Judith L. Clayton, a clinician and an educator at Gwinnett Medical Center–Duluth, has been a perioperative nurse for 33 years.

"I've been a staff nurse, a scrub nurse, an educator, shift manager, supervisor and director — all in the same specialty," she said.

Barry Williams/Special (ENLARGE)

Nurse Judith L. Clayton, uses an operating room monitoring-integration system at Gwinnett Medical Center–Duluth. The hospital is completely digital.

In the process, she has seen surgery go "from the dark ages to the future."

Clayton, RN, CNOR, believes in progress. When Joan Clancy Hospital was closed and the staff moved into the new, all-digital Gwinnett Medical Center–Duluth in October 2006, she was willing to add one more entry to her résumé: superuser.

Clayton was trained on the new hospital's technology so she could teach staff nurses how to use it and how to troubleshoot problems.

"We knew that wireless and all-digital systems were the wave of the future, so we decided to build it into the building from the get-go, rather than having to go back and do it later," Clayton said.

The new hospital's OR suite has three 850-square-foot, fully integrated operating rooms. At the old facility, electronic OR equipment was plugged into carts or sockets on the floor, but now light sources, cameras, computer monitors and even CD players are anchored to overhead booms with electrical cables plugged into the ceiling.

"Everything is on the boom, and that really minimizes clutter. It's a more organized operating room and eliminates the hazard of all those cords everywhere," Clayton said.

Because booths can be shifted and swiveled over operating tables, they are placed in the best position for each surgery.

"When laparoscopic procedures were first done, only the surgeon could look through the scope to see the field," Clayton said. "Now a digital camera attached to the scope projects a live image to a monitor for everyone to see."

The high-definition monitors can be programmed to show X-rays or lab results. Nurses use touch-screen technology to control and change monitors for surgeons.

"Using a split screen, a surgeon can see a live image and [an] X-ray of the hip that needs pinning," Clayton said. "I can remember when X-rays had to be developed and we had to send someone down to the file room to retrieve them for the surgeon. Now we store images digitally, and I can pull them up on a computer wherever I am."

New technical efficiencies come into play as soon as a surgeon schedules a procedure. A computer program generates a resource map, which lists everything that will be needed, including staff, equipment, and a surgeon's preference of sutures and instruments.

"Now, with three rooms, we can do block scheduling. A doctor can do five joint replacements [back-to-back] by using two separate teams and shifting from one room to the next," Clayton said. "It's more efficient for doctors to be able to operate on specific days and also allows us to increase the use of our facilities."

In its first year, Gwinnett Medical Center–Duluth increased inpatient surgeries by 61 percent over 2006 figures.

In February 2006, the hospital moved to all-computerized charting. Clayton arranged for in-service training for the staff and helped nurses make the transition after the technology was up and running.

"Some people are more comfortable with the computer than others. Some had to practice more or get more help, but those who had more trouble making the switch say they wouldn't want to go back to paper charting," she said.

Electronic charting is more concise, more complete and more legible, Clayton said.

"It's easier to go through everything step by step and catch things with electronic charting. There are lots of checks and balances in the system, so that you don't forget things," she said.

Consistency makes it easier for a floor nurse to see exactly how an OR nurse treated a patient postoperatively, and that improves care.

"We can get information out on our patients so much faster," she said.

Nurses can record vital signs directly into the chart by using a COW (computer on wheels) while they're with a patient.

"The program is step-by-step, so it's easy to go through. There are checks and balances for safety and triggers to remind you to do things," she said.

The hospital's nurse practice committee has recommended adding more links to the documentation system, so that a nurse might check it for drug interactions, for example.

"The wave of the future is to have more tools that you need right there," Clayton said. "I personally believe that electronic charting takes less time and gives me more time with my patient, and that's what you want as a nurse."