In January Anesthesia Service received emergent request from Vascular Surgery to assess the patient urgent surgery. Without delay, we saw the patient in Vascular Surgery Clinic and acknowledge complexity of existing comorbidities, as well as the necessity for additional pre-op assessment and consultations which results are essential to make surgical and intraoperative anesthesia management decisions. On patient's arrival to Same Day Unit (SDU), all Unit healthcare providers were busy accommodating or managing other pre-op or postop patients. I asked SDU leadership for help organizing sort meeting with the purpose to introduce the patient, explain the specificity of the case (URGENT surgery and the necessity to start patient management without delay), as well as the importance of FLEXIBILITY in performing SDU tasks usually applied for patients coming for ELECTIVE surgery. During emergent meeting at SDU I noticed some providers' uncertainty in capability to perform requested tasks in such short time (30 min), as well as deliver timely patient for already arranged STAT pre-op cardiac echocardiography. Mrs. Shchedrin acknowledge urgency of clinical situation, it complexity, time limitations and importance of Teamwork to make necessary pre-op preparation. She told me: "Dr. please, let me know what must be done at SDU, how much time we have to complete our tasks, when the patient must reach the cardiac echo lab and when is urgent surgery START time". I answer Mrs. Shchedrin's questions and was pleased by her help. The patient was appropriately managed at SDU, without delay reached the cardiac echo unit, surgery was performed timely with overall good results. The patient was discharged from VA hospital at Post Operative Day #2. Mrs. Shchedrin's professionalism and dedication is admirable. This is the true way how we must serve to who serve us.

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Recently I was consulted by my colleague regarding a medically complex patient who was immediately booked for urgent vascular surgery. I was promptly re-assigned during a busy OR day to attend this case requiring intraoperative TEE, and I received a comprehensive handoff from my colleague. He informed me that RN Shchedrin had adapted to the urgency of the situation, and she responded with outstanding initiative, focus, and accountability. For this medically complex patient requiring urgent surgery, time was truly of the essence. RN Shchedrin made thorough preparations so that I had the necessary information for the case (STAT preop echocardiography, labs, etc.). The case was uncomplicated and the patient was discharged after an uneventful inpatient admission. RN Shchedrin’s dedication to superior and timely patient care contributed to this outcome, and it sets an excellent example. I am grateful for RN Shchedrin’s outstanding efforts and willingness to prioritize patient care in a time of need.

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Advocacy: Yelena Shchedrin, RN (SDU) has been recognized by multiple providers for her positive demeanor, willingness to assist, and tireless advocacy for our veterans. In her position as the Telephone Nurse in the Outpatient Evaluation Clinic of SDU, she helps to prepare patients and families on what to expect during their preop and postop peri anesthesia timeframe by providing education on everything you can imagine from when to stop taking their medications, to bring their CPAP machines, ensure they get durable medical equipment consults, to expect skin assessments throughout the process, dietary restrictions, and is proactive in speaking about pain management expectations during the peri anesthesia period. While doing her daily duties, she overheard a conversation in which an OEC provider was asking for help from our day of surgery preop & recovery nursing staff. The provider urgently needed help with a decompensating patient being seen in the clinic side of the SDU. As is her work ethic, she exited her office to immediately offer assistance. She took control of the situation, assured the provider and the patient that the unit was ready to help, and proceeded to act on the provider's orders to provide urgent treatment for the veteran. Due to her quick action and advocacy, the patient proceeded to receive lab work and an echo resulting in positive patient outcomes. Ms. Shchedrin exuded advocacy, commitment, integrity, respect, and excellence in this situation as well as in her everyday work without prompting from others. She does not see the division of clinics, duties, and disciplines in the provision of services our unit or the VA provides, but rather, that we are all one community-- all here in service of veterans. Thank you, Yelena, for stepping out of one box, and into another to lead, serve, and advocate for our veterans.