Elective cases after hours

[BobLoblaw78]

How many people do elective cases during call hours?

We have the occasional questionable urgent/emergent cases that you do the case and move on. It gets the work done and usually the situation has decent reasoning for not waiting. Recently, we have a surgeon who does almost as many cases during call as during his block schedule. He has declined more block time (has anyone ever heard of a surgeon turning down block time?). The majority of his call cases are elective or very questionable. He even refuses to declare them urgent/emergent. He does more of these elective after hour cases than the rest of our surgeons combined. Just a very peculiar situation that I have not ran into previously (at least to this degree). It is pretty clear to me how to handle it with our capabilities, but I was curious about others' experiences in similar situations.

(I am not talking about elective cases going into call hours. More like 10 year h/o abdominal pain 2/2 chronic cholecystitis, without fever or leukocytosis, going at 11pm b/c the surgeon has nothing else going on and doesn't want to do it first thing in the morning)

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[nimbus]

We have podiatry and oral surgery cases every single day at 5pm. Those doctors have office/clinic during the day so they do their hospital cases in the evening. But we are staffed for it so it’s no big deal.

 

[Blockit]

I have several like this as well. For example calling the OR team in at 11 PM to do a closed distal radius fracture. This particular surgeon is bipolar and likely on the autism spectrum so he quite frankly doesn’t care about anyone but himself. Everyone hates him. But the sad fact is that my hospital administration couldn’t care less. They are all in their beds sleeping at 11 PM, probably sleeping on the pile of money they collect every year as their bonus.

as an anesthesiologist you will never make headway trying to resist this type of stuff unless you are able to tie it to a specific patient safety issue.

 

[anbuitachi]

define elective. during covid wave 2, we were not doing 'elective cases'. but hospital changed elective cases to pretty much only some basic cosmetic cases. so OR cases pretty much proceeded as usual

I think thats one of the benefits of being a surgeon. want to sleep in during teh day? book it for 10pm. want to go to an event or run some errands? do clinic then go take a nap? book your cases for night time.


Last week on call, gen surg attending wanted to do a lap chole at 10pm. I didnt. Im salaried and patient is extremely stable, no elevated white count, not in much pain, been in hospital for couple days, vitals rock solid. we have real emergencies here (adult/peds trauma, stroke, etc). Lap chole here from surgery booking the case to patient in the recovery, averages 5-6 HOURS. I count this as non urgent and i have told them no in the past for these cases. sometimes i get pushback sometimes i dont. oh well.

also hate the lap appys in the middle of the night. they are treated as true emergencies here. doesnt matter what time of teh day, they go to the OR, even though their exam/vitals are often extremely unremarkable. Also a multi hour ordeal. extremely frustrating

 

[GassYous]

Our surgeons are generally nice normal people and don't pull these stunts. They like sleeping at night in their homes with the fam and not being bleary eyed while seeing their clinic patients the next day.

We do lap appys at night but not choles. But the appys are generally less than an hour long from wheels in to wheels out. I'm pretty sure I could do one in an hour. How hard is it to put some trochars in and staple a tiny piece of bowel out? Robot choles are similar for the good surgeons but even the bad ones only take 2 hours at the most for the "tough anatomy" cases.

 

[BobLoblaw78]

Our surgeons are generally nice normal people and don't pull these stunts. They like sleeping at night in their homes with the fam and not being bleary eyed while seeing their clinic patients the next day.

We do lap appys at night but not choles. But the appys are generally less than an hour long from wheels in to wheels out. I'm pretty sure I could do one in an hour. How hard is it to put some trochars in and staple a tiny piece of bowel out? Robot choles are similar for the good surgeons but even the bad ones only take 2 hours at the most for the "tough anatomy" cases.

This is us. Unfortunately, we don’t have the manpower to run our staff into the ground all night and expect them to work the next day. And even more so, we can’t expect them to stay at our facility. Also the issue of when a real emergent case comes.

Some stupid elective case examples: non infected nodule that has been there for years, screening colonoscopy, old metal sliver excision, etc

 

[GassYous]

This is us. Unfortunately, we don’t have the manpower to run our staff into the ground all night and expect them to work the next day. And even more so, we can’t expect them to stay at our facility. Also the issue of when a real emergent case comes.

Some stupid elective case examples: non infected nodule that has been there for years, screening colonoscopy, old metal sliver excision, etc

If someone tried to schedule a screening colonoscopy at night I'm sure they would "trip" in the parking lot on the way home.

 

[Lookingforlolz]

Resident still, but my place has got to be one of the worst offenders for this. We’re a high volume level 1 center too, so stabbings/GSWs/motorcycles come in with high frequency at all hours of the day.

Even still, we do anything at any time. I’ve started choles at 5am, outpatient cataracts that sat in pre op all day at 10pm, toe amps in stable nonseptic pts at 4am, butt abscesses at 545am (just quick enough to get in and out before first case starts at 730a ). Surgeons here are all maniacs and clearly have all the power and influence as to what goes and what doesn’t. Doesn’t help that junior residents are doing these simple cases and the chole that goes at 2am isn’t out of the room until 5.

 

[Hoya11]

How many people do elective cases during call hours?

We have the occasional questionable urgent/emergent cases that you do the case and move on. It gets the work done and usually the situation has decent reasoning for not waiting. Recently, we have a surgeon who does almost as many cases during call as during his block schedule. He has declined more block time (has anyone ever heard of a surgeon turning down block time?). The majority of his call cases are elective or very questionable. He even refuses to declare them urgent/emergent. He does more of these elective after hour cases than the rest of our surgeons combined. Just a very peculiar situation that I have not ran into previously (at least to this degree). It is pretty clear to me how to handle it with our capabilities, but I was curious about others' experiences in similar situations.

(I am not talking about elective cases going into call hours. More like 10 year h/o abdominal pain 2/2 chronic cholecystitis, without fever or leukocytosis, going at 11pm b/c the surgeon has nothing else going on and doesn't want to do it first thing in the morning)

this is the routine for me as well

 

[partydoc]

Resident still, but my place has got to be one of the worst offenders for this. We’re a high volume level 1 center too, so stabbings/GSWs/motorcycles come in with high frequency at all hours of the day.

Even still, we do anything at any time. I’ve started choles at 5am, outpatient cataracts that sat in pre op all day at 10pm, toe amps in stable nonseptic pts at 4am, butt abscesses at 545am (just quick enough to get in and out before first case starts at 730a ). Surgeons here are all maniacs and clearly have all the power and influence as to what goes and what doesn’t. Doesn’t help that junior residents are doing these simple cases and the chole that goes at 2am isn’t out of the room until 5.

this sounds like where i work

 

[anbuitachi]

hope you guys are paid a lot for those awful calls

 

[GassYous]

Resident still, but my place has got to be one of the worst offenders for this. We’re a high volume level 1 center too, so stabbings/GSWs/motorcycles come in with high frequency at all hours of the day.

Even still, we do anything at any time. I’ve started choles at 5am, outpatient cataracts that sat in pre op all day at 10pm, toe amps in stable nonseptic pts at 4am, butt abscesses at 545am (just quick enough to get in and out before first case starts at 730a ). Surgeons here are all maniacs and clearly have all the power and influence as to what goes and what doesn’t. Doesn’t help that junior residents are doing these simple cases and the chole that goes at 2am isn’t out of the room until 5.

lol there was a time in residency when the surgery residents wanted to get first case starts on the weekend. So plastics and ortho would continually book earlier and earlier to outdo each other. 7 am. 630. 6 am. 530. It got to be too egregious with nonelective cases and everyone was banned from playing those games.

I mean I get it, the nurses sucked and turnover took forever but that's just bull****, especially if you were up until 3 doing ****ty cases and then have to get up again at 430? **** that!

 

[Shimmy8]

This is an admin/COO or chief of surgery issue. Strong leadership needed.

 

[DrOwnage]

This is the worst at my shop when a surgeon will put an elective 5-6 level posterior or ACDF as an 8am case on a Saturday or Sunday. It takes up the call person for 6-7 hours and the 2nd and 3rd call people end up getting called in first thing in the morning and don't leave until late afternoon. Then ortho trauma cases get stacked up because of it.

 

[jwk]

This is an admin/COO or chief of surgery issue. Strong leadership needed.

Bingo. And it's a culture issue.

Not sure how many people you have on call and how many late rooms you run. We start the day with 100 or more anesthetizing locations and can still run about 60 till 7pm. After that it drops off quickly. Elective surgeries get in line behind emergencies. We have late-posting surgeons piss and moan all the time about getting bumped for emergencies, but hey, they're the ones foolish enough to post an elective case at 6pm. Some get the message - some just keep pissing and moaning and posting late cases. We also don't keep staff around just to do these late cases. If everything is done around 3pm, we won't keep someone sitting around for a 6pm elective case. If nothing else is going on at 6pm, sure, we'll do the elective case. If something more urgent comes up, oh, so sorry, you have to wait. 🙂

Our elective schedule is supposed to end by 7pm. Doesn't always happen but most of the time it does. There are a finite number of anesthesia and OR staff working after 7pm and on weekends. Get in line and wait.

 

[drmwvr]

How many people do elective cases during call hours?
(I am not talking about elective cases going into call hours. More like 10 year h/o abdominal pain 2/2 chronic cholecystitis, without fever or leukocytosis, going at 11pm b/c the surgeon has nothing else going on and doesn't want to do it first thing in the morning)

Usually personality disorder with a disaster of a home life...

 

[pgg]

This is the worst at my shop when a surgeon will put an elective 5-6 level posterior or ACDF as an 8am case on a Saturday or Sunday. It takes up the call person for 6-7 hours and the 2nd and 3rd call people end up getting called in first thing in the morning and don't leave until late afternoon. Then ortho trauma cases get stacked up because of it.

There's the opposite problem at a hospital where I do some locums. I've seen ortho and gen surg sit around the OR desk with their foot tapping all night and all weekend trying to squeeze outpatient ankle fractures, trach/PEG cases for people who've been intubated for a week or two, and other assorted elective crap in between the GSWs and vehicle trauma and SBOs. It's maddening. They run the call teams ragged. It's just what they do.

They pay well so I keep going back, like the rat in the cage hitting the lever for another dose of cocaine, but I can only make myself do it occasionally.

And it's totally unnecessary. All hospital admin has to do is open up a couple rooms for elective block time on the weekends. Schedule an OR and anesthesia crew to work a regular shift then. The surgeons with cases backed up would have plenty of predictable time to get them done. Just terrible management. They're heavily dependent upon locums, and they always will be.

 

[Beach bum]

Have all surgeons salaried and not incentivized to do cases and you will be surprised how quickly those will disappea!!!