Thoughts on this job?

[Ignatius J]

Obviously up to local policy. Ours is PACU D/C by criteria because sometimes patients can be made to stay in the physical location for other reasons and at that point they are considered back to floor or outpatient or whatever. For example some of our same day outpatient surgery patients might have a drain placed and need the nurse to chart drain output for 4 hours before they can leave the building according to the surgeons orders. If they are the last case of the day and d/c from PACU by our criteria at 4 PM (after coming out of OR at 3PM), I'm not obligated to stay and stare at them til 7 PM nor am I the person the nurse will call with questions.

I agree.

Have a set criteria and leave out the grey area. If we're waiting on beds on the floor, the surgeon has some weird protocol where he wants patients to be observed for X number of pacu hours, etc., that is not my problem. I'm happy to help with any problems, but I'm not going to be the patient's floor doctor. When I sign them out, I am signaling that they have recovered from anesthesia and ready for phase II or the floor. Complications can still develop, and I expect if they are in PACU to be called, but it isn't ultimately up to me to be at the bedside in 15 seconds.

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[Planktonmd]

The issue with leaving while a patient is still in PACU is not simple and many anesthesiologists don't understand it very well.
You really need to go to your hospital's anesthesia manual and PACU policy and find exactly what it states concerning that specific situation when a patient is still physically in PACU although you have signed him/her out.
Don't assume that because you signed the patient out then you are off the hook and don't assume that the hospital is not going to blame you for abandoning the patient if anything goes wrong after your departure.

 

[criticalelement]

The issue with leaving while a patient is still in PACU is not simple and many anesthesiologists don't understand it very well.
You really need to go to your hospital's anesthesia manual and PACU policy and find exactly what it states concerning that specific situation when a patient is still physically in PACU although you have signed him/her out.
.

You need a frickin hospital manual to tell you what to do?
see video

 

[deleted171991]

Have a set criteria and leave out the grey area. If we're waiting on beds on the floor, the surgeon has some weird protocol where he wants patients to be observed for X number of pacu hours, etc., that is not my problem. I'm happy to help with any problems, but I'm not going to be the patient's floor doctor. When I sign them out, I am signaling that they have recovered from anesthesia and ready for phase II or the floor. Complications can still develop, and I expect if they are in PACU to be called, but it isn't ultimately up to me to be at the bedside in 15 seconds.

That is a great point.

We play floor doctor at the end of the day for D&E patients who need to be observed for 2 hours post-op (the patients recover from anesthesia and are ready to leave in less than 1 hour otherwise). I have always hated this, and wished we had a policy where the gynecologist deals with this crap. I bet the observation period would suddenly shorten.

Unfortunately, many places have a policy where any patient physically in the PACU is an anesthesia patient, regardless of sign-out etc.

 

[Mman]

Unfortunately, many places have a policy where any patient physically in the PACU is an anesthesia patient, regardless of sign-out etc.

I'd imagine you can change that policy fairly easily from a department POV. I mean it's a policy that has to come from the anesthesia department itself. I'd imagine in that situation it probably started as a request from nursing since it would be easier to get a hold of the anesthesiologist compared to the surgeon who may have left the building.

 

[deleted50478]

I don't get why you feel the need to be physically present for pacu patient once they are awake an stable. icu pts don't have a doctor at the bedside 24hrs a day.
Getting called about pacu pts is one thing but sitting there after they're stable is another. It should be a judgement call not a policy.

 

[Planktonmd]

I don't get why you feel the need to be physically present for pacu patient once they are awake an stable. icu pts don't have a doctor at the bedside 24hrs a day.
Getting called about pacu pts is one thing but sitting there after they're stable is another. It should be a judgement call not a policy.

What should happen and what actually happens are unfortunately 2 different things.
Unless the hospital policy specifically states that after signing out the patient you are no longer required to be present in the building, you will be thrown under the bus at the first occasion a patient has an event in PACU and you are not available, regardless of how silly this might sound to you.

 

[IlDestriero]

I don't get why you feel the need to be physically present for pacu patient once they are awake an stable. icu pts don't have a doctor at the bedside 24hrs a day.
Getting called about pacu pts is one thing but sitting there after they're stable is another. It should be a judgement call not a policy.

The reason you need a policy is because your partners may not always exercise the best judgement. We've all seen very bright people make really stupid decisions in and out of the hospital. People make bad choices sometimes and that may reflect badly on your group or put patients at risk. A clear policy, whatever it is, makes ones obligations clear and you can insure that your policy is consistent with hospital/state/Asc policy and expectation. When we are at the ASC, most of the surgeons peace out about 10 minutes after the tube comes out. If we were to leave before the patient is discharged, and something happened, there may be nobody there qualified to come to help. The rest of the facility is a multi specialty center. There might be several physicians there or none at 3pm.
There are a couple nurses who are happy to let a patient sleep forever, I make a point to wake the kids up to check on them, etc. to help keep things moving.

 

[amyl]

Thanks narcusprince I do have the potential to bring in a few pain docs - ccf'ers like us so good pain docs maybe a line on an ortho spine guy. Not Phoenix - Dallas. This one is 4 weeks vacation... If more the pay will be less, they are flexible. I also have an offer in academics - offering me decent $ great vacation n benefits and dept head right off the bat... Vs stay where I am. Decisions decisions. Advice anyone?

 

[pgg]

Thanks narcusprince I do have the potential to bring in a few pain docs - ccf'ers like us so good pain docs maybe a line on an ortho spine guy. Not Phoenix - Dallas. This one is 4 weeks vacation... If more the pay will be less, they are flexible. I also have an offer in academics - offering me decent $ great vacation n benefits and dept head right off the bat... Vs stay where I am. Decisions decisions. Advice anyone?

You're a couple years out of residency (right?) and an academic institution is offering you the chair from day 1? Why are they not promoting from within? Nobody there wants the position? I'm sure you're awesome and this offer is a reflection of that awesomeness, congratulations, but running a department is hard; doing it at a place you've never been before where you don't know any of the people (in OR out of your dept) is doubly hard. A place offering that to a new person who's recently out of residency is strange.

 

[deleted50478]

You're a couple years out of residency (right?) and an academic institution is offering you the chair from day 1? Why are they not promoting from within? Nobody there wants the position? I'm sure you're awesome and this offer is a reflection of that awesomeness, congratulations, but running a department is hard; doing it at a place you've never been before where you don't know any of the people (in OR out of your dept) is doubly hard. A place offering that to a new person who's recently out of residency is strange.

I think she meant section head, right? Running CV at a small center probably isn't bad.

 

[IlDestriero]

I think she meant section head, right? Running CV at a small center probably isn't bad.

I assumed she meant division chief as well.
I wouldn't want to run a department with more than a decade of experience.
There are good academic jobs out there if you go looking, the variability in pay, benefits and lifestyle can be dramatic, even in the same city. I've seen offers from under 200 to well over 400, but you have to account for time worked, etc. Out around 3 vs out around 5, 3 clinical days a week vs 4.5, 5 weeks of vaca vs 9, etc.

 

[amyl]

Yes sorry to be misleading - division head at one of their hospitals...
Which job would you guys take!

 

[narcusprince]

You're a couple years out of residency (right?) and an academic institution is offering you the chair from day 1? Why are they not promoting from within? Nobody there wants the position? I'm sure you're awesome and this offer is a reflection of that awesomeness, congratulations, but running a department is hard; doing it at a place you've never been before where you don't know any of the people (in OR out of your dept) is doubly hard. A place offering that to a new person who's recently out of residency is strange.

Pgg I am almost 3 years out and I am department head . Seriously department head of a civilian hospitals anesthesia department is tough. And the system she describes is a different model then our system. What she is describing is akin to division head of ob, regional, or neuro. I have had the pleasure of running a department of two and you learn a lot about big picture problems. Anyway AMYL take the academic gig work with the old ccf crew. Save a seat for me in a few years. Good luck!

 

[amyl]

Ty np.... Call me when you are ready to go civilian- how many years you have left?