes using special equipment now available.

When we performed surgeries 30 to 40 years ago, we used a rack of needles that had been sterilized and would thread each needle as the surgeon needed it. Today, we have swedged on sutures (the suture is already attached to the needle) that come from the manufacturer.

We used to use a stone to sharpen our needles prior to sterilizing them. We also had to check the needles and make sure that they did not have a "burr" on them. Today, items are used one time and then discarded.

• Today, many more disposable items are used, and then discarded, as we care for patients to control infection.

From an administrator's point of view, James Wente of Southeast Missouri Hospital said that among the greatest advances and changes have been in technology.

"I remember when they started talking about CAT scanners and what it does," he said. "Now we have a combination PET/CT scanner. Other examples are robotic surgery, the technology cardiologists use to repair damaged hearts. The technology we have to treat cancer is another example. It's absolutely remarkable science has been evolving in the diagnosis and treatment of various diseases.

That technology is expensive, Wente said, and "in health care any technology does not relate to reduction of staff. What it relates to is a requirement of more highly educated specialized staff who can understand this technology and work with physicians to get the best studies and results out of that technology.

"That leads us to the second point which is, I have seen relative to the education requirements of so many employees in our hospital now. There is a built-in redundancy in the hospital to serve as back-up resources in the event of allergies. Not only do we need highly technical people in critical areas such as radiology, the nursing division, cath labs, pharmacy, laboratories, but we even need people who understand the technology and infrastructure that supports the hospital. The maintenance, food service is a very important example of what we do here. The education and experience and quality of the staff have grown along with the technology we're bringing into the hospital."

Some change is not necessarily for the better.

"I am disappointed to say that one of the things we have not been able to do is keep prices down," Wente said. "I'm really not sure how to do that. Like a lot of other hospitals we write off 65 to 70 percent from our books."

Perhaps one of the greatest things Wente added is that in years past so much advanced medicine was impossible to do in this area, and patients had to travel to metropolitan hospitals for treatment. Now so much is done locally, which is less stressful on the patient and on the patient's family, and ultimately less costly for all concerned.