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This is a story that those of you who practice in a high ratio and multiple handoff practice should think about. I was briefly "that guy" in a practice. I left that situation because I questioned the ethics of it. Because I was so swamped I simply couldn't know all the details of every case including the cases dumped on me in the afternoon by the lazy fatcat grayhairs trying to make their tee time. "They" always told me I should simply trust our CRNA "colleagues" to do the right thing. Doing the right thing means actually directing the care you're involved in and having the time to do it properly, if that's what you're getting paid for, as well as making sound clinical decisions.
Issue 1: Talk to the surgeon.
Issue 2: Know who you are working with.
Issue 3: Know what's going on.
Issue 4: Know what you're handing off and, more importantly, know what you are getting.
Issue 5: Actually have a sound plan in advance of executing that plan. You are violating TEFRA if you don't.
Issue 6: Don't assume that (a) the CRNA you're working with knows what is going on (b) that they are going to communicate that with you and (c) if they don't that everything is going along okay. This point also reiterates issue 1, 3 & 5.
Conclusion: If you direct CRNAs, your job is to make sure this is true.
http://www.arbd.com/vicarious-liabi...-for-the-malpractice-of-its-independent-anest
Furthermore, although some of the deposition testimony is in conflict, neither the anesthesiologist nor the CRNA ever discussed our client’s procedure with the surgeon before the procedure began and the anesthesiologist never developed a plan for extubation after surgery ended
Issue 1: Talk to the surgeon.
Intubation occurred at 8:05 a.m. The anesthesiologist left the operating room as soon as our client was intubated. Unknown to our client, the CRNA, who was left unsupervised and in charge of her care, had been working at the hospital for only fifteen days...
Issue 2: Know who you are working with.
Without a physician’s order or supervision, this inexperienced CRNA began reversing our client from anesthesia halfway through the procedure. Later, she overdosed our client on lidocaine, she did not chart our client’s vital signs for at least two hours, she charted medications that she never gave and she failed to chart medications that were given.
Issue 3: Know what's going on.
Around noon, the anesthesiologist did return to the operating room, but only to tell the CRNA that a different anesthesiologist would be taking over. Without ever looking at the chart or giving the second anesthesiologist all of the details of the surgery or information about the extubation plan, the anesthesiologist left the CRNA alone with our client yet again.
Issue 4: Know what you're handing off and, more importantly, know what you are getting.
The second anesthesiologist made an appearance in the operating room only for the extubation of our client at the end of the surgical procedure. Meanwhile, the CRNA with no experience had decided to do a deep extubation to avoid ruining the plastic surgeon’s work by having the patient bucking or thrashing from removal of the tube. The anesthesiologist agreed with the CRNA’s proposal, although he had very little knowledge of the surgery that had occurred. At their depositions, all of the anesthesiologists agreed that a deep extubation should never have occurred in a plastic surgery where the patient’s nose is packed with gauze and lips are sutured at the midline, because there is no adequate airway for ventilation. No one, however, had ever discussed that with the inexperienced CRNA.
Issue 5: Actually have a sound plan in advance of executing that plan. You are violating TEFRA if you don't.
Once the code was called, the anesthesiologist who began the procedure learned for the first time that our client’s lips had been sewn together although he should have known this to begin with, since he made the anesthesia plan.
Issue 6: Don't assume that (a) the CRNA you're working with knows what is going on (b) that they are going to communicate that with you and (c) if they don't that everything is going along okay. This point also reiterates issue 1, 3 & 5.
When our client presented to this hospital for her surgery, she reasonably presumed that the personnel providing her medical services were competent, trained medical personnel that would provide her with the services necessary to perform her surgery.
Conclusion: If you direct CRNAs, your job is to make sure this is true.
...this case settled prior to trial for a confidential amount.
http://www.arbd.com/vicarious-liabi...-for-the-malpractice-of-its-independent-anest