Procedure time records (the surgeons, not us)

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2010houston

2010houston

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Was in a 5 min tonsil the other day- procedure start 16:29, end 16:34. I was impressed. Especially given that it’s July - though obviously this was the attending doing the case, not a resident. Anyone have a shorter tonsil? Other remarkably short cases?
 
Also, this makes me even more angry at the culture in my hospital with anesthesia residents. Surgeries that could be quick are always longer than they need to, but god forbid I take an 5 extra minutes at the start to place lines, do a fiber optic intubation, etc and it’s the end of the world.
 
dipriMAN said:
Also, this makes me even more angry at the culture in my hospital with anesthesia residents. Surgeries that could be quick are always longer than they need to, but god forbid I take an 5 extra minutes at the start to place lines, do a fiber optic intubation, etc and it’s the end of the world.
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Yeah agree that’s not cool. We all need to train residents; surgeons and anesthesiologists alike. Tell them to go wait in the lounge and you’ll call them when you’re ready for them.
 
Do records in the opposite direction count? Also at large academic center, there is an attending who is notorious for 3+ hour lap choles. Every time I do one with them I hear from the other side of the drapes "this is the worst one I've ever seen."
 
Many things need to go right for both tonsils to be out that fast, not just surgeon skill, but also good anatomy with good hemostasis. Plus, if I am in charge of the surgical start and end times, then I may add in the snobby ENT tax, which will add in an extra few minutes to their time.
 
I've seen 7 minute elective C-sections performed by one OB I used to work with (stapled at the end). 6 minute trach done in the OR (non emergent). Lap choles under 20 min.
 
dipriMAN said:
Also, this makes me even more angry at the culture in my hospital with anesthesia residents. Surgeries that could be quick are always longer than they need to, but god forbid I take an 5 extra minutes at the start to place lines, do a fiber optic intubation, etc and it’s the end of the world.
Click to expand...
Look at it this way. It trains them to be efficient at least. Think a few steps ahead. In the long run you will (they) benefit as does everyone else. I rarely tell the surgeon to wait while I place a line. Learn how to drape so you can get to the pt. I usually am done before the prep starts with a CVL. Definitely done before it ends. Maximize your time and everyone else’s. I don’t have the scrub standing by me when I induce. They don’t leave the room but they are doing stuff nonetheless, Foley, counting “again”, tying up gowns etc. make efficient use of everyone’s time. They can always drop what they are doing to assist. Even if they are sterile for foley placement. Just get another set of gloves.
 
Surgeons/proceduralists can do anything lightning quick if they have the right mindset and experience: being taught by a very fast surgeon, who himself was taught by a fast surgeon, ad infinitum.



Rapid probabilistic thinking combined with technical mastery, bolstered by a mental inventory of several hundred procedures.


Next time you get called to OB for an epidural, time yourself:

Introduction
Anesthesia history
Risk of epidural
Possibility of C-section and GA
Dismissing family
Positioning
Sterile tray setup
Needle advancement
Catheter placement
Test dose
Securement
Bolus
Infusion start
Charting


Lots of steps... But, if you can do every single step with the minimum amount of time necessary and some things simultaneously with help from nurses, then you will be lightning quick. My record was ~6 minutes from introduction to start of charting but it might have been faster, was more focused on speed than using a stopwatch.



We can be extremely fast with intubations, arterial access, venous access, epidurals, nerve blocks, etc, because we have so much experience with a limited number of procedures and we know how to shave off seconds.

Surgeons have it harder because they don't do the same procedures multiple times every day of the week.

But, if surgeons have enough experience after a few years and with the right teachers, they can easily do a 20 minute cholecystectomy or a 12 minute appendectomy or a 7 minute C-section.

I work with a GI doc who can do a diagnostic EGD in 20-30 seconds from beginning to end because no time is wasted. But, they do an excellent job and have the best bedside manner, and they get referrals up the wazoo. No third/fourth looks to make up their mind or convince themselves... just go in, do a comprehensive visual exam, and leave. Add 8 seconds for each biopsy. I worked with another GI that reaches cecum in 15-30 seconds consistently. I've worked with a neuro spine surgeon who can do multi level lumbar fusions from cut to close in 75 minutes.
 
shepardsun said:
Do records in the opposite direction count? Also at large academic center, there is an attending who is notorious for 3+ hour lap choles. Every time I do one with them I hear from the other side of the drapes "this is the worst one I've ever seen."
Click to expand...

At the VA in residency we had an orthopedic surgeon who would come every other Friday and do arthroscopic shoulders. Her speed was a running joke amongst our program. She would spend an hour or two complaining about the TV and demand another one, then complain about all the “adhesions” making her views difficult, then throw her hands up and say “let’s just go open!” Each case took about 4-5 hours. The last time I worked with her she looked at me and said “do any of these structures look familiar to you? Where am I?”
 
AdmiralChz said:
At the VA in residency we had an orthopedic surgeon who would come every other Friday and do arthroscopic shoulders. Her speed was a running joke amongst our program. She would spend an hour or two complaining about the TV and demand another one, then complain about all the “adhesions” making her views difficult, then throw her hands up and say “let’s just go open!” Each case took about 4-5 hours. The last time I worked with her she looked at me and said “do any of these structures look familiar to you? Where am I?”
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Only the finest for our veterans. The patient satisfaction is high because the price is right.
 
As far as fast surgeons go...

I work with one who can easily do a C-section in under 10 minutes (with suture closure), I think the fastest I’ve seen is 8 minutes. At the end he pulls his gown off and asks for the time.

In fellowship I worked with a ridiculous CT surgeon who could do a 1 vessel CABG in about 90 minutes door-to-door, 2 hours for 2 vessel or straightforward AVR. Pump times were insane. Had 2 rooms, averaged 5 or 6 cases a day 4 days a week in his late 60s/early 70s- guy was an absolute animal. Downside? A good portion of his cases came back for bleeding 😵

We have a Gyn/Onc here who does a 90 minute Da Vinci hysterectomy. Does 4 or 5 a day easily out by 4 PM - our surgeon in residency could barely do 1 by then.
 
AdmiralChz said:
As far as fast surgeons go...

I work with one who can easily do a C-section in under 10 minutes (with suture closure), I think the fastest I’ve seen is 8 minutes. At the end he pulls his gown off and asks for the time.

In fellowship I worked with a ridiculous CT surgeon who could do a 1 vessel CABG in about 90 minutes door-to-door, 2 hours for 2 vessel or straightforward AVR. Pump times were insane. Had 2 rooms, averaged 5 or 6 cases a day 4 days a week in his late 60s/early 70s- guy was an absolute animal. Downside? A good portion of his cases came back for bleeding 😵

We have a Gyn/Onc here who does a 90 minute Da Vinci hysterectomy. Does 4 or 5 a day easily out by 4 PM - our surgeon in residency could barely do 1 by then.
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Our people take 90 minutes just to DOCK the da Vinci!
 
Why rush if one is just a lowly employee? Don't we already have enough people dying younger in this specialty?

I remember reading somewhere that anesthesiology is like working in a brothel. The better one works (and the faster one finishes) the more one works (for the same money).

From where I stand, this wh-re will work slower than wh-res making double/triple, who posted here. Not worth the stress; nobody gives a crap, or, at least, doesn't put their money where their mouth is.
 
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My best C/S was 17 min door in to door out, including spinal. I doubt that will be repeated, the 30-45 min time is much more common.
One of the ENTs in training was scheduled every 7 for BMTs and 15 for tonsils. Normally done 10-15 late at the end of 5 hours. You worked hard on those days though. As a resident it was great to see how to be efficient and set up the system in a safe way.

I’m guessing some of you guys aren’t counting from in room to out.
Either way, I wish our times were that fast. As a PP guy paid by production, I would gladly go home early or make more money, as long as it is done right.
 
In Mexico we have a Peds ophtho who does 50-60 strabismus surgeries from 7-5 with 2 workstations in the same room. We wake up and put next kid to sleep while he’s works on one kid. No jcaho there but we still time out for every case. Everybody hustles even though nobody is getting paid.
 
Noyac said:
Look at it this way. It trains them to be efficient at least. Think a few steps ahead. In the long run you will (they) benefit as does everyone else. I rarely tell the surgeon to wait while I place a line. Learn how to drape so you can get to the pt. I usually am done before the prep starts with a CVL.
Click to expand...

What are your scrub techs doing? Our are usually prepping before the tube is even taped!
 
2010houston said:
Was in a 5 min tonsil the other day- procedure start 16:29, end 16:34. I was impressed. Especially given that it’s July - though obviously this was the attending doing the case, not a resident. Anyone have a shorter tonsil? Other remarkably short cases?
Click to expand...
what technique does he use, and what's his post tonsillectomy bleed rate?
 
nimbus said:
In Mexico we have a Peds ophtho who does 50-60 strabismus surgeries from 7-5 with 2 workstations in the same room. We wake up and put next kid to sleep while he’s works on one kid. No jcaho there but we still time out for every case. Everybody hustles even though nobody is getting paid.
Click to expand...

This doesn’t seem humanly possible. How many muscles/eyes? If it’s one eye one muscle, MAYBE it’s doable. Our opthos average 30 min per muscle.
 
btbam said:
This doesn’t seem humanly possible. How many muscles/eyes? If it’s one eye one muscle, MAYBE it’s doable. Our opthos average 30 min per muscle.
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1-4 muscles. He takes 3-5min/muscle. I couldn’t believe it the first time I went.

I mentioned the anesthesia technique a few years ago. No IV. Preop zofran ODT, mask sevo, LMA, IM ketorolac, +-intranasal fentanyl. Older kids and adults get IV propofol because it takes too long to get them deep enough for LMA with sevo alone.
 
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nimbus said:
1-4 muscles. He takes 3-5min/muscle. I couldn’t believe it the first time I went.

I mentioned the anesthesia technique a few years ago. No IV. Preop zofran ODT, mask sevo, LMA, IM ketorolac, +-intranasal fentanyl. Older kids and adults get IV propofol because it takes too long to get them deep enough for LMA with sevo alone.
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Insane. You don’t worry about oculocardiac reflex? Guess you could always give IM atropine.
 
btbam said:
Insane. You don’t worry about oculocardiac reflex? Guess you could always give IM atropine.
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Most cases of bradycardia we get because we forget to turn the sevo down. I think it has to do with gentle handling of the eye. When we do think it’s OCR, we just ask him to stop and it resolves. We have atropine drawn up and taped to a wall between the work stations but I’ve never had to give it.
 
nimbus said:
Most cases of bradycardia we get because we forget to turn the sevo down. I think it has to do with gentle handling of the eye. When we do think it’s OCR, we just ask him to stop and it resolves. We have atropine drawn up and taped to a wall between the work stations but I’ve never had to give it.
Click to expand...

Lives without JACHO and Department of health.....🙂
 
Do you even chart? If you're just literally doing cases without worrying about anything like paperwork or wasting drugs, can do as many cases that roll in the door
 
2Fast2Des said:
Do you even chart? If you're just literally doing cases without worrying about anything like paperwork or wasting drugs, can do as many cases that roll in the door
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Yes we chart. Preop screening, pictures, consent, and instructions all done on Monday. Operate full day Tuesday through Thursday and a half day on Friday.
 
Some personal favorites:
1 minute lysis of penile adhesions/meatoplasty
8 minute appy (single port)
Sub 15 minute pump time for tetralogy of fallot repair and sub 10 min pump times for ASD/VSD repairs (this guy remains the best surgeon I have ever seen)
 
In my previous group, there was a vascular+cardiac surgeon who would schedule one day a week dedicated to AV fistulas. Usually doing hearts the other days. Anyways, he'd routinely finish 15 AVF's scheduled from 0730-1700. He'd have 2 rooms and a PA. Still have never seen anything close to that.
 
dipriMAN said:
Also, this makes me even more angry at the culture in my hospital with anesthesia residents. Surgeries that could be quick are always longer than they need to, but god forbid I take an 5 extra minutes at the start to place lines, do a fiber optic intubation, etc and it’s the end of the world.
Click to expand...
So get used to that! If it really bothers u don’t do anesthesia!!!
 
GhostTree said:
In private practice there’s one guy who does 3h open whipples of or time. Compared to the 8+h in academics it’s incredible.
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There’s a guy at Emory who does straightforward whipples in <3 hours. Sometimes he books 3 in one day!
 
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