- Joined
- Dec 10, 2005
- Messages
- 181
- Reaction score
- 47
What do you mark for surgery end time? Last suture, dressings/cast on, staff surgeon scrub out, etc?
That's pretty much what I do to. If they're still messing around putting on dressings/braces/etc, I don't mark surgery end. But I was doing some locums at a place and the circulator asked me what end time was and I replied, "I'll let you when they're done". And they all looked at me indignantly and said ," the surgeon is done. They're just doing dressings". So I just figured I'd ask what other people put.When I can wake them up.
That's pretty much what I do to. If they're still messing around putting on dressings/braces/etc, I don't mark surgery end. But I was doing some locums at a place and the circulator asked me what end time was and I replied, "I'll let you when they're done". And they all looked at me indignantly and said ," the surgeon is done. They're just doing dressings". So I just figured I'd ask what other people put.
Some of the surgeons here want the patients to do a dance from the West Side Story before they feel comfortable in letting us take the ETT out
That's pretty much what I do to. If they're still messing around putting on dressings/braces/etc, I don't mark surgery end. But I was doing some locums at a place and the circulator asked me what end time was and I replied, "I'll let you when they're done". And they all looked at me indignantly and said ," the surgeon is done. They're just doing dressings". So I just figured I'd ask what other people put.
Still using paper records. I don't document a surgery end time, just a anesthesia end time. I let
The nurses document out of room etc. Any reason this surgery end time stamp actually matters?
This makes sense and it's how we determine case booking times as well, however shouldn't the actual bookings be based on the average time it takes to complete the whole procedure and anesthetic (in room to out of room)? It's not like most places have a dedicated team consisting of the same anesthesiologist, circulator, surgeon and tech? That would take into account the variation in induction and wake up times and would lead to more accurate case times.It matters now when it comes to case scheduling, because it helps us tell a slow surgeon he can't book 4 cases that our data proves routinely takes him 3 1/2 hours each, even if he pinky-swears he can do them in 2. This, more than anything else, is why I make sure the surgeon's time is documented in the computer as the surgeon's time.
It'll probably matter when anesthesia quality metrics start mining EMRs to look at things like
1) room time --> turnover to surgeon time
2) surgery end --> out of room time
Fraught with peril this line of thinking is, but it's coming. I'd rather have bad data used badly in a way that favors me instead of the surgeon.
We have tried both ways. The anesthesia department and nursing staff gets consistently screwed when using "surgeon time" for the case length rather than in room to out of room or "room time". You are expected to perform all the operating time and not given any in and out time, so basically every case over-runs into another. Then the surgeon sits there pissed about how they are not in the room yet for next case which was scheduled at XX:XX. This has been the source of a lot of political discord about our staffing model and abilities, which largely went away when we switched to "room time" for scheduling.
With "room time" scheduling I can consistently call surgeons and ask them if they would like to go early rather than always be last minute getting to the cases. It makes people happier all over (in my environment) and I would recommend if you are ever asked for input that you suggest that way over the other.
I personally owned the mistake at my hospital we made initially when going to epic as I thought they were discussing room set up time when showing me the break down and said we didnt need to include that. I was thinking that they meant time prior to patient in room, when really they meant after patient is in room, setting up for cutting.
Agree with the above comment regarding needing accurate surgeon time to show for political reasons, I find our biggest issue is that surgeons dont realize how freaking slowly some of their PAs close wounds. "Yes, that knee took you 35 minutes, but your PA took 25 minutes to close it, thus surgery time is 1 hour."
Looking at efficiency and case volumes scheduled, it is too early to say for sure being only 6 months in, but so far there is no major trend towards less cases scheduled and performed. I can update after a full year if someone bumps the thread.
Sent from my iPad using SDN mobile app