IV or monitors first?

[IMGASMD]

It is amazing. All you have to do is let people go when they are done early and amazingly turnover times are super fast with no bs games. But they give people multiple disincentives for a fast turnover and wonder why turnovers take forever/ first time starts suck.

People will complain about anything that’s what I’ve learned. When they have to stay late; they complain. When they don’t get overtime; they complain.

When PACU nurses have nothing to do that evening, they can stay until 7pm to recover a patient that just “says” she feels a little nauseous. It’s Friday at 430, you better bring your last patient out ready to walk out as soon as you hit PACU.

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[anbuitachi]

Working alone is more efficient than trying to trust some resident or nurse to do something and checking their work

Your pacu nurses don't hook up the monitors?

You can't set up the room after you see the patient? I can set up a room in the time it takes the or nurse to do sign in and move the patient to the table. That takes around 2-3 minutes and I usually have them intubated and ready to go within 5-6 minutes of in the room.

Why can't you write the note for the next guy during the previous case and sign the previous case chart when you're chilling in the next case? Take literally twenty seconds on epic...

What is your out of room to in the room time? In our outpatient centers it is like ten to fifteen minutes but at the main it is easily 45 minutes to an hour (purposefully so they don't get an addon)

I just find it hard to believe that your preop and pacu nurses don't do their jobs at all but somehow your or nurses are a paradigm of efficiency.

oh i mean there are a lot of variations and changes depending on the case. i alter a lot of things based on how i envision things will go since i review the chart during the previous case.

our turnover time is around 30 minutes which is pretty good in my opinion considering everything.

if i REALLY need to i may still be doing some setup with the patient in the room. but its not the best look, and sometimes we are out of certain equipments in the room, and id have to get it which is annoying if patient is already in the room.

Don’t you have IV supplies in the anesthesia cart? Why not make up an IV start kit during the previous case? I almost never start my own IVs, but when I do, I get the stuff from the anesthesia cart because we stock non-safety IVs in there and I don’t have to hunt around the preop area where I’m not familiar with their carts

I also chart review and make a preop note during the preceding case and modify it for accuracy after I put the patient to sleep.

Sadly I usually have time to drop off, preop, block, have lunch and poop during our turnovers.

we do have IV stuff in our OR carts, thats why i prefer to do them in the OR rather than preop. doesnt really benefit me IMO to start it in preop. also we dont have extensions with a valve in our carts so its annoying to place IV in preop. Sometimes we bring entire IV bag setup to hook up to IV that Id then tell the patient to hold onto cause theres no where to hang them in preop.

But wow that's an amazing turnover if you have that much time. Hopefully you arent paid per case

 

[Wolverines83]

At our ambulatory center the nurses go home when their room is done. They get paid only for the hours they work and they still work their tails off to get out early even when it means they get paid less. Turnovers are as fast as you can bring the next patient back. They're ready.

Main hospital the turnovers are 45m to an hour. Around 2 oclock they start dragging their feet to avoid an add-on. If you don't call to ask if they're ready the nurses will report you for not asking. First cases start at 0730. Except your ass better call first because they're NEVER ready. These nurses work shifts and go home when the shift is over regardless of work done / pending.

I hate it but to be honest I can't blame them for it....why work your ass off and then get rewarded with more work? Might as well not work as hard, get less work, less stress, get out at the same time with the same pay and actually have some leftover energy to enjoy your evening.

Gotta match the reward with the motivation. Don't hang a carrot in front of a wolf....

 

[Simba1711]

At our ambulatory center the nurses go home when their room is done. They get paid only for the hours they work and they still work their tails off to get out early even when it means they get paid less. Turnovers are as fast as you can bring the next patient back. They're ready.

Main hospital the turnovers are 45m to an hour. Around 2 oclock they start dragging their feet to avoid an add-on. If you don't call to ask if they're ready the nurses will report you for not asking. First cases start at 0730. Except your ass better call first because they're NEVER ready. These nurses work shifts and go home when the shift is over regardless of work done / pending.

I hate it but to be honest I can't blame them for it....why work your ass off and then get rewarded with more work? Might as well not work as hard, get less work, less stress, get out at the same time with the same pay and actually have some leftover energy to enjoy your evening.

Gotta match the reward with the motivation. Don't hang a carrot in front of a wolf....

My hospital is like the second situation. Annoying as hell.

 

[nimbus]

At our ambulatory center the nurses go home when their room is done. They get paid only for the hours they work and they still work their tails off to get out early even when it means they get paid less. Turnovers are as fast as you can bring the next patient back. They're ready.

Main hospital the turnovers are 45m to an hour. Around 2 oclock they start dragging their feet to avoid an add-on. If you don't call to ask if they're ready the nurses will report you for not asking. First cases start at 0730. Except your ass better call first because they're NEVER ready. These nurses work shifts and go home when the shift is over regardless of work done / pending.

I hate it but to be honest I can't blame them for it....why work your ass off and then get rewarded with more work? Might as well not work as hard, get less work, less stress, get out at the same time with the same pay and actually have some leftover energy to enjoy your evening.

Gotta match the reward with the motivation. Don't hang a carrot in front of a wolf....

Sounds like we work at the same surgery center and the same hospital.

 

[nimbus]

But wow that's an amazing turnover if you have that much time. Hopefully you arent paid per case

I am so on really bad days I can have more turnover time than anesthesia time.

 

[Ezekiel2517]

One of the hospitals I go to tracks turnover times for every room. It should be less than 30 minutes. It has become a metric for everyone involved (nurses, anesthesiologists, surgeons). Obviously outpatient sites will always have much faster turnovers

 

[Dawkter]

This thread is a good reminder that practicing medicine in NYC will take years off your life.

 

[narcotics999]

oh i mean there are a lot of variations and changes depending on the case. i alter a lot of things based on how i envision things will go since i review the chart during the previous case.

our turnover time is around 30 minutes which is pretty good in my opinion considering everything.

if i REALLY need to i may still be doing some setup with the patient in the room. but its not the best look, and sometimes we are out of certain equipments in the room, and id have to get it which is annoying if patient is already in the room.




we do have IV stuff in our OR carts, thats why i prefer to do them in the OR rather than preop. doesnt really benefit me IMO to start it in preop. also we dont have extensions with a valve in our carts so its annoying to place IV in preop. Sometimes we bring entire IV bag setup to hook up to IV that Id then tell the patient to hold onto cause theres no where to hang them in preop.

But wow that's an amazing turnover if you have that much time. Hopefully you arent paid per case

Dude, you need to get out of that ****hole. If I remembered correctly, you are not paid so well. Get out as soon as you can. You will only be happier and richer.

 

[GassYous]

oh i mean there are a lot of variations and changes depending on the case. i alter a lot of things based on how i envision things will go since i review the chart during the previous case.

our turnover time is around 30 minutes which is pretty good in my opinion considering everything.

if i REALLY need to i may still be doing some setup with the patient in the room. but its not the best look, and sometimes we are out of certain equipments in the room, and id have to get it which is annoying if patient is already in the room.




we do have IV stuff in our OR carts, thats why i prefer to do them in the OR rather than preop. doesnt really benefit me IMO to start it in preop. also we dont have extensions with a valve in our carts so its annoying to place IV in preop. Sometimes we bring entire IV bag setup to hook up to IV that Id then tell the patient to hold onto cause theres no where to hang them in preop.

But wow that's an amazing turnover if you have that much time. Hopefully you arent paid per case

Everyone is paid per case homie. That's how anesthesia billing works. How much someone steals from you is what is different.

Why are you out of equipment? All your techs died? They should replenish everything you used between every case. And if you dont have something they should be able to set it up and bring it to you. Wtf do you need anyway, one syringe for meds, a laryngoscope and a tube or a spinal tray and that's the setup for 90% of cases.

Also the nurses bring the patient back like they should

 

[Simba1711]

Nurses call in sick all the time too.

It’s the culture at my hospital that if they don’t get approved for vacation they call in sick morning of

 

[chocomorsel]

Dude, you need to get out of that ****hole. If I remembered correctly, you are not paid so well. Get out as soon as you can. You will only be happier and richer.

He’s been told for years. Somehow there is something tying him down to that city that he cannot leave. Maybe it’s all the sex. Apparently it’s great for single people. Maybe all his people are there and they need frequent checking in on. Maybe he can’t live without the 3 am takeout.
Whatever the case, poor dude.

 

[IMGASMD]

He’s been told for years. Somehow there is something tying him down to that city that he cannot leave. Maybe it’s all the sex. Apparently it’s great for single people. Maybe all his people are there and they need frequent checking in on. Maybe he can’t live without the 3 am takeout.
Whatever the case, poor dude.

All the sex and 3am takeout isn’t my definition of being a “poor” dude.

 

[chocomorsel]

All the sex and 3am takeout isn’t my definition of being a “poor” dude.

Being used and abused at work is my definition. I suppose any big city, getting laid ain’t that hard these days. Wasn’t hard for me when I was single.
Now at 3 am, I am sleeping or working.

 

[thetoddJR]

I… Don’t really understand your question. Shouldn’t the patient already have an IV by the time they get into the room?

I suppose if you’re working in whatever parallel universe your job seems to exist in, where are you are expected to mop the floor, cook the surgeon lunch, start the IV, braid the circulators hair, and apply the monitors while making less than minimum wage… then I would start the IV first, since I would want the blood pressure cuff on the opposite side (all other things being equal)

you're describing residency

 

[thetoddJR]

I… Don’t really understand your question. Shouldn’t the patient already have an IV by the time they get into the room?

I suppose if you’re working in whatever parallel universe your job seems to exist in, where are you are expected to mop the floor, cook the surgeon lunch, start the IV, braid the circulators hair, and apply the monitors while making less than minimum wage… then I would start the IV first, since I would want the blood pressure cuff on the opposite side (all other things being equal)

you're describing anesthesia residency. Academic center circulators are incapable of applying monitors. We do a rotation with a private group and i was astounded when i turned around and the nurses had put on stickers and were preoxygenating the patient

 

[IMGASMD]

you're describing anesthesia residency. Academic center circulators are incapable of applying monitors. We do a rotation with a private group and i was astounded when i turned around and the nurses had put on stickers and were preoxygenating the patient

I was surprised that the OR nurse was pushing patients in the room for me and I didn’t need to help pushing from pre-op. And real knowledgeable anesthesia techs in the room when I was fumbling around.

After residency of course.

 

[deleted875186]

I was surprised that the OR nurse was pushing patients in the room for me and I didn’t need to help pushing from pre-op. And real knowledgeable anesthesia techs in the room when I was fumbling around.

After residency of course.

100%. It’s a culture thing, somehow during my residency the anesthesia residents were s**t on everywhere, place all the monitors in OR and PACU, preop didn’t place any IVs, push every patient alone, even the ICU patients, circulator would just be sitting in the room and wouldn’t even call you when ready, you were just supposed to magically know they were ready. OR doors weren’t even automatically open doors, I had to balance the door open with my foot while tryin got push a patient bed through it while the jerks in the room just watched me.

 

[IMGASMD]

100%. It’s a culture thing, somehow during my residency the anesthesia residents were s**t on everywhere, place all the monitors in OR and PACU, preop didn’t place any IVs, push every patient alone, even the ICU patients, circulator would just be sitting in the room and wouldn’t even call you when ready, you were just supposed to magically know they were ready. OR doors weren’t even automatically open doors, I had to balance the door open with my foot while tryin got push a patient bed through it while the jerks in the room just watched me.

It is a very culture dependent thing, I am a little spoiled now.

In PACU, when I bring patients out, they have a PCA and a nurse receiving patients. I get this weird look from them when I instinctively start putting all the monitors back on…..

 

[Hork Bajir]

you're describing anesthesia residency. Academic center circulators are incapable of applying monitors. We do a rotation with a private group and i was astounded when i turned around and the nurses had put on stickers and were preoxygenating the patient

My first day in private practice I turned around to draw up all of my drugs for the day in one 3cc syringe, and saw that the circulator and anesthesia tech had already applied the monitors, started an epidural, induced and intubated the patient, and started a central line

 

[Wolverines83]

Sometimes we get travelers that are from more...how should I say....teamwork oriented places and when I see them applying monitors or holding the mask to preoxygenate I almost get defensive. It's such a foreign concept to me that I assume it must be an insult of some kind. Then I take a deep breath and realize this isn't some statement about how I need help....this is just other human beings being good human beings....such a strange feeling.

One time a traveler even paid attention during induction. It confused me.

 

[GassYous]

My first day in private practice I turned around to draw up all of my drugs for the day in one 3cc syringe, and saw that the circulator and anesthesia tech had already applied the monitors, started an epidural, induced and intubated the patient, and started a central line

How long does it take you to fill a 3 cc syringe? And what kind of meds??

 

[narcotics999]

How long does it take you to fill a 3 cc syringe? And what kind of meds??

Probably Omnipaque through 30g needle.

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[Monterosso]

To answer the question, if the IV wasn't placed in preop I would first put on the pulse-ox so that there are at least some monitors (SpO2, heartrate) loading into the EMR and then place the IV. Plus, hearing the pulse-ox tone lets you know it's anesthesia time!

 

[abolt18]

To answer the question, if the IV wasn't placed in preop I would first put on the pulse-ox so that there are at least some monitors (SpO2, heartrate) loading into the EMR and then place the IV. Plus, hearing the pulse-ox tone lets you know it's anesthesia time!

Yeah, I was always told to put on the pulse-ox first and remove it last, as it provides you SpO2, HR and rhythm, and tells you the patient has adequate blood pressure to perfuse that extremity. Information gold mine.