Anesthesia Is F'ing Awesome.

[OB1🤙]

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Please to not be turning this thread into a discussion of appropriate staffing during CPB.

K thx.

 

[KungPOWChicken]

can I assume there is a CRNA with the patient? It's kinda malpractice to have a patient anesthetized in a room without a qualified person with them every second of the way. And no, perfusion and a surgeon doesn't count.

I rarely supervise CRNA's. And No CRNA's where I work don't do hearts, crani's, or any complicated case. They do GI and cataracts most of the time. That's why I love where I work. I do hearts but not every day, crani's, thoracic cases, trauma, as well as bread and butter OB, ortho etc. The people are great to work with including nurses. We are well respected by our surgeon colleagues. And we are paid well above average. So I can't complain. I love my job and I love going to work every day.

And No I don't need to be in the room when we are on Pump. The perfusionist we have is more than adequate and I'm readily available if needed.

 

[Mman]

And No I don't need to be in the room when we are on Pump. The perfusionist we have is more than adequate and I'm readily available if needed.

You can be on the moon while you are on pump for all I care, I'm just pointing out you are committing billing fraud if you bill for the anesthetic time while you are not in the room and you are violating ASA standards of care. And the more I think about it, unless the surgeon in the room is credentialed to provide general anesthesia in that hospital, it's probably technically considered fraud on any Medicare/Medicaid patient for the whole procedure since they spell out pretty explicitly who is allowed to administer general anesthesia in the CMS Interpretive Guidelines and a perfusionist isn't one of them.

You should probably hope JCAHO doesn't become aware of your situation, because I think CMS can retroactively penalize for 3 full years of billing charges.

 

[bullard]

Mman you are right but that's how it's done at every MD-only group in the country.

 

[Mman]

Mman you are right but that's how it's done at every MD-only group in the country.

I'm aware of several MD only groups that do not do hearts that way. I would venture CMS and/or JCAHO are not aware it is happening anywhere.

 

[nimbus]

Once the aorta is cross clamped, the heart has been arrested, and the patient has been cooled, there is not much "trained anesthesia personnel" can do except table up and table down. I personally wouldn't care if my anesthesiologist left the room at that point.

And the reality is that perfusionists administer general anesthesia in every single pump case I have ever done.

 

[Mman]

Once the aorta is cross clamped, the heart has been arrested, and the patient has been cooled, there is not much "trained anesthesia personnel" can do except table up and table down. I personally wouldn't care if my anesthesiologist left the room at that point.

And the reality is that perfusionists administer general anesthesia in every single pump case I have ever done.

I don't disagree with any of that. I'm just speaking to the actual federal guidelines and the ASA standard of care.