Poll: Do you push your patients back to the OR (private practice)

[Voodoo]

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I'm in an MD only private practice group. I won't post anything further so that I don't reveal my thoughts on the matter. However, any comments are more than welcome.

- Edit: I clearly don't know how to make a poll, so please just respond. Thanks. Again, no residents in this facility. What have you seen, how do you feel about this...

 

[urge]

Someone has to push the bed.An orderly would be nice but unnecessary. I guess the circulator could do it too but it might be better for her/him to spend the time checking the room. That pretty much leaves you. It's not going to kill you. Mmmhhhh... Maybe the surgeon should do it. We are on to something....

 

[InductionAgent]

I answered "yes" because sometimes I help push the patient back. However, the circulator usually does this with or without my help. There are usually 2 circulating RNs in each OR where I work. They usually do the work of about 1.

 

[jwk]

We go back WITH the circulator with almost all our patients. The main exception is for rapid-turnover eye cases, in which case the nurse does it by themselves while we get ready for the next patient. I don't push patients back by myself ever - JCAHO requires a handoff from pre-op nurse to OR nurse.

 

[proman]

We go back WITH the circulator with almost all our patients. The main exception is for rapid-turnover eye cases, in which case the nurse does it by themselves while we get ready for the next patient. I don't push patients back by myself ever - JCAHO requires a handoff from pre-op nurse to OR nurse.

This may be the very key to getting the nurses to transport.

 

[IlDestriero]

I answered "yes" because sometimes I help push the patient back. However, the circulator usually does this with or without my help. There are usually 2 circulating RNs in each OR where I work. They usually do the work of about 1.

PP job, I rolled back after circ saw them and went back to check OR. Work quickly and efficiently, go home early, score w/ the prom queen.

Academic hell, circ picks up pt after setting up room, 30-45min turnover , it's still wrong. Policy requires nurse to nurse turnover in pre op, excludes ICU pts. After checking how the room was set up, they still have to hit the lounge for a cup a Joe and a potty break. Than it's off to pre op where it takes more than 5 minutes to confirm the procedure, consent, ID and allergies. Than she has to find the pts pre op nurse for the "signout". Gotta check that box. To the room, finally, "oh yeah, this needs the ... (Jackson table, prone supports, yellow fins, extra tower, etc.)". 5 more min ... Now the premed is wearing off and the kid goes nuts on induction, maybe he'll vomit or cry himself into laryngosoasm.👍 Repeat x 4 or 5. ENT is the only exception.
1/2 go home earlyish the other 1/2 pick up the pieces of a wrecked day.
Than it's home to a scotch to contemplate where it all went so wrong.

 

[sbmed100]

In my private practice we always put in our own IVs and transport the patients to the OR. We almost always give 1-2mg of midazolam before transport. This has become pretty ingrained in my practice. It does speed things along...

 

[IN2B8R]

I'm in an MD only private practice group. I won't post anything further so that I don't reveal my thoughts on the matter. However, any comments are more than welcome.

- Edit: I clearly don't know how to make a poll, so please just respond. Thanks. Again, no residents in this facility. What have you seen, how do you feel about this...

RN brings and sets up basic monitors. Otherwise, I will let the surgeon go get the patient, since I'm too busy doing my billing.... J/K. Rn usually picks'em up around here.....

 

[pgg]

I usually push the patient back with the circ nurse. Most of the time I prefer it - I've just finished seeing the patient, talking about the anesthetic, (usually) given some midazolam. It just makes sense to be with the patient continuously vs disappearing and meeting them again in the OR.

The majority are good about helping with applying monitors, pre-O2ing the patient, etc.


I had a pretty negative view of most periop nurses as a resident to the point that I favored firing them all, having security escort them to the door, and replacing them with random homeless people for minimum wage, but out here they're mostly helpful.

 

[pd4emergence]

If the surgeon is there and ready to work, I will go and get the patient on the floor. I did this one time. OR staff was horrified. I don't have to ask more than once for a patient now.

 

[Noyac]

During a regular day schedule I don't push the pt back. The RN needs to make sure the room is ready and I just can't tolerate waiting while they count and tie up the scrub tech and what ever it is they do. But mostly I don't do it because it is rude to just push the pt back without the room being ready and I am not going to stand around waiting for them to get ready.

But after hours is an entirely different story. I get called to do a case and I will go straight to the ER when I drive in the parking lot. I grab the pt (ER nurses know that if I am on call I will more than likely come their way to grab the pt on my way into the hospital) and wheel them upstairs to the PACU. I then go to the OR and setup (actually I go to setup only because I know that the nurses are there and I want to tell them I'm bringing the pt back in 5 minutes). It works out really well. The nurses like it, the surgeon likes it ( he can't do it because he is not that well tied into the OR and doesn't know when they are ready like an anesthesiologist is) and I get home a bit earlier which is the goal.

 

[bostonblaz]

At our place the circulating nurse comes out the the pt, interviews them, puts them in the room with basic monitors on. They get a total of 20 min from when the last patient gets its cpu nursing record activated in pacu before they have to start there or record in the room or they have to list delays and the or manger deals with it, there are some rooms where there is a delay due to equipment needed but that is understood. great system that keeps or throughput going.blaz

 

[Jay K]

JCAHO requires a handoff from pre-op nurse to OR nurse.

In residency yes.

In PP, at our hospitals, the circulating RN does her final check (to prevent medical mistakes) after I've done my preop/signed orders and then rolls the patient back. I would not be allowed to roll the patient back. I could walk with them, but this neither saves time nor increases turnover. This is the time for me to prep my room (I go straight from recovery to the preop first, then get drugs and prep my room), go to the bathroom, eat or see post-op pts. I could wait in the lounge until the RN has the patient on the bed with monitors and calls me, but THIS I feel wastes time, so I'm typically waiting for the patient in the room and assist with moving to the OR bed, monitors, etc so I can have a rapid induction/lines/etc.

Our circulating RN's, surg techs and anes techs definitely have a higher skill set than in academics. Here the surg tech actually will assist with lines (opening and handing you stuff) to speed up the process while you're doing other steps. The circ RN will tape down A-lines and PIV's you've started, administer rectal meds and start IV's in peds patients while you're managing the airway.

At times I wish I could push my own patient back, but it's not hospital policy here.

 

[soonerfrog]

---From IDest---
"Academic hell, circ picks up pt after setting up room, 30-45min turnover , it's still wrong. Policy requires nurse to nurse turnover in pre op, excludes ICU pts. After checking how the room was set up, they still have to hit the lounge for a cup a Joe and a potty break. Than it's off to pre op where it takes more than 5 minutes to confirm the procedure, consent, ID and allergies. Than she has to find the pts pre op nurse for the "signout". Gotta check that box. To the room, finally, "oh yeah, this needs the ... (Jackson table, prone supports, yellow fins, extra tower, etc.)". 5 more min ... Now the premed is wearing off and the kid goes nuts on induction, maybe he'll vomit or cry himself into laryngosoasm.👍 Repeat x 4 or 5. ENT is the only exception.
1/2 go home earlyish the other 1/2 pick up the pieces of a wrecked day.
Than it's home to a scotch to contemplate where it all went so wrong."

This should be SERIOUSLY considered for "Post of the Year"!!!!

Love it. Only thing I'd change would be scotch---->vodka tonic. But kudos all the same good sir!

 

[sevoflurane]

The only reason I bring the patient back is if I sense a delay.

Drop off my patient in the pacu, see my next patient, then to chill for 5-10 minutes in the lounge. I get a page or a nurse informs me when the patient is in the room with monitors on. Walk in, up on my 02 flows, have the nurse pre-O2 while I get ready for induction (less than 1 minute).

I am acutely aware of our 20 min turn over time for inpatient and 15 minute turn over time for outpatient as I believe it to be our jobs to keep the flow going in the OR. We have cameras outside our lounge so we can see if the patient is in the room or not. I go back and see if there is anything I can do to help things move along if we are starting to push the envelope on time. Da Vinci's are usually the one's that take longest to set up at my institution.

What kills me is when the patient wants to use the bathroom at 19 min. for inpatient or 14 min. for outpatient..... I have had discussions with my nursing staff to offer a "potty" break before we hit the pacu. It doesn't happen often and yet it is one of the few things that tickle me the wrong way as it is an avoidable delay.

 

[scoobydum]

Ah, the infamous potty break. Gotta love it. Our setup is pretty much the same with nurses calling us when the monitors are on and helping preoxygenate, but in quick turnover rooms like a cysto train, I usually try to help wheel the patient back or will see one of the following patients to save time. Typically, we do a bunch of elective cystos on Saturday mornings, so I'll get there a few minutes early and see the first couple of patients, and keep seeing the following ones in between cases. That five to ten minute head start often adds up to me going home an hour earlier and keeps everyone happy.

 

[maceo]

In residency yes.

. I would not be allowed to roll the patient back. .

the nurses probable demand 10 more dollars per hour just to do that task.. LOL

g******** it, the nurses have the health care system by the balls. they suck.