Economics of having a McGrath in every OR

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ToKingdomCome

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Some attendings push only using a McGrath. How feasible is it to have a Mcgrath in every OR cost-wise. Do you end up saving more money if there's an adverse respiratory event?
 
I feel like a curmudgeonly attending every time I tell my residents they're not allowed to use the McGrath. Their skills with a DL are absolutely terrible and their ability to troubleshoot is severely undermined.

On the other hand, this technology is only getting cheaper, so it is feasible that in 5-10 years DL isn't used at all.
 
Ronin786 said:
I feel like a curmudgeonly attending every time I tell my residents they're not allowed to use the McGrath. Their skills with a DL are absolutely terrible and their ability to troubleshoot is severely undermined.

On the other hand, this technology is only getting cheaper, so it is feasible that in 5-10 years DL isn't used at all.
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I would love if you were my attending and forced me to DL everyone
 
We just switched from having one glidescope for our 6 ORs to having a McGrath in each room. They lease the actual McGrath for free and they make money off the blades. The blades are cheaper for us than glidescope blades so it’s a win win. I really like having it up in OB
 
ToKingdomCome said:
I would love if you were my attending and forced me to DL everyone
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Before every case I grab a Mac 3/4, Miller 2/3 and put them in a suction canister. Then have the resident close their eyes while bagging and pick one out. Go through them all by the end of the day.

Learned it from an attending in residency.
 
whatever the cost, bougies are far less expensive....
 
Ronin786 said:
I feel like a curmudgeonly attending every time I tell my residents they're not allowed to use the McGrath. Their skills with a DL are absolutely terrible and their ability to troubleshoot is severely undermined.

On the other hand, this technology is only getting cheaper, so it is feasible that in 5-10 years DL isn't used at all.
Click to expand...

Kids these days just can’t drop ether like they used to.
 
I only did dl in residency. Mac, miller I was good at everything. But we used a smaller disposable blade. In my job we have these huge metal blades and I almost chipped a tooth in a fatty with a small mouth. After that it's been mcgrath only no stylet.
 
Ronin786 said:
Before every case I grab a Mac 3/4, Miller 2/3 and put them in a suction canister. Then have the resident close their eyes while bagging and pick one out. Go through them all by the end of the day.

Learned it from an attending in residency.
Click to expand...
Using this, for sure.
 
I think for sure the new CA1 and probably upcoming interns dealing with covid they all were doing VL for the first 3 or so months and also cases were way down so not as much practice overall. It might be just my bias but definitely felt they were not up to par by this point. So they have a bit of a handicap no fault of their own but they need to unlearn some habits to properly learn and feel comfortable with DL. I’m certainly not saying I’m the best at laryngoscopy as I sometimes goose an airway too. But definitely I can tell the older attendings are able to DL patients that I couldn’t opting for using the boogie/stylet before going to VL.
 
It’s expensive, and not environmentally friendly. We switched to glide after someone ashole sold to the power that be, someone can/will walk out of the hospital with McGrath. And they would lose their investment. WTF?! Any of you gets to that attached to your McGrath?!

Disposable mental blade isn’t so good either. Why **** got to be one time use? When the blade is inserted into one of dirtiest place in the human body, I couldn’t tell you.

I had an experience when one of our most experience CRNA who couldn’t intubate with a Miller, showed him up with a Mac. Thought it was funny and also it’s just what you’re used to and self awareness that will save you and the patient at the end of the day.
 
When you have a wasteful rule that makes zero sense, 95% of the time you can trace it back to some jcaho visit. Those idiot ****ers are responsible for so much waste in this country.

Speaking of bougies, how are you guys doing it? I rarely use it because mcgraths make the airway so easy but I've had a few instances where the tube seems to be in the airway but when I go to bag, no end tidal. I think I am not twisting the airway properly and getting caught on the arytenoids and the tube is just out of the cords.
 
Ronin786 said:
I feel like a curmudgeonly attending every time I tell my residents they're not allowed to use the McGrath. Their skills with a DL are absolutely terrible and their ability to troubleshoot is severely undermined.

On the other hand, this technology is only getting cheaper, so it is feasible that in 5-10 years DL isn't used at all.
Click to expand...
"You won't always have a calculator in your pocket!" -all of our math teachers, circa childhood
 
Ronin786 said:
I feel like a curmudgeonly attending every time I tell my residents they're not allowed to use the McGrath. Their skills with a DL are absolutely terrible and their ability to troubleshoot is severely undermined.

On the other hand, this technology is only getting cheaper, so it is feasible that in 5-10 years DL isn't used at all.
Click to expand...
I'm straight out of residency, and I have to agree. People should learn DL first. The DL skills I've seen are horrible.
 
It’s only time where technology takes over anesthesia completely.

how many still do central lines without ultrasound. I did a subclvian for the kicks of it my usual blind style last year. But do 100% of my IJs with ultrasound.

it’s the same way with DLs these days. I don’t attempt more than two times before I grab the video scope.
 
there really isn't any equivalency between central lines/ US and intubation/VL....
aneftp said:
It’s only time where technology takes over anesthesia completely.

how many still do central lines without ultrasound. I did a subclvian for the kicks of it my usual blind style last year. But do 100% of my IJs with ultrasound.

it’s the same way with DLs these days. I don’t attempt more than two times before I grab the video scope.
Click to expand...
bill for VL? Rhetorical...but a difference with u/s.
 
Ronin786 said:
Before every case I grab a Mac 3/4, Miller 2/3 and put them in a suction canister. Then have the resident close their eyes while bagging and pick one out. Go through them all by the end of the day.

Learned it from an attending in residency.
Click to expand...

I would love this as a CA1 right now. Some of my attendings I almost have to beg them to let me try DL first before jumping immediately to the glidescope and I hate the glidescope, it takes the fun out of everything.

I mean if a patient is an easy bag, doesnt matter if I failed to DL a few times right? That’s why I have an attending there as backup.
 
UnoMas said:
I would love this as a CA1 right now. Some of my attendings I almost have to beg them to let me try DL first before jumping immediately to the glidescope and I hate the glidescope, it takes the fun out of everything.

I mean if a patient is an easy bag, doesnt matter if I failed to DL a few times right? That’s why I have an attending there as backup.
Click to expand...

In December, I will probably probably give you two shots. Maybe 3 if I feel generous.

Don’t you guys have to get at least X number of intubations before you can cover airways? Or we just altogether skip that and go straight to VL all the time now?
 
IMGASMD said:
In December, I will probably probably give you two shots. Maybe 3 if I feel generous.

Don’t you guys have to get at least X number of intubations before you can cover airways? Or we just altogether skip that and go straight to VL all the time now?
Click to expand...

Airway on the floor is always VL. The first time I responded to an airway, they rolled out VL, I asked for a mac 3 laryngoscope and the RT looked at me like I have 3 heads.

And I would love to take those 2 shots. At least let me troubleshoot and try different things at least one time. I log my cases religiously and I have logged around 140-150 DLs now, I feel like I am ok with my DL skill but I just want more experience with difficult ones and try to troubleshoot it as if I had no other alternatives.
 
Lightwand is the most economical! You don't even have to open the airway that much or even look inside! I bet if I did a hundred or so it would make the most difficult of airways look easy. I've only done like 3 unfortunately..
 
UnoMas said:
Airway on the floor is always VL. The first time I responded to an airway, they rolled out VL, I asked for a mac 3 laryngoscope and the RT looked at me like I have 3 heads.

And I would love to take those 2 shots. At least let me troubleshoot and try different things at least one time. I log my cases religiously and I have logged around 140-150 DLs now, I feel like I am ok with my DL skill but I just want more experience with difficult ones and try to troubleshoot it as if I had no other alternatives.
Click to expand...

One of my attending in training said something like, after the first 100, I am probably as good as him. Maybe not that fast, but after the first 300, you are very proficient.

Now in PP, I rarely intubate anymore. The other day, someone set up my room accidentally, and put a Miller on the machine. I was very excited I got the tube without switch to my go-to Mac 3. Little things in life.....

But don’t worry, when you’re more senior, I am sure your attendings will let you do whatever you want.... that day will come. Before graduating, I made a point to only intubate with Miller. Pretty sure I tried the longest Miller I can get my hands on, just because.
 
secretasianman said:
Lightwand is the most economical! You don't even have to open the airway that much or even look inside! I bet if I did a hundred or so it would make the most difficult of airways look easy. I've only done like 3 unfortunately..
Click to expand...

Thought they stopped making these
 
The first shot should be the best shot in an emergent situation. So on the floor, coding patient, do vl. Also no need if you can't get it first attempt to keep doing dl, just make things easier and do vl. The only benefit to learning good dl skills is in placement of dlts.
 
I miss the Shikani. That thing was cool. Even cooler was the secret agent style briefcase it came in.
 
UnoMas said:
I would love this as a CA1 right now. Some of my attendings I almost have to beg them to let me try DL first before jumping immediately to the glidescope and I hate the glidescope, it takes the fun out of everything.

I mean if a patient is an easy bag, doesnt matter if I failed to DL a few times right? That’s why I have an attending there as backup.
Click to expand...

It sure as hell matters to the patient.
 
dabears505 said:
The first shot should be the best shot in an emergent situation. So on the floor, coding patient, do vl. Also no need if you can't get it first attempt to keep doing dl, just make things easier and do vl. The only benefit to learning good dl skills is in placement of dlts.
Click to expand...

I do all my DLTs with a glidescope these days.
 
Any of you guys ever use Pentax-AWS? About 1/4 the price of everything else, but extremely cumbersome and awful camera/display.
 
Not to derail the thread any further, but has anyone used a Rusch Flipper scope? I opened my cart in my new PP job and have been too weirded out by it to give it a try.

I do love the idea of yelling "Get me the Flipper!" during a stressful/peri-code situation though.
 
Anyone ever use an Easy View? We recently had a locums come through who kept one of these on him.
 
I work at a place that lets us buy whatever we choose, but we have incentives in place to keep equipment costs as low as reasonable.

Numbers may be old by a few years:

McGrath ~2k (or lease for free as above, apparently, which would have likely changed calc) Blades ~$4. Need 1 per room with a few spares. Need a DL handle/blades per room, which would be disposable at a negligible cost.

Nicest DL handle/blade ~160+100. Need ~3 per room. Cost of cleaning and restocking in the $0.50-3 range depending on who is doing calculations. Need a McGraths per 4-6 rooms at 2000 per 4-6 rooms, or ~400 per room.

We bought reusable DL handles and blades rather than McGraths for every room due to long term cost of replacement and slightly lower cost per use. We chose our favorites without regard for cost, which happened to be the #3/6 most expensive option for DL.
The McGrath handles bought at the time require replacement due to washed out screens at 3-4 years of heavy use. The reusable equipment is as good as new.

Cost was 120k for the whole hospital.
I expect in ~10 years we will buy it all again, and it will be a different choice.

Disposable blades are now more prevalent in our hospital system, but I personally like the reusable better.
 
One thing your attendings may have overlooked is it's a good idea to have a few different types of VLs available at any one time.

With the COVID outbreak Medtronic stopped exporting battery packs to many Australian hospitals as the demand was too high in America/Europe. Our hospital couldn't place any orders and couldn't compete with the scalpers on eBay after a few weeks --> we ended up having 20+ McGrath's completely unusable. That's why we had to source some old Pentax-AWS scopes out of some storage/surplas warehouse on the other side of the country... This at a 800+ bed hospital.

I'd push for 2 different VLs minimum; never put all your eggs in one basket. Especially a propriety basket with a timer.
 
anaesthetic said:
I'm fresh out of fellowship training and am already starting to feel "old school" compared to the residents/fellows coming through. I rescued an airway from a fellow that was a grade I view for me with literally no adjustments in positioning or blade. Made me question a lot of things about the current quality of training and the temptation to coddle trainees for the sake of avoiding any conflicts/issues.
Click to expand...
So apparently you can’t even yell at them anymore when they screw up. It hurts their feelings. And they really try to act like they are your equal.
 
IMGASMD said:
It’s expensive, and not environmentally friendly. We switched to glide after someone ashole sold to the power that be, someone can/will walk out of the hospital with McGrath. And they would lose their investment. WTF?! Any of you gets to that attached to your McGrath?!

Disposable mental blade isn’t so good either. Why **** got to be one time use? When the blade is inserted into one of dirtiest place in the human body, I couldn’t tell you.

I had an experience when one of our most experience CRNA who couldn’t intubate with a Miller, showed him up with a Mac. Thought it was funny and also it’s just what you’re used to and self awareness that will save you and the patient at the end of the day.
Click to expand...
Most people in this country could give a rats ass about the environment.
At work, the OR is the absolute worst. It’s quite disturbing.
 
chocomorsel said:
So apparently you can’t even yell at them anymore when they screw up. It hurts their feelings. And they really try to act like they are your equal.
Click to expand...
While I agree with the sentiment that people are getting soft, I can't help but see the parallels to my drill sergeants complaining about not being able to beat the soldiers anymore. Lol
 
MirrorTodd said:
While I agree with the sentiment that people are getting soft, I can't help but see the parallels to my drill sergeants complaining about not being able to beat the soldiers anymore. Lol
Click to expand...
Give me a break. I was in the military 20+ years ago and no one ever beat me or even came close. How long ago was this for you? Your drill sergeant is likely feeding you horse****.
All they did was yell.
I am talking of panic intubating a Covid patient like we are still in NY in the spring. They need to slow their roll.
 
chocomorsel said:
Give me a break. I was in the military 20+ years ago and no one ever beat me or even came close. How long ago was this for you? Your drill sergeant is likely feeding you horse****.
All they did was yelled.
Click to expand...
Of course they didn't actually beat us nor did our grandparents have to walk uphill both ways in the snow to school. I wasn't trying to make you aggressive or call you out or anything. Although, I can only say that after a lifetime (well 37 years) of teachers/instructors yelling at me, maybe yelling isn't a very good teaching method...even if they have screwed up.
 
MirrorTodd said:
Of course they didn't actually beat us nor did our grandparents have to walk uphill both ways in the snow to school. I wasn't trying to make you aggressive or call you out or anything. Although, I can only say that after a lifetime (well 37 years) of teachers/instructors yelling at me, maybe yelling isn't a very good teaching method...even if they have screwed up.
Click to expand...
So I really need to know what is it about my response that makes me seem “aggressive.”
Smart ass, yes.
Aggressive? How?
Your drill sergeant was lying to you about beating up trainees in the past.
Drill sergeants are hardly ever past their forties so he was making up stuff that never applied to he or she. Maybe to his predecessors.
 
chocomorsel said:
So I really need to know what is it about my response that makes me seem “aggressive.”
Smart ass, yes.
Aggressive? How?
Your drill sergeant was lying to you about beating up trainees in the past.
Drill sergeants are hardly ever past their forties so he was making up stuff that never applied to he or she. Maybe to his predecessors.
Click to expand...
The use of the expletive. I understand you didn't mean it to be aggressive. That's just how I read that in that moment. 5 minutes later, I would've read it in a completely different tone. Thats just how I read things on the internet...tone is completely random for me.
 
I’ve never learned from anyone yelling at me. Nor have I ever learned from someone that spoon fed me. It’s a balance. I learned from people who had high expectations of me, challenged me to make me feel a bit uncomfortable but at the same time, I knew that they respected me as a person. I’m actually thinking of an attending I had at the VA who is a colonel, she was amazing but I would be lying if she didn’t scare me a little bit.
 
Katheudontas parateroumen said:
I’ve never learned from anyone yelling at me. Nor have I ever learned from someone that spoon fed me. It’s a balance. I learned from people who had high expectations of me, challenged me to make me feel a bit uncomfortable but at the same time, I knew that they respected me as a person. I’m actually thinking of an attending I had at the VA who is a colonel, she was amazing but I would be lying if she didn’t scare me a little bit.
Click to expand...
Never learned really? Never got yelled at, received an explanation for it, read about that potentially damaging thing you just did to a patient, and learned something? And the next time you were about to make the same dumb choice you paused and thought better of it?
Yeah, I don’t buy that. It’s one thing to yell at someone and go on and on in a rant verbally abusing the person. It’s another to do it once and explain your reasoning, move on and make it a teaching moment.

Glad I don’t work with trainees on a full time basis.
 
GassYous said:
When you have a wasteful rule that makes zero sense, 95% of the time you can trace it back to some jcaho visit. Those idiot ****ers are responsible for so much waste in this country.

Speaking of bougies, how are you guys doing it? I rarely use it because mcgraths make the airway so easy but I've had a few instances where the tube seems to be in the airway but when I go to bag, no end tidal. I think I am not twisting the airway properly and getting caught on the arytenoids and the tube is just out of the cords.
Click to expand...
are you maintaining direct visualization the whole time (2 man operation), or do you remove the blade and railroad the tube over the bougie blindly?
 
MirrorTodd said:
While I agree with the sentiment that people are getting soft, I can't help but see the parallels to my drill sergeants complaining about not being able to beat the soldiers anymore. Lol
Click to expand...

Just order the code red.
 
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chocomorsel said:
Never learned really? Never got yelled at, received an explanation for it, read about that potentially damaging thing you just did to a patient, and learned something? And the next time you were about to make the same dumb choice you paused and thought better of it?
Yeah, I don’t buy that. It’s one thing to yell at someone and go on and on in a rant verbally abusing the person. It’s another to do it once and explain your reasoning, move on and make it a teaching moment.

Glad I don’t work with trainees on a full time basis.
Click to expand...

I definitely respect where you are coming from. Maybe we meant something different about yelling. The type of yelling that doesn't respect the person as a learner, hard headed and not willing to explain, unreasonable my way or the highway... I only remember being yelled at during med school and don't remember what was actually said... but I remember the person who pulled me aside after my berating to teach me to be better. Anyways, not to derail this thread.
 
Katheudontas parateroumen said:
I definitely respect where you are coming from. Maybe we meant something different about yelling. The type of yelling that doesn't respect the person as a learner, hard headed and not willing to explain, unreasonable my way or the highway... I only remember being yelled at during med school and don't remember what was actually said... but I remember the person who pulled me aside after my berating to teach me to be better. Anyways, not to derail this thread.
Click to expand...
I am not talking of the type of yelling we see with surgical trainees and their attendings. Not at all.
I chalk it up to inexperience from both fellows and nurses but totally pissed me off because I had staved off the patient from being intubated by talking to the other fellow the previous day and now this other one jumped the gun.
It takes a lot for me to actually yell at a person in real life at work believe it or not. I try to avoid conflict because I want to build lasting relationships that I can keep coming back to the same place, but sometimes, the place is toxic enough to where I don't care.

I am passionate about my ICU patients and especially my Covid patients. Seen too much death and trying to avoid it for them as much as I can.
 
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