decrease supervisory ratios?

[ProRealDoc]

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http://www.asahq.org/For-the-Public-and-Media/Press-Room/ASAP/Epstein-and-Dexter-letter

 

[jwk]

I read this study when it first came out in the journal and kind of blew it off as an egg-head academia study that wasn't really applicable to the real world. Except for the real-world implications of such a bone-head study and the AANA pouncing on it, I would still be blowing it off.

Clearly the authors don't work in a high-volume and efficient anesthesia practice, nor apparently have they ever observed one to know how things work in the real world. They admittedly work in a place with long slow cases, and then assume that a higher volume would make things worse.

I assume the average "release time" quoted of 22 minutes implies that an anesthesiologist is somehow occupied for 22 minutes at the start of a routine case. Seriously? That's akin to the studies that claim 1% of patients suffer anesthesia awareness, and the appropriate response to both is "you need to find a better way to do anesthesia". How long do the authors spend starting a case with a resident? Do they hang around till the incision is made?

I'm in a very high volume ACT practice. Each and every case starts with an MD and an anesthetist. The patient is on the table, wired up, and propofol in hand when the anesthesiologist walks in. Induction, intubation, breath sounds - how long does that take the authors? Surely not 22 minutes.

Of course we stagger starts - is this a new concept to the authors as well? The difference for us is we staggered starts EARLIER than the "routine" start time of 7:30 at our facility, so we've actually increased the utilization of our OR's by being willing to start earlier. And it didn't change our actual time at work at all. We come in at the same time that we always did, we just don't sit around waiting for the surgeons as long as we had to before. And if the surgeon has to wait a minute or two for the anesthesiologist to come along? No problem - it pales in comparison to the time we wait on surgeons who are late for first starts of the day, which is truly the source of most OR inefficiency besides nursing staff that is on shifts (but that's another thread altogether. 😉 )

 

[Jay K]

jwk, you are a wealth of experience and information.

 

[Southpaw]

I read this study when it first came out in the journal and kind of blew it off as an egg-head academia study that wasn't really applicable to the real world. Except for the real-world implications of such a bone-head study and the AANA pouncing on it, I would still be blowing it off.

Clearly the authors don't work in a high-volume and efficient anesthesia practice, nor apparently have they ever observed one to know how things work in the real world. They admittedly work in a place with long slow cases, and then assume that a higher volume would make things worse.

I assume the average "release time" quoted of 22 minutes implies that an anesthesiologist is somehow occupied for 22 minutes at the start of a routine case. Seriously? That's akin to the studies that claim 1% of patients suffer anesthesia awareness, and the appropriate response to both is "you need to find a better way to do anesthesia". How long do the authors spend starting a case with a resident? Do they hang around till the incision is made?

I'm in a very high volume ACT practice. Each and every case starts with an MD and an anesthetist. The patient is on the table, wired up, and propofol in hand when the anesthesiologist walks in. Induction, intubation, breath sounds - how long does that take the authors? Surely not 22 minutes.

Of course we stagger starts - is this a new concept to the authors as well? The difference for us is we staggered starts EARLIER than the "routine" start time of 7:30 at our facility, so we've actually increased the utilization of our OR's by being willing to start earlier. And it didn't change our actual time at work at all. We come in at the same time that we always did, we just don't sit around waiting for the surgeons as long as we had to before. And if the surgeon has to wait a minute or two for the anesthesiologist to come along? No problem - it pales in comparison to the time we wait on surgeons who are late for first starts of the day, which is truly the source of most OR inefficiency besides nursing staff that is on shifts (but that's another thread altogether. 😉 )

i'd love to be in a group like this. awesome post, jwk!

 

[Endee]

I've rotated through jwk's group as a student and it really is a model for ACT practices nationwide.

 

[VentdependenT]

KY #17 opt out. Canning the covering academic docs for crna rooms. Money saved.