I just want to be faster between cases

[cubs3canes]

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The circulating nurses all hate me. I am okay with this.

Monday, first day of neuro, two backs. I hate backs..first C1-C2..glidescope, beautiful anesthetic, woke up with a smile

It is now 10:30, surgeon to bathroom and get something to eat. I set up for the L4-L5 and L5-S1 fusion. Now, 10:45, can I bring the patient back I ask? Yes says the circulator. After all, I need to do an aline, second IV, intubation..blah ...blah.

Back in the room, ready to flip at 11:05. My STAFF asks "can you call Dr. Surgeon?" She says in 10 minutes because she is not ready...with attitude. My staff is like WTF. He then blows it off and leaves and tells me to call when they are ready to flip...okay...give antibiotics, place an esophageal temp..get ready for the flip. Surgeon paged and returned at 11:15. Now everyone is sitting on their butts waiting for the surgeon..everything is open. Surgeon in the room at 11:25, flip at about 11:35. Cut at about 12. I call this a 90 minute turnover...that is horrible.

If the nurse would just call the surgeon when we are ready, then he could all of the little things he needs to do before we flip and save twenty minutes...remember this is 20 minutes I am not at home and spending with my kids and wife.

I also hate that the feeling that they need to completely ready before the surgeon comes in. That is not true. Everything should be in the room, but the rod that you are not going to need for 6 hours can be opened in 5 hours.

I am sorry for going faster and trying to get everyone home quicker. Also, this is a community hospital, not a large University center...we are a private hospital that is supposed to make money.

Thanks for reading my vent. I now feel better.

 

[coprolalia]

Even though you are a resident in a non-university setting, just remember that the faster and more efficiently you work the more work you will get. I've learned this the hard way. I can turn cases quickly, but that usually just means more work for me. Now, I just try to time it right so that I get dismissed without having to go takeover someone else's room (for whatever reason) or get a bunch of add-ons.

-copro

 

[ucsfgaspain]

Copro,

I used to have a saying about this in residency.

"Punish the strong, and reward the weak"

It happens all the time during training. They keep the stronger residents longer b/c the attendings wanted people they could trust and didn't need to baby sit. If they had a choice between the village idiot or the good resident, who do you think they are going to give the add ons to? The only saving grace...when you finish these attendings usually go to bat for you and give you great recs. and hook you in with the best groups.

 

[Planktonmd]

The circulating nurses all hate me. I am okay with this.

Monday, first day of neuro, two backs. I hate backs..first C1-C2..glidescope, beautiful anesthetic, woke up with a smile

It is now 10:30, surgeon to bathroom and get something to eat. I set up for the L4-L5 and L5-S1 fusion. Now, 10:45, can I bring the patient back I ask? Yes says the circulator. After all, I need to do an aline, second IV, intubation..blah ...blah.

Back in the room, ready to flip at 11:05. My STAFF asks "can you call Dr. Surgeon?" She says in 10 minutes because she is not ready...with attitude. My staff is like WTF. He then blows it off and leaves and tells me to call when they are ready to flip...okay...give antibiotics, place an esophageal temp..get ready for the flip. Surgeon paged and returned at 11:15. Now everyone is sitting on their butts waiting for the surgeon..everything is open. Surgeon in the room at 11:25, flip at about 11:35. Cut at about 12. I call this a 90 minute turnover...that is horrible.

If the nurse would just call the surgeon when we are ready, then he could all of the little things he needs to do before we flip and save twenty minutes...remember this is 20 minutes I am not at home and spending with my kids and wife.

I also hate that the feeling that they need to completely ready before the surgeon comes in. That is not true. Everything should be in the room, but the rod that you are not going to need for 6 hours can be opened in 5 hours.

I am sorry for going faster and trying to get everyone home quicker. Also, this is a community hospital, not a large University center...we are a private hospital that is supposed to make money.

Thanks for reading my vent. I now feel better.

I am not sure why you are upset?
You are a resident, you don't make the rules.
If they want to be slow, fine, put your legs up, open a book and do something good, you could even sit there and day dream.
If you haven't mastered the art of day dreaming yet I advise you work on it because in this specialty you will need it.
There will be plenty of time to be efficient and fast when you are in the real world.

 

[cubs3canes]

I actually expect to come to work and WORK!!!!
I figure if I got to be there, I want to make the most of it.

Also, every case that you have to do is an opportunity to learn something new.

I just hate having an anesthetized patient that is waiting for the nurse to CALL the surgeon. I am just advocating for the patient and I am sure they do not expect to be waiting, for the nurse to finish her work that she should have done 30 minutes ago.

The good news is that I got through the entire mini-Barash chapter on Neuroanesthesia a couple of times. The reverse steal and barbituates is my new favorite theory.

I think this is why I like peds...fast turnover and many cases in one day (at least ENT and general)

Cubs

 

[urge]

I actually expect to come to work and WORK!!!!
I figure if I got to be there, I want to make the most of it.

That's totally un-American. Where are you from?

 

[Planktonmd]

That's totally un-American. Where are you from?

😆​

 

[cubs3canes]

You will be shocked...I am in New Orleans.

 

[drccw]

please don't tell me that you were on PACU hold at the end of the day? That would just be the icing on the cake... or shall I say the poop on the bottom of the show...

 

[Laurel123]

Duck under the drapes, and page the surgeon to the room number on your cell phone.

 

[coprolalia]

I actually expect to come to work and WORK!!!!
I figure if I got to be there, I want to make the most of it.

Also, every case that you have to do is an opportunity to learn something new.

Let me guess.... CA1?

-copro

 

[Ferdie]

if you use that "down time" (ie inefficiency in health care time) for reading, that's 20 minutes when you're with the family later on that you don't have to do "homework" for the next day's cases. I'm not saying it's ideal, I'd rather get home early and read after the kiddos were asleep (if I had kiddos), but it's something...
what makes me annoyed about the situation is how it contributes to inefficiency and waste in the health care system, which means less profit, which means down the road someone's gonna start talkin' 'bout lowering our salaries...

 

[Ferdie]

or, if you use that "down time" for suduko or a crossword puzzle, you will decrease your future risk of alzheimer's disease, thereby increasing the amount of time you will ultimately get to enjoy with your family...

 

[militarymd]

that's EXCELLENT advice...to a newby that is supposed to join a society whose motto is : VIGILANCE

I am not sure why you are upset?
You are a resident, you don't make the rules.
If they want to be slow, fine, put your legs up, open a book and do something good, you could even sit there and day dream.
If you haven't mastered the art of day dreaming yet I advise you work on it because in this specialty you will need it.
There will be plenty of time to be efficient and fast when you are in the real world.

 

[Planktonmd]

that's EXCELLENT advice...to a newby that is supposed to join a society whose motto is : VIGILANCE

It's better than telling them to use Sux in patients with hyperkalemia.

 

[zippy2u]

Hott Damm Plank, you sure are a lil' pistol with that comment. Ain't lettin' nobody walk all over you now are we? Regards, ----Zippy

 

[cchoukal]

the really irritating part of all this is that no matter how frequently you bust your a$$ being efficient, the one time you blow it and end up being the cause for a delay, you'll hear about it.

Copro's point is pretty funny. I have started to have a little more vision into the schedule and can see things now in terms of "likelihood to be relieved" and "likelihood to get add-ons" rather than "short schedule" or "cool cases." I'm not proud of it, but you can't help but think of it...

 

[Monty Python]

You will be shocked...I am in New Orleans.

A philosophy widely heard at Charity Hospital New Orleans:

"In the private business world, time is money.
At Charity Hospital, time is ........................ just time."

 

[coprolalia]

Copro's point is pretty funny. I have started to have a little more vision into the schedule and can see things now in terms of "likelihood to be relieved" and "likelihood to get add-ons" rather than "short schedule" or "cool cases." I'm not proud of it, but you can't help but think of it...

Yesterday I did 9 cases. NINE cases!

I'm making someone a sh*tpile of money right now, but it ain't me.

-copro

 

[cubs3canes]

A philosophy widely heard at Charity Hospital New Orleans:

"In the private business world, time is money.
At Charity Hospital, time is ........................ just time."

I remember this quote...I miss Charity sometimes. That was a place that could just lose money.

I do read during the cases (once things are going good). However, when you are sitting there waiting to go prone, all you are thinking about is the way all of your cables and IVs are going to be flipped and screwed up.