CRNA Whistleblower retaliation for hiring AA's in Northern Michigan

[chocomorsel]

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Really? Patient prepped and draped, CRNA already consented, all you do is walk in put the epidural and bounce.

CRNA does the charting and manages the usual hypotension. Sounds like an excellent use of my skills.

Well, I have never worked in an ACT model where the CRNAs are prepping the patients for an epidural and all you do is stick them. The docs do everything epidural related and CRNAs help with Sections.

If there are practices set up like what you describe, then sure it makes it easier.

But I absolutely hate being called in the middle of the night for an epidural I could have done before 9pm on a mom who originally wanted to do it “all natural” but now cant! F that ****!

And I hate awake, whiny, patients. So yeah, shoot me now. OB and trauma is what keeps people at night and I would rather do trauma any day over OB.

 

[jwk]

Honestly I haven’t figured out why they haven’t come up with an automated system for charting and administering drugs. I mean if you could get that down groups could maybe reduce staff needs. I guess if you stagger the cases right you can be there for emergence and extubation. Watch 2 or 3 rooms from a single monitor.

Ofcourse the details of that are rough and regulatory stuff would be a problem.

Do you remember Sedasys? Massive flop. Sold like 14 of them. Not 14,000 or 1400. 14.

 

[jwk]

So what do you do when the anesthesiologist is unavailable for a period of time? Dealing with disaster elsewhere, in ICU starting a central line, struggling with a pediatric IV on induction, etc. Do you just wait around?

With a large practice that's not typically a problem.

 

[Endee]

Agree with jwk. I'm in similar group, 100% medical direction of CRNAs/AAs. If our attending is tied up, we call the board runner and he/she comes in or finds someone for induction. There's always someone available to come in. Never have to wait more than a few minutes.

With a large practice that's not typically a problem.

 

[Ronin786]

So what do you do when the anesthesiologist is unavailable for a period of time? Dealing with disaster elsewhere, in ICU starting a central line, struggling with a pediatric IV on induction, etc. Do you just wait around?

Do your CRNAs just go to sleep without you?

 

[deleted87051]

His practice is 100% medical direction.

Then I guess wait or find other coverage.

 

[Arch Guillotti]

Do your CRNAs just go to sleep without you?

No, someone else goes in there.

He said, "Nobody can sign in for anybody else for anything - the EMR requires ID and passwords, and everything is automatically time/date recorded."

Not sure what this means.

If an anesthesiologist is unavoidable tied up and another one starts the case, do they sign the chart? What if the one who comes in to start the case already has 4 rooms?

 

[psychbender]

I think he meant that nurses or other docs can't sign the chart as the doc that was supposed to sign the chart?

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[deleted126335]

No, someone else goes in there.

He said, "Nobody can sign in for anybody else for anything - the EMR requires ID and passwords, and everything is automatically time/date recorded."

Not sure what this means.

If an anesthesiologist is unavoidable tied up and another one starts the case, do they sign the chart? What if the one who comes in to start the case already has 4 rooms?

Sure they can. Just give the CRNA your password.


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[Status Sciaticus]

With electronic charting, they have figured out a way to keep us busy clicking boxes all day long.

Why not create a macro that basically autopopulates the same entries you put in 5 minutes ago? NSR, pressure free, eyes checked, etc..

 

[IMGASMD]

Sure they can. Just give the CRNA your password.


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[emoji1787]

 

[Shimmy8]

In a place that busy I'm sure there's almost always another partner around.

 

[jwk]

No, someone else goes in there.

He said, "Nobody can sign in for anybody else for anything - the EMR requires ID and passwords, and everything is automatically time/date recorded."

Not sure what this means.

If an anesthesiologist is unavoidable tied up and another one starts the case, do they sign the chart? What if the one who comes in to start the case already has 4 rooms?

My point was that the doc can only sign in for him/herself, and they have to do that by going in the room, swiping their badge/entering ID, and entering a password. In the Michigan complaint above, some of the issues involved docs having an anesthetist indicate they were there when they weren't, or entering "signatures" into the record after the fact to indicate they were present when they were not. Our EMR setup prevents that from happening.

The docs keep track of how many rooms they are signed in on - no more than four - and the EMR would flag it if they attempt to sign in on a 5th room. Most of the time during the regular workday, we run 1:2 or 1:3. We have outside compliance auditors come in an review our records and workflow as well.

 

[chocomorsel]

So what do you do when the anesthesiologist is unavailable for a period of time? Dealing with disaster elsewhere, in ICU starting a central line, struggling with a pediatric IV on induction, etc. Do you just wait around?

Find another anesthesiologist that is free?

 

[Arch Guillotti]

Find another anesthesiologist that is free?

Of course you do.

My point is (and I am not trying to argue, just trying to understand the practice workflow) that he said "Nobody can sign in for anybody else for anything". You have to badge in and presumably enter a PIN.

Say you are unavoidably tied up somewhere and can't get out to start a case that everyone is waiting on. A partner carrying 4 rooms goes in to start the case. So they start the case and don't badge in. Once the original partner is free, what happens after the fact? They probably sign in and attest. Except they are attesting to an induction that they didn't attend. Correct me if I am wrong. Guys cover for each other in busy practices, that's just how it goes.

 

[chocomorsel]

Of course you do.

My point is (and I am not trying to argue, just trying to understand the practice workflow) that he said "Nobody can sign in for anybody else for anything". You have to badge in and presumably enter a PIN.

Say you are unavoidably tied up somewhere and can't get out to start a case that everyone is waiting on. A partner carrying 4 rooms goes in to start the case. So they start the case and don't badge in. Once the original partner is free, what happens after the fact? They probably sign in and attest. Except they are attesting to an induction that they didn't attend. Correct me if I am wrong. Guys cover for each other in busy practices, that's just how it goes.

Ok. Missed his part about sign in with badges and such. But it sounds like they don’t run lean enough to where that is a problem. Some doc can always be available to sign in and start a case.
That’s the problem with running too lean. Leads to all these problems you’re asking about.

 

[deleted162650]

What’s the point of the ACT model if A) you supervise at low ratios - 1:2/1:3 and B) you don’t run lean??

At that point it would be more lucrative to just be MD only and not have to deal with all the CRNA BS and TEFRA gymnastics.

 

[PieOHmy]

SDFS

What’s the point of the ACT model if A) you supervise at low ratios - 1:2/1:3 and B) you don’t run lean??

At that point it would be more lucrative to just be MD only and not have to deal with all the CRNA BS and TEFRA gymnastics.

Some (most) places you simply cannot hire enough physicians. That is the reality. So either you do the supervision thing or you go all crna independence everywhere.

We are not ready to go all crna independence everywhere, so we do the next best thing.Supervision.

Once the surgeons extend their training by 24 months and do anesthesia for 24 months scattered in their residency.. we are DONE.

 

[psychbender]

Once the surgeons extend their training by 24 months and do anesthesia for 24 months scattered in their residency.. we are DONE.

That part will never happen. The surgical community is already struggling with the fact that about half of their grads cannot effectively function independently upon completion of residency. They're not a about to lengthen training by incorporating two years of nonsurgical education that gains then nothing but more liability in the long run.

Your first point regarding not enough physicians is accurate. My group is about 60-80% solo, and 3:1 the rest of the time (2:1 in some locations). We keep trying to bring on more physicians because of recent expansion, but it's difficult due to our location and payor mix. As a result, we continue to need a partial ACT model to keep everything running.

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[DrZzZz]

If an anesthesiologist is unavoidable tied up and another one starts the case, do they sign the chart? What if the one who comes in to start the case already has 4 rooms?

It's allowable to supervise 4 rooms but "sign in" to another that you're present for an induction. The doc responsible can still sign in that they were available for all other parts of the case.

 

[Mman]

It's allowable to supervise 4 rooms but "sign in" to another that you're present for an induction. The doc responsible can still sign in that they were available for all other parts of the case.

actually you can delegate any (almost any?) of the parts of TEFRA to someone else. If you were truly tied up, you could have someone else attest to the induction and emergence and whatever else and still meet the criteria.