Plus with a falling optempo and garrison environment, people are finding things to do to stand out for their promotion. This usually means goofy policies that create unnecessary admin or other nonclinical work for everyone else.
The pain of this cannot be overstated. I saw it in action. It is nice to be in anesthesia, because other than the surgeons, nobody understands what we really do or how we work. It makes it essentially impossible to try to rig trackable metrics to claim as their idea to aid in their promotion by messing with me and my department.
One day the senior OB nurse corps Commander called me to come and talk to her about our response times for epidurals. The conversation went something like...
Go to her office. She gets up and closes the door.
Hmmm, this ought to be interesting...
RN. We've noticed that it can take an hour or more from when we call you for an epidural and when it is bolused overnight and on weekends, and it is usually placed much faster during the day, sometimes in 15 or 20 minutes.
Me. Ok. Well, we are usually here during the day.
RN (perplexed) Well don't you think that an hour is too long for a woman to be in pain when she NEEDS an epidural?
Me. (Now annoyed and seeing what is coming).Nobody needs an epidural...
RN. (Huff) Well I think an hour is too long for the patients to wait for pain relief...
Me. (Sigh) Well for a crash c/s, a real run around screaming emergency, we have 30 minutes from the call to get the lady asleep and cut right? That's the standard of care?
Rn. Yes. That's right.
Me. Well, in that case I would park in the ED lot, sprint up the stairs, throw on the bunny suit over my clothes, meet the already prepped and draped lady in the OR, do a 60 second H&P, and be asleep and intubating 60 seconds after that while the OB is cutting.
If I come in from home in a very reasonable 30 minutes for an elective epidural, I have to park, change, get equipment, do a proper H&P and exam, discuss the risks and benefits of the procedure to get true informed consent, perform the epidural, a test dose, hook it up, secure it, and after confirming a negative test dose, which alone takes several minutes, then I can begin blousing the epidural.
RN. Ahh...
Me. Are you aware that at the big house (a reference to the real military medical center that does actual medicine, unlike this shabby glorified outpatient clinic where we are both unfortunate enough to be stationed) the surgeons and second call faculty that are at home have 60 minutes to come in and BEGIN to evaluate a patient in the ED for example, let alone be done with a procedure?
RN No.
Me. Not to toot my own horn, but can anyone place an epidural faster than me?
Rn. No, probably not.
Me. Well then, it sounds like my response time is about as good as anyone's could be, and certainly a lot faster than some of my colleagues, AND any surgeon in San Diego called in to the ED for an actual emergency overnight.
RN. (Silence.)
Me. Right? I could be faster, but I'd have to cut corners, and that is probably not smart for an elective procedure on a stable patient.
RN. No...
Me. Anything else, I'm going for a run.
RN Still looking confused.
Me. (Using my best Anthony Hopkins simultaneously condescending and completely dismissive trademark tone, clearly implying that while you think this is some gravely important matter that we are having a high level discussion about, in my mind, I'm already planning my run and wondering what to do for dinner) O-k.
Out the door. And out the door.