Musculoskeletal Center Opens Doors

When she was an undergraduate on the women’s crew team back in 1976, Mary O’Connor and her 18 teammates one day became sick and tired of shivering after practice. Yale University had not gotten around, under Title IX, to provide women their own lockerroom.

So one day they marched up to the powers that be at Yale athletics, stripped off their sweats to show just what shivering, cold, and naked looks like.

The next semester and a New York Times story later, women had their own locker room at Yale, and O’Connor had learned the power of team work.

The now Dr. Mary O’Connor, orthopedic surgeon and professor of orthopedics and rehabilitation at Yale Medical School, has brought that lesson of teamwork home as the inaugural director of the Center for Musculoskeletal Care (CMC) at Yale New Haven Hospital’s Saint Raphael Campus.

Having broken ground in the spring of 2017, the center recently opened for business specializing in ambulatory, same-day surgery on spines, hands, ankles, and feet. Some 295 operations have successfully taken place since August.

A red-letter moment comes this Monday when surgeons will perform same-day surgery in more complex cases involving hips and knees.

A $7 million investment, the center comprises six operating rooms, 23 prep and post-operative recovery beds, an eight-seated patient alcove, therapeutic evaluation for return home (and an overnight stay at Saint Raphael’s if patients are deemed not ready), a physical therapy room immediately adjacent to the recovery rooms, and the rollout of a remote rehabilitation program called VERA, for Virtual Exercise Rehabilitation Assistant.

“I am committed to the concept of a team, and my role as inaugural director of CMC is to create teams in order to break down the silo-ed approach to medicine that has existed in academia,” and beyond,” she said.

As a one-stop orthopedic surgical shop, the CMC features surgeons with different specialties cheek by jowl with nurses, physical therapists, pain and movement specialists, physicians assistants, and others so patients can be treated in a comprehensive and efficient manner to avoid surgery. Surgeons are on hand too if you do need surgery, often with patients able to go home within a day.

Heretofore patients wanting same-day surgery would have to go to other towns. Now CMC has satellites in Stamford, North Haven, Old Saybrook, an office in Long Wharf, but the headquarters is on the Saint Raphael campus, part of the hospital’s McGiveny Surgical Center at 659 George St.

“One of the reasons we can do same-day surgery is because we are getting better and better at pain management,” O’Connor said.

“We have surgeons who are doing cutting-edge research on, for example, nerve blockers, that is, the use of small amounts of anesthesia carefully placed around the nerve; that minimizes more general anesthesia, recovery from which delays a return home.

Another major advantage of CMC — besides the specialists all working on the same floor, as a team — is its attachment to a full hospital, in case of emergency snafus.

A physical therapy area adjoins the post-op rooms. ​“We’ve elevated the game,” said physical therapist Roland Perreault, ​“by giving instructions right away” to both the patient and to the family. Those instructions might have to do with stair climbing at home, or managing appliances.

Whereas in most hospital or post-surgical settings, it is the nurse who assesses safety concerns for a patient on discharge, not so at CMC. ​“Can a nurse assess safety of ambulation? We love our nurses, but a physical therapist can do this better,” O’Connor said.

She also said that as plans for the spiffy new facility evolved there were the to-be-expected battles of priorities. ​“There’s always a fight for space. ​‘We are not giving up this room,’ she reported, of the physical therapy space. ​“This is part of our vision. Not physical therapy on another floor,” but all the specialists working together.

In short, that team again.

O’Connor recollected that had just a single member of her long-ago Yale crew, even the captain alone, gone up to the director of Yale athletics, change would not have occurred. Or not so quickly. The whole team had to act as one.

Dr. Ray Walls praised the experience for both patient and for surgeons like himself. The ORs are large enough for any equipment he needs to bring in, he said.

There are dimable lights and calming music as part of the experience for the patient. There are screens everywhere so that Walls can see his X‑rays before the procedure and what he is doing during the procedure. Each OR has a nursing station as well as a small desk where surgeons can work while patients fall asleep. In many OR settings, operating room nurse Jessica DeLucia explained, the doctors and nurses sometimes have to jumble their stuff together.

All the ORs are ​“mindfully ” designed, said DeLucia. For example, the outlets for equipment, including the tubing for the anesthesiologists’ oxygen and other chemicals, emerge from fixtures near the ceiling. That eliminates cords across the floor, and frees up the room for equipment and people to move without danger.

“Less waiting, less downtime, we’re dedicated to maximizing surgery,” Walls said.