CRNA lead Cardic Anestheia Dept

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sevoflurane said:
Yup. In a malignant environment that might be the case. Any cardiology group that works for a hospital should have enough balls to say no. This is a VERY unusual setup.
I don’t think I’ve ever had a cardiologist in the CT room in 10+ years (probably since residency). I definitely have never seen a cardiologist at 3am during a Type A dissection. Good luck having a nurse identify a true and false lumen. Mess that up and you could easily kill the patient.
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Not only that, but think about the other issues that arise with CT - severe protamine reaction causing near immediate cardiac collapse? Blood transfusion reactions? If they are anything like the CRNAs I deal with a on a regular basis, how will the ICU deal with 4L of crystalloid infused each case? Cardiologists would be helpful with the echo, but not with intraoperative care as much.

Side note - I am sure that if the hospital is too cheap to employ real CT anesthesiologists (or even regular anesthesiologists) then I’m sure they dont have in house ICU either. State and national societies can’t act unless it’s revealed which institution this is - from a patient care perspective, I think if people know of this going on then you have a duty to report it at least privately to these groups if not publicly on forums like this.
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Hamhock said:
I think for all the chest pounding anesthesiologists do about this, there is little action when situations like this come up.
So far the hospital hasn't even been named!
Until that is the case and until more facts are released, this is all just a hypothetical that is getting emotional responses on the interwebs.
HH
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It’s actually a fact jack, guy I tried to hire took this position instead. I know all the deets
 
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Man o War said:
Yep. This is why you don’t see widespread solo CRNA use in non critical access hospitals. The day rural pass through applies to both CRNAs and anesthesiologists, things will start changing in the country. The CRNAs want to act like they’re the preferred provider in the country because of their super special nursing educations....
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Are hearts done in critical access hospitals? And somehow I don't think a place that's doing 300 a year is all that rural. Maybe it depends on your definition of "rural".
 
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sevoflurane said:
What cardiologist wants to come in and do TEEs first thing in the morning and in the middle of the night? TEEs pay is negligible.

Cardiologist that sign up for this ridiculousness are getting a bad deal as well. RVUs generated for the availability is not worth it IMO.

Sounds like administrators poor decisions will lead to them being replacement at some point.
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Economic pressures on administrators have never been higher. The tension at my shop among them has never been worse. Their jobs are on the line if they don’t improve the financials. They are very simply making hard decisions and taking risks to keep their jobs and/or the doors open. Of course those risks sometimes show up and wind up hurting patients-not them.
 
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a rural (did someone say critical access pass-through?) hospital doing 300-350 hearts a year? With only 1-2 CRNAs on call 24/7? I call BS, and if true, that’s destined to be short lived.
 
jwk said:
Are hearts done in critical access hospitals? And somehow I don't think a place that's doing 300 a year is all that rural. Maybe it depends on your definition of "rural".
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You know... that Rural NYC hospital..
 
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Critical access is always rural, rural is not always critical access. I would need the name of this hospital to be able to tell if they’re getting pass through funds for CRNAs.
Rural is definitely subjective, and some of these hospitals do highly questionable acuity based on the infrastructure they have in place IMO.
 
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chocomorsel said:
I thought rural pass through was geared towards CRNAs in this instant. Do doctors outside of anesthesia benefit from this?
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The short answer is yes but I'm just too damn tired to explain all the details.
 
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jwk said:
Are hearts done in critical access hospitals? And somehow I don't think a place that's doing 300 a year is all that rural. Maybe it depends on your definition of "rural".
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Who said anything about critical access? It’s not. I said “somewhat rural”. I’d say the facility if I didn’t want you pricks to know where I reside
 
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300-350 hearts isn’t a lot for a year for a hospital. U figure 1-2 hearts a day.

They will have a lot of selection bias so can cherry pick the heart cases. The sicker ones will get sent out.

Couple of questions
1. CT surgeon hospital employed? Or hospital subsidized?

Small hospital in the south i knew did this. They had cardiologist do the intraop TEE. They had Anesthesiologist covering hearts with crna. but they weren’t echo trained. Eventually just used crna. Not busy heart place. That’s the key. Selection bias. Keep and do healthy ones with normal preserved EF. Ship out the EFs less than 25%. Hospitals aren’t stupid. Especially with employed CT surgeon. Now the private CT surgeons are a different story.
 
acidbase1 said:
It’s actually a fact jack, guy I tried to hire took this position instead. I know all the deets
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If we didn't trust anonymous internet sources as fact would we have SDN discussions anymore?
 
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Another example of administrators making hard calls and taking risk: one of the hospitals that our group covers, less than 1000 deliveries. No open heart. After hours the contract calls for two concurrent anesthetizing locations maximum. The hospital added neurointerventional and wanted to change the number of after hours locations to three. We said ok, but You need to pay us to have someone else on call. They said we don’t have the $$. We said have a nice day. They said they would get someone else. We said fine. Do it. They caved and said “WE” (meaning the hospital) will take the risk. Kept the after hour numbers at two locations. Lots of written correspondence between our attorney and administration on the safety issues and risk. They know that it will find its way into court if the perfect storm strikes. “They” took the risk. Of course if the risk shows up the patient will pay-not just the hospital. They just did some hard math. There will be lots more of this going forward. I guarantee everyone that there are administrators doing the hard math about more CRNA intensive anesthesia models as they lie awake at night... The only weapon that we have is the threat of piercing the corporate veil and making individual named administrators own these types of risk in writing. One cost is putting a target on your back.
 
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dr doze said:
Another example of administrators making hard calls and taking risk: one of the hospitals that our group covers, less than 1000 deliveries. No open heart. After hours the contract calls for two concurrent anesthetizing locations maximum. The hospital added neurointerventional and wanted to change the number of after hours locations to three. We said ok, but You need to pay us to have someone else on call. They said we don’t have the $$. We said have a nice day. They said they would get someone else. We said fine. Do it. They caved and said “WE” (meaning the hospital) will take the risk. Kept the after hour numbers at two locations. Lots of written correspondence between our attorney and administration on the safety issues and risk. They know that it will find its way into court if the perfect storm strikes. “They” took the risk. Of course if the risk shows up the patient will pay-not just the hospital. They just did some hard math. There will be lots more of this going forward. I guarantee everyone that there are administrators doing the hard math about more CRNA intensive anesthesia models as they lie awake at night... The only weapon that we have is the threat of piercing the corporate veil and making individual named administrators own these types of risk in writing. One cost is putting a target on your back.
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Well done.
Negotiating with administration reminds me of buying a car.
Call their bluff and be willing to walk away.
 
the admonishment not to train these nurses falls on deaf ears on this forum. this is at the academic level - how many academic guys who make those kinds of decisions are on this board?
 
dr doze said:
Economic pressures on administrators have never been higher. The tension at my shop among them has never been worse. Their jobs are on the line if they don’t improve the financials. They are very simply making hard decisions and taking risks to keep their jobs and/or the doors open. Of course those risks sometimes show up and wind up hurting patients-not them.
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Since the fxxxing ACA, hospital profit has increased significantly due to less forced charity care. Medicaid pretty much covers the hospital cost. Economic pressure from bigger suits' paycheck???
 
Psai said:
I was in Williamsburg the other day and had me some fresh picked lettuce and apple cider from the rural farmers of Brooklyn
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Farms from brooklyn? the 200sq feet backyard behind the brownstones?
 
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