Elective add on policy

[pd4emergence]

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For those in practice, I was wondering how other practices manage (schedule wise) purely elective add ons. I have been becoming more and more frustrated lately regarding our policy or lack thereof. We basically do elective cases anytime as long as the patients are NPO. We also have a big problem with surgeons wanting to do long cases after clinic and on weekends(like long backs and elective Crani's). I work in a busy community hospital and most of the time the surgeons don't want to be working at unreasonable times. But, there are always those one or two which seems to change daily. Is my frustration justified or is this just the way it is?

 

[Gas]

Add ons go at the end of the day, in order that they were booked. If the case is emergent, it has to bump a scheduled room, and that room is random and changes every day (example, Monday is OR 1, Tues 2, etc.) If it is a short case, and there is a big gap in a room, we try to squeeze the surgeon in, but we don't if there is any chance we could delay the next scheduled case. Weekends are open, but if there are more than 4 or so scheduled cases, we open a second room. We can do a third room on weekends for emergencies, but that is rare.

BTW, my hospital does not do cardiac, trauma, or cranis so these scheduling issues and emergencies bumping elective cases does not happen all that often.

 

[deleted126335]

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[jwk]

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[jwk]

Add-on cases are just that - add-ons. They're not part of the regular OR schedule. We place them on an add-on list, and we attempt to do them on a time/space available basis. However, we will not place them where they will delay the start of a scheduled case. A surgeon can indicate his desired time, but more often than not, we don't start getting to add-on's till mid-afternoon on most days.

All our rooms run pretty full - we don't keep a room empty for add-ons or emergency cases. Emergency cases go in the first available room. If that means bumping a scheduled case, it requires a surgeon-to-surgeon phone call from the bumping doc to the doc being bumped. It takes the OR and anesthesia out of the discussion of what constitutes an emergency. Obviously a little common sense prevails, and a ruptured AAA is going to get placed pretty quickly, where an "emergency appendectomy" that has been in the ER all night and then waits for the surgeon to finish his morning office is going to get a little less sympathy and urgency.

Add-ons are disruptive to the OR schedule. Just because a sugeon wants to squeeze in an add-on case while his office staff is at lunch doesn't mean it's going to happen. We run more than 2/3 of our 35+ OR's past 3pm to get in as many cases as we can, but by 9pm, it's two OR's and two OR's only. We have an agreement with the hospital as to how many OR's we will cover depending on the hour of the day (or night), the day of the week, and holidays.

 

[deleted126335]

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[zippy2u]

Transition to a surgery center and most of that BS goes away. It won't get any better, trust me I've been where you're at. Barry, the ketamine-before-the-propofol-guy, doesn't have to deal with that nightmare either. When I was doin' locums, I loved these inefficient surgeons-- I was gettin' paid good coin to wait for them... Regards, ----Zippy

 

[jwk]

What happens when the Joe orthopod notifies you at 9 am today and wants to put on a 6 hour Acetabular fracture to start "after 6pm" tonight and you have OR time available today and tomorrow during the day? Do you say "NO- schedule it during daylight hours" or do you do the case in the evening?, Crimping your available resources for the night, or mandate that someone involuntarily stay late?

I really want to know how most people handle this type of situation.

We would do it sooner or later - the "after 6pm" really doesn't mean much in our case. They're on the add-on list. If someone else adds on a case an hour later, but wants to come at 4pm and the other guy can't come do his case until "after 6pm", we'll do the guy at 4pm. We won't hold an OR for hours on end just to accommodate him at 6pm. His "after 6pm" case might not get started until midnight. Not likely, but certainly possible. And by posting a case at 9am to be done after 6pm, it makes it very obvious that it's not an emergency case, so it could be bumped anyway. Very few of our surgeons would be willing to start a 6hr case late in the evening unless it was really important for medical reasons (as opposed to convenience) to get it done. In most cases, if they find out that their start time will likely be very late, they'll try for an OR the next day - we usually have something available by lunchtime.

 

[pd4emergence]

What happens when the Joe orthopod notifies you at 9 am today and wants to put on a 6 hour Acetabular fracture to start "after 6pm" tonight and you have OR time available today and tomorrow during the day? Do you say "NO- schedule it during daylight hours" or do you do the case in the evening?, Crimping your available resources for the night, or mandate that someone involuntarily stay late?

I really want to know how most people handle this type of situation.

We would do it. Honestly it would not matter if it was a bad looking mole that needed to come off at 2 a.m. on a sunday morning we would do it. At my institution, if this same surgeon had two cases of bad looking moles at 2 a.m. on sunday, he would complain that he did not have two rooms to do them in. It is very frustrating at times. We have no set policy to deal with elective cases and we just do what is scheduled. Sure the regularly scheduled stuff gets done. But many days there is just as many add on and on call cases as there were regularly scheduled cases. It all comes down to the fact that no one wants to say no. Because of competition, the hospital will staff any room no matter how much overtime they have to pay. My group consensus is that we will staff any room the hospital is willing to staff. This keeps the surgeons happy, as for my group the morale sucks. I find myself longing for my academic days when I could truly tell the surgeon go f**k himself (or herself)...well maybe not that but at least I could say "no".