Consents for Surgery

[RussianJoo]

How do you guys handle the issue of no surgical consent and the patient needing a procedure prior to going back to the OR? We typically just end up doing procedures like epidurals, and central lines in the OR so as not to have an "anesthesia delay" for the case, however, a lot of times it's a pain in the butt because now you're rushing to get things done because the surgeon is watching/waiting and this can be dangerous for the patient.

Do you guys get your own surgical consents if the patient seems like they know what procedure they're going to have done? Are your surgeons awesome and get consents in their office and scan them into the hospital EMR? What about blocks? Do you simply just do the case under general and do the block post operatively? This is a daily issue in my institution and since we're a teaching hospital with anesthesia residents this in turn sometimes compromises patient care and doesn't give enough time for the anesthesia residents to practice/learn procedures. It gets really frustrating some days.

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[G0S2]

I call/page surgeon and wait for consent before any pre-op procedure. Simple. Delay is marked as surgeons fault.

 

[jwk]

Our patients cannot go to the OR without a surgical consent, and not having the consent is always the surgeon's fault.

 

[RK.md]

I call/page surgeon and wait for consent before any pre-op procedure. Simple. Delay is marked as surgeons fault.

+1

 

[pgg]

You can't do the surgical consent. That's crazy talk. Our surgeons get it at the preop appointment. I don't think I can remember it ever not being done by the time the patient arrives in preop. Sometimes the H&P is out of date though.

Our policy is to not block people until the RN has done the preop interview and doc check, and part of that is the surgical consent and H&P currency check.

I suppose if you were willing to do the block without any sedation, so as to not addle the patient's brains before the other paperwork, that'd be fine.

Regardless, if there's no surgery consent and that holds up the day, that's a surgery delay, period.


At an academic institution I would have zero qualms about taking my sweet time with a resident to do a block. If the surgeons bitch about it, then you can innocently ask how they'd like to code the delay when they let the med student close. Don't be timid. What are they going to do? Take their patients somewhere else? That patient/surgeon are at the academic place for a reason.

 

[jwk]

If the surgeons bitch about it, then you can innocently ask how they'd like to code the delay when they let the med student close.

Oh, I gotta remember that one!

 

[Ipassgas]

If your at a teaching institution they have an entire team. Nobody is capable of getting consent? Where is the intern, resident or PA?

I'm with everyone else. Their problem is not your problem.

 

[lobelsteve]

I do scs implants and some other procedures in OR. Cannot get case posted without completing 3 forms: h&p, consent, preop lab order with abx, dvt proph, and hair removal q.

 

[RussianJoo]

Thanks guys for the replies. Yeah at my institution if the consent is done at 7:20 for a 7:30 start and we still have to do an epidural or an A-line/central line for the procedure it becomes anesthesia delay and we're expected to bring the patient to the room on time and do it all in the OR. Sometimes we do our lines under the drapes, which I hate doing. The residents/Interns/ PA's don't answer pages a lot of times, and sometimes they have protected lecture time which we can't bug them for. I'll talk to my supervisors to see if we can make it surgeon delay if the consent is done after 7am for a 7:30 start thus not giving us enough time to do our lines/blocks.

 

[Urzuz]

Thanks guys for the replies. Yeah at my institution if the consent is done at 7:20 for a 7:30 start and we still have to do an epidural or an A-line/central line for the procedure it becomes anesthesia delay and we're expected to bring the patient to the room on time and do it all in the OR. Sometimes we do our lines under the drapes, which I hate doing. The residents/Interns/ PA's don't answer pages a lot of times, and sometimes they have protected lecture time which we can't bug them for. I'll talk to my supervisors to see if we can make it surgeon delay if the consent is done after 7am for a 7:30 start thus not giving us enough time to do our lines/blocks.

I have never heard of a culture where they will start draping before the anesthesiologist is ready for the surgery to begin. Even at my training program, the worst it ever got was a surgeon sitting in the corner of the room growing visibly impatient, but I've never heard of them actually prepping and draping before the anesthesiologist gives the go-ahead. Now granted, many times I tell the nurses to prep if all I have to do is an arterial line or PIV and I am comfortable doing them while the patient is being prepped, but at the end of the day that is my decision. If you don't want them to drape since you still have lines to do and think it will interfere with your line placement, you should purposefully contaminate their drapes and tell them to **** off since you aren't ready to begin yet.

 

[pgg]

Sometimes we do our lines under the drapes, which I hate doing.

I don't see how that can get done with the required full body drape, gown, sterility, etc ... if this is routine you might point out that placing lines in this manner isn't in compliance with hospital QI initiatives. Sic the hospital infection control cabal on them.

 

[twoliter]

I'm late to the party, but two points. 1) I can't imagine ever consenting a patient for surgery. Can you imagine trying to defend the lawsuit if you left something out of the consent (no matter how rare) that happened to the patient. Then again, it could/should still fall on the surgeon for performing a procedure without adequate informed consent. But I still wouldn't want to be anywhere in the middle of that. 2) It's certainly not reasonable to ding Anesthesia for a delay for doing something in the best interest of the patient. I could see them wanting you to do it in the OR so as to be in the OR on time (not that it actually makes a difference except for the clipboard holders), but they shouldn't rush you once you're there.

 

[fakin' the funk]

How do you guys handle the issue of no surgical consent and the patient needing a procedure prior to going back to the OR?

Um...if the patient hasn't been consented for the procedure, don't start doing stuff necessary for the procedure (epidural for thoracotomy) and don't do things postop that are necessary for the procedure (epidural for thoracotomy) without a consent! What kind of jacked up surgery/anesthesia culture is this. If an institution has the space and time and staff to do epidural etc prior to (say) a 0730 start, that's great, if not, then you do it at 0730 and don't let the surgeons cut corners on the patient being consented by the surgeons for their surgery !!!

 

[Mman]

Thanks guys for the replies. Yeah at my institution if the consent is done at 7:20 for a 7:30 start and we still have to do an epidural or an A-line/central line for the procedure it becomes anesthesia delay and we're expected to bring the patient to the room on time and do it all in the OR. Sometimes we do our lines under the drapes, which I hate doing. The residents/Interns/ PA's don't answer pages a lot of times, and sometimes they have protected lecture time which we can't bug them for. I'll talk to my supervisors to see if we can make it surgeon delay if the consent is done after 7am for a 7:30 start thus not giving us enough time to do our lines/blocks.

for us...
1) if H&P, consent, and site marking are not done by 715, it's a surgeon delay. Anesthesia delay if all those things are done on time and we aren't in the room by 730. Room delay if all those things are ready and they won't let us bring patient back.
2) if patient needs an epidural and surgeon doesn't get stuff signed till the last second I just bring patient to the OR and do it there so can't be dinged for anesthesia delay

 

[RussianJoo]

This is a culture that was set here by the old group. We're trying to change it. Just wanted to see if things were like this at other institutions.

 

[Pooh & Annie]

This is a culture that was set here by the old group. We're trying to change it. Just wanted to see if things were like this at other institutions.

That has to change ASAP. You guys are getting treated like doormats

 

[Direct Laryngoscopy]

Be a trailblazer and just not do it. They'll (surgeons) not like you after you put an end to the shenanigans, but they will also realize that they're gonna have to step to you properly anytime there is an issue. An if your current Chair doesn't have your back, maybe your in the wrong group. Can't have a resident mentality when your a boss.