Elective cases in the middle of a Warzone

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chocomorsel

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Full speed ahead in the ORs at the academic institution where I currently am doing locums. RNs in the ICU have 4 patients many on CRRT and iNO and even travelers are leaving and breaking down left and right.
I go downstairs to the Doctors lounge in the morning for a breakfast taco and coffee and see a bunch of CRNAs sitting around shooting the sh..
Patients are dying. Governor is not making masking a mandate, asking for FEMA help nor preventing restaurants and public places from filming up to the brim.
Patients are dying from poor care as the ORs keep going like nothing is happening. Since they have a brand new building they are letting us use the old one for more ICUs. Opening up more ICUs but no accounting for the lack of nurses and techs.
This is madness, ridiculousness and lack of foresight if I ever saw any. And quite frankly all about the money maker OR. Screw the rest of the hospital and drowning floor and ICU RNs.

Anyway, just pissed and venting. Emergency meeting this week with the C-Suite to hopefully close them and divert their staff to the Units. This is the only hospital that I have been in for Covid help where the ORs are going full speed ahead.
Madness.

Yeah, I know this is probably an unpopular opinion on this forum, but I don’t care. We need to be able to assist in the ICU as anesthesiologists with our skill set when the hospital is over capacity and drowning outside of the OR, instead of continuing with elective cases.
 
Seems so alien to me. We cancelled all elective cases statewide, sent staff to icu and emptied the wards in preparation for disaster... then the state only had 500 cases and 4 deaths all year. Thoughts go out to you in the US doing it tough... hopefully it settles with the vaccine
 
woopedazz said:
Seems so alien to me. We cancelled all elective cases statewide, sent staff to icu and emptied the wards in preparation for disaster... then the state only had 500 cases and 4 deaths all year. Thoughts go out to you in the US doing it tough... hopefully it settles with the vaccine
Click to expand...

What state?
 
chocomorsel said:
Full speed ahead in the ORs at the academic institution where I currently am doing locums. RNs in the ICU have 4 patients many on CRRT and iNO and even travelers are leaving and breaking down left and right.
I go downstairs to the Doctors lounge in the morning for a breakfast taco and coffee and see a bunch of CRNAs sitting around shooting the sh..
Patients are dying. Governor is not making masking a mandate, asking for FEMA help nor preventing restaurants and public places from filming up to the brim.
Patients are dying from poor care as the ORs keep going like nothing is happening. Since they have a brand new building they are letting us use the old one for more ICUs. Opening up more ICUs but no accounting for the lack of nurses and techs.
This is madness, ridiculousness and lack of foresight if I ever saw any. And quite frankly all about the money maker OR. Screw the rest of the hospital and drowning floor and ICU RNs.

Anyway, just pissed and venting. Emergency meeting this week with the C-Suite to hopefully close them and divert their staff to the Units. This is the only hospital that I have been in for Covid help where the ORs are going full speed ahead.
Madness.

Yeah, I know this is probably an unpopular opinion on this forum, but I don’t care. We need to be able to assist in the ICU as anesthesiologists with our skill set when the hospital is over capacity and drowning outside of the OR, instead of continuing with elective cases.
Click to expand...

Unpopular because it means the CEO won't be getting a big fat bonus?
 
My hospital lost $300M the first time, there won’t be a second until it’s overflowing, and even then they would only cancel elective cases that are planned admissions. I don’t think the governor has plans to mandate anything. You can’t have hospital systems collapse as well.
 
chocomorsel said:
Unpopular because many docs on here would hate to be pulled to the ICU.
Click to expand...
Let’s be honest. Most of us have no clue what to do in the ICU. just because we can intubate and place lines does not make us ICU doctors. This became painfully clear in March - April. We had some anesthesia run ICU’s. Things did not go well...
 
IlDestriero said:
My hospital lost $300M the first time, there won’t be a second until it’s overflowing, and even then they would only cancel elective cases that are planned admissions. I don’t think the governor has plans to mandate anything. You can’t have hospital systems collapse as well.
Click to expand...
Well it’s overflowing. Over 100% capacity.
Yeah those planned admissions don’t need to happen. Surgeons can run ICUs especially in an academic setting.
What’s the alternative? Oh yeah, I am living in the alternative. And it’s a friggin nightmare.
It’s a major academic medical center and one of two level ones in the state. Not gonna collapse.
But money before people. Capitalism at its best!
 
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dannyboy1 said:
Let’s be honest. Most of us have no clue what to do in the ICU. just because we can intubate and place lines does not make us ICU doctors. This became painfully clear in March - April. We had some anesthesia run ICU’s. Things did not go well...
Click to expand...
Well I am talking about just even being available to assist with procedures. Proning. Assist the nurses, assist us in any way or form if you aren’t comfortable running the unit. All that is helpful.
Whatever the case the CRNAs and PACU nurses are ICU and are more needed in the ICU at this stage in time.
 
Good luck getting a crna to work as an icu nurse again. The reality is that you can't pay for a hospital to run without keeping the ORs going. Our hospitals also lost millions a month when they shut down the ORs. You can't stick circulators on the wards and expect them to seamlessly transition.
 
GassYous said:
Good luck getting a crna to work as an icu nurse again. The reality is that you can't pay for a hospital to run without keeping the ORs going. Our hospitals also lost millions a month when they shut down the ORs. You can't stick circulators on the wards and expect them to seamlessly transition.
Click to expand...
Didn’t say circulators. I said PACU nurses. Totally different species. Circulators can help prone.
Something has gotta give. Guess it will be the dying patients.
 
Choco, no one is handcuffing you to stay there.

If you want X hospital system to survive past the pandemic, some elective cases will need to continue. Period. You have alluded to ICU training in the past, why aren’t you doing ICU shifts if it bothers you this much.
 
AdmiralChz said:
Choco, no one is handcuffing you to stay there.

If you want X hospital system to survive past the pandemic, some elective cases will need to continue. Period. You have alluded to ICU training in the past, why aren’t you doing ICU shifts if it bothers you this much.
Click to expand...
Well, I am speaking as an intensivit who is currently working in the unit. I guess you didn’t get that from the long post. Is it vague? Did the part about going for a breakfast burrito not give it away? I never have time to eat breakfast in the OR. Who does besides the CRNAs?

And I am leaving. Already told them. Can’t participate in this madness.

And I haven’t alluded to ICU training in the past. I have been very open about it.
 
chocomorsel said:
Well, I am speaking as an intensivit who is currently working in the unit. I guess you didn’t get that from the long post. Is it vague? Did the part about going for a breakfast burrito not give it away? I never have time to eat breakfast in the OR. Who does besides the CRNAs?

And I am leaving. Already told them. Can’t participate in this madness.

And I haven’t alluded to ICU training in the past. I have been very open about it.
Click to expand...

No, I incorrectly assumed you were doing General OR. I didn’t pick up on the hints that you were covering the unit. I have time to go to the docs lounge while supervising, often, so didn’t know... sorry?

As to before, I know you’ve covered the unit this year a lot but didn’t know if you did so as a generalist or as a fellowship-trained doc. You didn’t seem to talk much about the unit before, so wasn’t sure. My mistake.
 
GassYous said:
I have time to go to the docs lounge while doing my own cases.
Click to expand...
Depends on the place. And how much “move there meat” mentality they had. The doctors lounge where I am is two floors down after a hallway outside the OR. Not exactly convenient. And hardly ever had time in the past to go there.

Certainly not for breakfast unless my first case delayed or cancelled.

Besides in the OP I stated that they evacuated to the new building and are letting “us” use the old one for more ICU beds. I don’t know how much more clear I need to be.
 
chocomorsel said:
I never have time to eat breakfast in the OR.
Click to expand...

Chocs, you must be doing it wrong.

Step 1: Never sit your own case.

Step 2: Leave the case entirely in the hands of the qualified "doctor" who is definitely a "doctor" because we all know she wrote a 7th grade book report thesis to earn that "doctorate."


Now you have time for breakfast, 2nd breakfast, mid-morning snack, lunch, 2nd lunch, mid-PM snack, and so on. You're welcome.
 
chocomorsel said:
Depends on the place. And how much “move there meat” mentality they had. The doctors lounge where I am is two floors down after a hallway outside the OR. Not exactly convenient. And hardly ever had time in the past to go there.

Certainly not for breakfast unless my first case delayed or cancelled.

Besides in the OP I stated that they evacuated to the new building and are letting “us” use the old one for more ICU beds. I don’t know how much more clear I need to be.
Click to expand...
Haha I don’t unless supervising, which isn’t often. I can commiserate.
 
dannyboy1 said:
Let’s be honest. Most of us have no clue what to do in the ICU. just because we can intubate and place lines does not make us ICU doctors. This became painfully clear in March - April. We had some anesthesia run ICU’s. Things did not go well...
Click to expand...

I think if we were tasked to run a COVID ICU our anesthesia training would give us a big advantage over other non ICU specialties.
 
Well, if you think about it this way, if that OR wasn't full steam ahead, then that hospital system could not have the money to pay you for COVID help. Even if an agency is paying you, that agency is getting money from the hospital. I'll add that sure I have skills that are "useful" in the ICU, but I'm in no way an intensivist. There's a reason there is an extra year or two of fellowship and a board certification for that field. I'm sure at this point someone in the financial department did the number crunch and decide that the financial hit of shutting down ORs and diverting PACU/Cath lab nurses to ICU didn't outweigh, well, just making people work harder and burning them out. It's happening everywhere. Now that we have testing that is more standard than it was in March and April, most hospitals are staying full steam ahead.

As for what's happening at the state level where you are, well, that's political and I'll leave that for the "SCOTUS" thread.

Lastly, if you're having that hard a time finding a moment to eat, you have to improvise. Yes, take care of patients, but I'm sorry, also take care of yourself. "When nature calls.......always answer."
 
coffeebythelake said:
I think if we were tasked to run a COVID ICU our anesthesia training would give us a big advantage over other non ICU specialties.
Click to expand...
I agree to an extent. I know some anesthesiologists out there with years of experience that look like a deer in the headlights if a patient is on more than one drip.
 
Twiggidy said:
I agree to an extent. I know some anesthesiologists out there with years of experience that look like a deer in the headlights if a patient is on more than one drip.
Click to expand...

i think that says a lot about how much their skill and knowledge has degraded
but i suppose the same can be said of any other field out there, like a surgeon who only does inguinal hernias
 
coffeebythelake said:
i think that says a lot about how much their skill and knowledge has degraded
but i suppose the same can be said of any other field out there, like a surgeon who only does inguinal hernias
Click to expand...
Exactly. In a critical care situation, I'd probably rather have a MICU 2nd year resident than someone who's made a career taking care of ASA 1s and 2s.
 
Twiggidy said:
Lastly, if you're having that hard a time finding a moment to eat, you have to improvise. Yes, take care of patients, but I'm sorry, also take care of yourself. "When nature calls.......always answer."
Click to expand...

toss some trail mix into the N95 mask. Fill it until you have to eat more to make breathIng easier. Alway a win.
 
To be clear, my intention wasn’t to denigrate docs who supervise. I will be supervising myself soon, and I have done so previously so I don’t think I’m speaking without experience here. What I was trying to imply is that there’s a difference between actually supervising, and putting your feet up in the lounge while letting a CRNA take total ownership of the case.

Nothing against people who supervise, people who make a career out of ASA 1 and 2 patients, or those of us who sub specialize. But if you’ve been so hands off for so long that “taking care of a patient who is on more than one drip” makes you “a deer in the headlights”... maybe you should not be practicing anesthesiology anymore.

i’ll never forget the time I had to do a simulation session along with a couple of anesthesiologists who have done exclusively OB for the last xx years. They didn’t know basic ACLS- a medicine intern would have been more helpful. At the end of the day our job is to function as a critical care doc for the rare patient who becomes seriously ill, even if it’s an ASA1 at an outpatient surgicenter. All I meant by my previous post was that anyone who has any business calling themselves an anesthesiologist needs to have a baseline level of comfort dealing with emergencies and caring for sick patients. When that is no longer the case, our specialty is dead- the nurses can have it
 
I’d be more comfortable in the derm clinic than in the ICU. I haven’t done that in 20 years. Need a line, tube, prone? I’m your man. I’m pretty handy with a fiber for a bronch. I can manage an asa5 patient in the OR as well, but there’s a whole specialty’s worth of knowledge that I never learned.
I think of OR critical care like battlefield surgery. You stabilize the patient and get them to the higher echelon of care.
 
Twiggidy said:
Well, if you think about it this way, if that OR wasn't full steam ahead, then that hospital system could not have the money to pay you for COVID help. Even if an agency is paying you, that agency is getting money from the hospital. I'll add that sure I have skills that are "useful" in the ICU, but I'm in no way an intensivist. There's a reason there is an extra year or two of fellowship and a board certification for that field. I'm sure at this point someone in the financial department did the number crunch and decide that the financial hit of shutting down ORs and diverting PACU/Cath lab nurses to ICU didn't outweigh, well, just making people work harder and burning them out. It's happening everywhere. Now that we have testing that is more standard than it was in March and April, most hospitals are staying full steam ahead.

As for what's happening at the state level where you are, well, that's political and I'll leave that for the "SCOTUS" thread.

Lastly, if you're having that hard a time finding a moment to eat, you have to improvise. Yes, take care of patients, but I'm sorry, also take care of yourself. "When nature calls.......always answer."
Click to expand...
The hospital also makes money outside the OR. It’s not like these patients won’t get billed.
Yeah, I know the OR is the biggest money maker but hospitals also got a lot of Covid relief money.
Whatever the case, it can’t always be about the bottom line.
People are dying and beds are being taken up by elective hips and knees and backs and nurses are drowning.
I guess certain people will only care if it’s their loved one who gets ****ty care. Otherwise, make that money.
 
chocomorsel said:
Full speed ahead in the ORs at the academic institution where I currently am doing locums. RNs in the ICU have 4 patients many on CRRT and iNO and even travelers are leaving and breaking down left and right.
I go downstairs to the Doctors lounge in the morning for a breakfast taco and coffee and see a bunch of CRNAs sitting around shooting the sh..
Patients are dying. Governor is not making masking a mandate, asking for FEMA help nor preventing restaurants and public places from filming up to the brim.
Patients are dying from poor care as the ORs keep going like nothing is happening. Since they have a brand new building they are letting us use the old one for more ICUs. Opening up more ICUs but no accounting for the lack of nurses and techs.
This is madness, ridiculousness and lack of foresight if I ever saw any. And quite frankly all about the money maker OR. Screw the rest of the hospital and drowning floor and ICU RNs.

Anyway, just pissed and venting. Emergency meeting this week with the C-Suite to hopefully close them and divert their staff to the Units. This is the only hospital that I have been in for Covid help where the ORs are going full speed ahead.
Madness.

Yeah, I know this is probably an unpopular opinion on this forum, but I don’t care. We need to be able to assist in the ICU as anesthesiologists with our skill set when the hospital is over capacity and drowning outside of the OR, instead of continuing with elective cases.
Click to expand...
I am pretty proud that the hospital system I work at made the right decision when we had a surge in the summer and now that we are being pounded again. Any elective case can go to ahit and end up needing admit or critical care. Even if the staff can't necessarily function like whatever staff is needed there are things they can do to help or at least not contribute to more workload.
 
chocomorsel said:
The hospital also makes money outside the OR. It’s not like these patients won’t get billed.
Yeah, I know the OR is the biggest money maker but hospitals also got a lot of Covid relief money.
Whatever the case, it can’t always be about the bottom line.
People are dying and beds are being taken up by elective hips and knees and backs and nurses are drowning.
I guess certain people will only care if it’s their loved one who gets ****ty care. Otherwise, make that money.
Click to expand...

The OR is pretty much the only place the hospital makes money. A well run/poorly run OR is literally make or break for a hospital in terms of margin.

In the US system, money is made when care is delivered. If care is not delivered, then no money is made and your hospital system closes and the nurses and employed physicians are let go. In a single government payer system, the system (govt) loses money when care is delivered. So something like COVID is ideal for those single payer systems, but is totally screwing America right now because we have the choice of

1) Charging along with elective cases
2) Shutting down ORs and bankrupting hospitals
3) Massive government subsidization of an industry that is 17% of GDP to prop it up. The COVID relief bill would be a drop in the bucket compared to that, and you had legislators scoffing at giving US tax payers any money while sending billions in foreign aid for god knows what reason why.
 
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good discussion.

in the American health care system, forcing a stop to elective surgeries endangers ruining the hospitals without significant government aid. While upsetting, it’s the truth.

I think the hosptial needs to do something for staffing though if it’s really 1:4 for nurses in the ICU.
 
chocomorsel said:
Who is saying anything about working for free?
Click to expand...

OR is a cash cow, as you well know. I would guess you’ve negotiated a lot and know how to get a good deal for yourself. Can’t get those deals if hospital can’t generate revenue to offer them. The ICU may operate at a loss, but the surplus from OR may subsidize the those units as someone mentioned above.

Also, how will the hospital be able to pay for those complimentary breakfast burritos you like?
 
D P356 said:
OR is a cash cow, as you well know. I would guess you’ve negotiated a lot and know how to get a good deal for yourself. Can’t get those deals if hospital can’t generate revenue to offer them. The ICU may operate at a loss, but the surplus from OR may subsidize the those units as someone mentioned above.

Also, how will the hospital be able to pay for those complimentary breakfast burritos you like?
Click to expand...
They are kinda disgusting as full of American gooey cheese honestly.
But it beats being hungry. I pick out as much cheese as possible.

It’s the flavored fancy coffee that I like more. Frothy and thick and sweet.
I wound not rate myself as a great negotiator but not complaining.
 
dipriMAN said:
good discussion.

in the American health care system, forcing a stop to elective surgeries endangers ruining the hospitals without significant government aid. While upsetting, it’s the truth.

I think the hosptial needs to do something for staffing though if it’s really 1:4 for nurses in the ICU.
Click to expand...

This country's priorities are ****ed up. Counting pennies over healthcare while spending hundreds of billions freely for defense projects.
 
dabears505 said:
People gotta get paid. 8 million plus people have been reduced to poverty. If you can, I think it's best to try and keep economic activity going. It's easy for most people who are as fortunate as us to advocate shut downs, but for regular people it's not that simple.
Click to expand...
Those people can have jobs outside the OR temporarily. There is plenty of work right now on the floors. Plenty.
 
chocomorsel said:
Those people can have jobs outside the OR temporarily. There is plenty of work right now on the floors. Plenty.
Click to expand...
I’ll say that our organization tried this during the first shutdown. Most of our ICUs didn’t need us outside help for intubations (which weren’t many) and lines and even the “respiratory clinics” that were set up to give us a reason to be paid, the clinic MDs were even saying our skills were not needed there, especially since we aren’t clinic physicians. Our peeps who did it were literally doing nothing. Interesting enough some of the reports coming out of the East coast when the hospitals needed help, many of the doctors and nurses said the same, ie, they were paid to do nothing.

So while there is work to be done, the bean counters just figure have the people who are already staffed there do the work or maybe hire a locum/travel nurse to fill some gaps. Meanwhile the OR stays running to fund all of these things. The hospital gets more money billing a room of commercial insurance knees than the one COVID patient
 
Airway said:
Ignoring economics, I am shocked by this attitude that Anesthesiologists can't run a covid ICU in crisis (not optimal but better then 80% of non ICU doctors would be my goal). I would expect it from all the pgy4 graduating residents (not interest just the ability).
Click to expand...
I don't think anyone is saying we couldn't "get by" but I would argue outcomes would be worse than an ICU trained physician running the unit. It's not just tubing people and placing lines. Plus it's not just "keeping people alive" but also having the awareness of when someone is NOT going to live and being able to determine when doing to much is doing to much. There's a reason they do that fellowship and have a board certification.
 
Twiggidy said:
I don't think anyone is saying we couldn't "get by" but I would argue outcomes would be worse than an ICU trained physician running the unit. It's not just tubing people and placing lines. Plus it's not just "keeping people alive" but also having the awareness of when someone is NOT going to live and being able to determine when doing to much is doing to much. There's a reason they do that fellowship and have a board certification.
Click to expand...
No one is advocating for replacing critical care trained docs and nurses with OR folks. The question is when there is no locums/traveler pool to being you more people (because they are already working somewhere else that is getting slammed) is it better to just have the staff there take on ever increasing numbers of patients or at some point is another person, even not as well trained, better. You think that nurse currently taking care of 4 critical patients would rather take on a fifth patient than let someone from pacu do their best with him or her? How about the doc who has been working 15 hour days trying to round on all their patients, you think they would rather cover more patients than have an anesthesiologist do their best with a few or at least do some of the procedures so they can get through the day faster?
 
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