Stopping Elective Cases

[Beeftenderloin]

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Trying to manage someone actually sick in pacu is extremely dangerous. They are usually unfamiliar with who to call, depending on layout can be far from the icu, tend to lack typical icu resources/drips, RT isn’t around to help with vent issues if they arise and the rn can’t fix it etc etc. I would board people in er long before pacu.

One of the places I rotated in residency ran out of beds in their ICUs a lot. So frequently that the anesthesia group basically refused to babysit patients in the OR anymore. So they hired PACU nurses with CC experience (a lot of PACU nurses already have that background) and just had a section of PACU w/ dedicated staff specifically for ICU boarders. I recognize the ability to do this is highly hospital/staff dependent, but this placed seemed to do it reasonably well.

 

[MediCane2006]

One of our PACUs is being temporarily converted to overflow med surg space. So far elective cases are still a go (children’s hospital) but if this trend continues I wonder how long that will last

 

[chessknt]

One of the places I rotated in residency ran out of beds in their ICUs a lot. So frequently that the anesthesia group basically refused to babysit patients in the OR anymore. So they hired PACU nurses with CC experience (a lot of PACU nurses already have that background) and just had a section of PACU w/ dedicated staff specifically for ICU boarders. I recognize the ability to do this is highly hospital/staff dependent, but this placed seemed to do it reasonably well.

At the 4 hospitals I’ve worked at in the last year all pacu rns with icu experience either moved to travel nursing or were cannibalized by icus. The ones left over were as useful as a general floor nurse when it came to icu level management. I’ve been lucky and either had lower acuity pacu boarders or been able to get high acuity ones out but while the high acuity ones were in there I basically had to circle back once an hour and check to make sure they hadn’t cranked pressors/oxygen up to the maximum without calling me

 

[deleted87051]

Hard to do cases if you’re running low on oxygen.

Florida Hospitals Fighting to Get Oxygen With ‘Hand Tied’

Florida hospitals are struggling to get oxygen due to a rise in Covid-19 cases attributable to the delta variant and Florida Gov. Ron DeSantis’s decision not to declare another state of emergency.

www.bloomberg.com

 

[deleted126335]

Hard to do cases if you’re running low on oxygen.

Florida Hospitals Fighting to Get Oxygen With ‘Hand Tied’

Florida hospitals are struggling to get oxygen due to a rise in Covid-19 cases attributable to the delta variant and Florida Gov. Ron DeSantis’s decision not to declare another state of emergency.

www.bloomberg.com

ICU ventilators consume huge levels of Oxygen compared to anesthesia machines. Like one order of magnitude + more.

 

[anbuitachi]

glad nyc isnt flooding with covid again. that first wave was bad.

 

[Mman]

ICU ventilators consume huge levels of Oxygen compared to anesthesia machines. Like one order of magnitude + more.

Having never taken apart an ICU ventilator I assume they have no CO2 scrubbing and no rebreathing of gas.

 

[deleted875186]

Having never taken apart an ICU ventilator I assume they have no CO2 scrubbing and no rebreathing of gas.

Indeed, look at how compact the vent is compared to an anesthesia machine. It’s the reason they always have humidified gas going in.

 

[deleted87051]

ICU ventilators consume huge levels of Oxygen compared to anesthesia machines. Like one order of magnitude + more.

Also HFNCs use a huge amount of O2.

 

[Mman]

Also HFNCs use a huge amount of O2.

yes, the high flow part is like 30-60 LPM or something like that

 

[ChiDO]

The two hospitals I work at are cancelling elective surgeries that go past 3pm due to staffing issues and anesthesia being terrible. I heard rumors, both anesthesia groups are at risk of losing their contracts this year... So tensions are getting high.

 

[dchz]

Sarcasm aside, there are only 3 places I’ve ever seen bleed more than 15L intra-op: portal vein injury with HPB surgery, aorta during AAA or TAAA, and pulmonary vein injury during VATS. I think each of these locations has anatomic factors which render surgical control of hemorrhage difficult. (This is excluding cardiac surgery with RV injuries during redo sternotomy, etc- it feels a bit different when you’re hemorrhaging but you can go on sucker bypass). I guess the other way to lose that much blood would be bleeding from raw surfaces or bone marrow: liver txp, major craniofacial synostosis type stuff, multi level redo scoliosis, etc. Probably need to include C-section gone wrong —> embo —> salvage hysterectomy on that list, too.

edit: forgot to add retrohepatic IVC injury to the list… I still get nightmares thinking about that one case…

You have some really ****ty surgeons.

 

[deleted87051]

The two hospitals I work at are cancelling elective surgeries that go past 3pm due to staffing issues and anesthesia being terrible. I heard rumors, both anesthesia groups are at risk of losing their contracts this year... So tensions are getting high.

Usually when they “switch” anesthesia groups, it’s about money more than service. The “new group” will try to retain the same terrible anesthesiologists that are already there except that they’ll pay them less. So you’ll be stuck with largely the same personnel who will be even less motivated to do a good job. With an adequate, incentivized compensation system you’d have anesthesiologists jumping over each other to do those late afternoon cases.

 

[Mman]

The two hospitals I work at are cancelling elective surgeries that go past 3pm due to staffing issues and anesthesia being terrible. I heard rumors, both anesthesia groups are at risk of losing their contracts this year... So tensions are getting high.

this seems appropriate here

 

[GassYous]

The two hospitals I work at are cancelling elective surgeries that go past 3pm due to staffing issues and anesthesia being terrible. I heard rumors, both anesthesia groups are at risk of losing their contracts this year... So tensions are getting high.

No elective surgeries after 3? Are they hiring?

If you're so slow that you need to book elective cases after 3, you need to shape up.

 

[ChiDO]

No elective surgeries after 3? Are they hiring?

If you're so slow that you need to book elective cases after 3, you need to shape up.

Again, staffing and anesthesia issue.

I do 6 primaries at our asc done by 1 pm, 10 by 5 pm.

6 primaries at the hospital are scheduled till 5 pm (even with two rooms😩). So now, only 4 are allowed with two rooms (losing second room also), 3 with one room. I had a revision scheduled to finish at 330. They just called my office and said it needs to be rescheduled. 😑

I also agree that there needs to be incentives for staff and anesthesia. We do that at our asc and it's run efficiently and profitablely.

The CEO took a $10m bonus last year. 😵 Also, one hospital has more OR travelers than full time staff. 🙄

 

[dpmd]

It makes no sense to me either. Cancel ridiculous big spine surgeries or whatever that require 5 day admissions if necessary (although surgeons will find a way around it). Unexpected admission to the ICU? - board them in the pacu as far as I am concerned.

Pacu becomes overflow icu in some hospitals. When that happens there is no room to recover even outpatient elective cases.

 

[dpmd]

Again, staffing and anesthesia issue.

I do 6 primaries at our asc done by 1 pm, 10 by 5 pm.

6 primaries at the hospital are scheduled till 5 pm (even with two rooms😩). So now, only 4 are allowed with two rooms (losing second room also), 3 with one room. I had a revision scheduled to finish at 330. They just called my office and said it needs to be rescheduled. 😑

I also agree that there needs to be incentives for staff and anesthesia. We do that at our asc and it's run efficiently and profitablely.

The CEO took a $10m bonus last year. 😵 Also, one hospital has more OR travelers than full time staff. 🙄

Rotated at a small town hospital where the deal was if they did at least x amount of cases then whatever time they got done the or staff would get paid for a full day but be allowed to leave early. Turnovers were lightning fast (like barely done dictating and they are ready for cutting on the next patient) and it wasn't unusual to see the nurse cleaning the room or transporting the next patient. Not sure if anesthesia was somehow cut into this deal but there was definitely less mandatory anesthesia ****ing around time there.

 

[GassYous]

Again, staffing and anesthesia issue.

I do 6 primaries at our asc done by 1 pm, 10 by 5 pm.

6 primaries at the hospital are scheduled till 5 pm (even with two rooms😩). So now, only 4 are allowed with two rooms (losing second room also), 3 with one room. I had a revision scheduled to finish at 330. They just called my office and said it needs to be rescheduled. 😑

I also agree that there needs to be incentives for staff and anesthesia. We do that at our asc and it's run efficiently and profitablely.

The CEO took a $10m bonus last year. 😵 Also, one hospital has more OR travelers than full time staff. 🙄

Do they need a new ceo

 

[chocomorsel]

yes, the high flow part is like 30-60 LPM or something like that

Rotated at a small town hospital where the deal was if they did at least x amount of cases then whatever time they got done the or staff would get paid for a full day but be allowed to leave early. Turnovers were lightning fast (like barely done dictating and they are ready for cutting on the next patient) and it wasn't unusual to see the nurse cleaning the room or transporting the next patient. Not sure if anesthesia was somehow cut into this deal but there was definitely less mandatory anesthesia ****ing around time there.

These are people. Not cattle. Lightning fast ORs can lead to problems even thought people don’t want to admit it. Everyone is so focused on getting done and going home that bad stuff can happen to patients.
Don’t miss the OR very much for this very reason.

 

[Blockit]

These are people. Not cattle. Lightning fast ORs can lead to problems even thought people don’t want to admit it. Everyone is so focused on getting done and going home that bad stuff can happen to patients.
Don’t miss the OR very much for this very reason.

Choco, in so many places nowadays these people ARE cattle. Not in MY mind of course, and not in the minds of the nurses in our preop/PACU, but in the minds of administrators and surgeons. And crooked gastroenterologists. In my experience over the last five years gastroenterologists are the most crooked proceduralists that I work with.

 

[deleted87051]

These are people. Not cattle. Lightning fast ORs can lead to problems even thought people don’t want to admit it. Everyone is so focused on getting done and going home that bad stuff can happen to patients.
Don’t miss the OR very much for this very reason.

I first heard the term “move the meat” during a 4th year ICU rotation at the Cleveland Clinic.

 

[dchz]

I first herd the term “move the meat” during a 4th year ICU rotation at the Cleveland Clinic.

Fixed that for ya

 

[chocomorsel]

I first heard the term “move the meat” during a 4th year ICU rotation at the Cleveland Clinic.

This applies so much more in the OR. Everyone is always moving “meat” throughout the hospital but there are some terrible places that don’t give a **** about the patient. Surgeons always bitching we aren’t moving past enough, front desk and charge nurse calling and rushing, doing preops in the middle of another case, etc.
And it’s all about the damn surgeons. Not even the patients. Like the surgeons and proceduralists don’t give a F and just care about move, move, move,. Money, money, money.
And they will give birth to a damn cow like the one they are trying to move if you cancel their cases.
Bad **** happens to patients when we constantly rush.
Way less pressure in the ICU.
Let’s face it. OR culture in many places is toxic. And honestly, anesthesiologists play right into it as well. They be all about “ I will starve, go into to acute renal failure, be constipated every damn day, but get to go home early.“

 

[MediCane2006]

Rotated at a small town hospital where the deal was if they did at least x amount of cases then whatever time they got done the or staff would get paid for a full day but be allowed to leave early. Turnovers were lightning fast (like barely done dictating and they are ready for cutting on the next patient) and it wasn't unusual to see the nurse cleaning the room or transporting the next patient. Not sure if anesthesia was somehow cut into this deal but there was definitely less mandatory anesthesia ****ing around time there.

This is the dream right here.

The majority of turnover delay in my experience is not anesthesia assessment, surgeon discussion, etc. It’s nursing staff dragging their feet on bringing the patient back, equipment delays, and slow room cleaning. Obviously rushing through patient care delays is a problem, but it’s interesting how incentivizing end time suddenly magically improves all the other roadblocks.

 

[MediCane2006]

This applies so much more in the OR. Everyone is always moving “meat” throughout the hospital but there are some terrible places that don’t give a **** about the patient. Surgeons always bitching we aren’t moving past enough, front desk and charge nurse calling and rushing, doing preops in the middle of another case, etc.
And it’s all about the damn surgeons. Not even the patients. Like the surgeons and proceduralists don’t give a F and just care about move, move, move,. Money, money, money.
And they will give birth to a damn cow like the one they are trying to move if you cancel their cases.
Bad **** happens to patients when we constantly rush.
Way less pressure in the ICU.
Let’s face it. OR culture in many places is toxic. And honestly, anesthesiologists play right into it as well. They be all about “ I will starve, go into to acute renal failure, be constipated every damn day, but get to go home early.“

I mean I’m not starving or going into renal failure but I would rather work during my work time and eat/relax during my leisure time

 

[chocomorsel]

I mean I’m not starving or going into renal failure but I would rather work during my work time and eat/relax during my leisure time

Work hours in most jobs in the US actually provide lunch time, and bathroom time to their employees. Just an FYI.
I don’t know why doctors think it’s so wrong to eat and pee and poop during work hours. Like we are some kind of people who lack bodily functions.

 

[dabears505]

This applies so much more in the OR. Everyone is always moving “meat” throughout the hospital but there are some terrible places that don’t give a **** about the patient. Surgeons always bitching we aren’t moving past enough, front desk and charge nurse calling and rushing, doing preops in the middle of another case, etc.
And it’s all about the damn surgeons. Not even the patients. Like the surgeons and proceduralists don’t give a F and just care about move, move, move,. Money, money, money.
And they will give birth to a damn cow like the one they are trying to move if you cancel their cases.
Bad **** happens to patients when we constantly rush.
Way less pressure in the ICU.
Let’s face it. OR culture in many places is toxic. And honestly, anesthesiologists play right into it as well. They be all about “ I will starve, go into to acute renal failure, be constipated every damn day, but get to go home early.“

Lol I do all that and don't even get to go home early.

 

[PainDrain]

The case I was referring to, after being taken back to the OR for the fifth time for life threatening hemorrhage in the ICU, the surgeon ended up completely lighting the IVC. I had not previously ever considered that doing so was compatible with life… but that guy walked out of the hospital about five months later.There aren’t that many truly miraculous “saves” in medicine, but that case was one of them

Ligation of the IVC used to be treatment for DVT prior to the development of the filter. I ran in to several patients who had this done and you should see the collaterals that develop. Granted ligation has to be infrarenal. You could do dialysis through some of their abdominal collaterals.

 

[deleted697535]

I put surgeons into renal failure ha ha ha...

 

[ChiDO]

I mean I’m not starving or going into renal failure but I would rather work during my work time and eat/relax during my leisure time

Agree!

Two rooms. You get a small 5-10 min break everytime I'm in the other room for an hour doing my next case.

Let's plow through these cases in 6 hours then go home. I don't want to dick around and sit in the lounge for 1:30 between cases twiddling my thumbs and eating a ****ty cafeteria lunch. I'd rather go out for a drink and lunch at 2pm, be home by 3-4ish and hang out with my family.

So yes, keep moving please.

 

[chocomorsel]

Agree!

Two rooms. You get a small 5-10 min break everytime I'm in the other room for an hour doing my next case.

Let's plow through these cases in 6 hours then go home. I don't want to dick around and sit in the lounge for 1:30 between cases twiddling my thumbs and eating a ****ty cafeteria lunch. I'd rather go out for a drink and lunch at 2pm, be home by 3-4ish and hang out with my family.

So yes, keep moving please.

Move the meat. Move the meat.
I am not talking about getting done at 1 and eating. I am talking of starting 630 am not getting any kind of break till 3-4 pm.
And yeah, running two rooms by yourself. Not with another anesthesiologist. And still not moving fast enough for some of y’all.
What’s a primary?

 

[dpmd]

These are people. Not cattle. Lightning fast ORs can lead to problems even thought people don’t want to admit it. Everyone is so focused on getting done and going home that bad stuff can happen to patients.
Don’t miss the OR very much for this very reason.

Let me guess, you were one of those who needed an hour to get your room ready and 45 minutes to induce the patient while everyone else was wondering what the **** was taking so long?

 

[chocomorsel]

Let me guess, you were one of those who needed an hour to get your room ready and 45 minutes to induce the patient while everyone else was wondering what the **** was taking so long?

Yeah, that was me. You know me way too well.
And you are one of those that does the 4 hour choles but are pissed off that the turnover times are 60 minutes instead of 30 and that we’re taking too long to induce.
“Damn anesthesiologists always trying to delay me.”

 

[ChiDO]

What’s a primary?

Primary total joint = first time knee or hip replacement, not a revision or conversion. Should take 1:45 room time max.

Physician owned building start times:
7, 815, 930, 1045, 12, 1315😷🤓

Hospital start times:
7, 845, 1030, 1215, 1400, 1545....but why 😢
And since a couple weeks ago, last case allowed is 1215 if they give me two rooms.

Lately one room, so 7,10,13 start times. 😭 Turnover times are just awful.

 

[chocomorsel]

Primary total joint = first time knee or hip replacement, not a revision or conversion. Should take 1:45 room time max.

Physician owned building start times:
7, 815, 930, 1045, 12, 1315😷🤓

Hospital start times:
7, 845, 1030, 1215, 1400, 1545....but why 😢
And since a couple weeks ago, last case allowed is 1215.

If you are talking about two rooms with two anesthesiologists, well that sounds reasonable. I have done spine cases like that where it was just me for all those rooms. Six to seven of them and I would get done around 5-6 pm.
That sucked and it was all about moving meat. They would have the patient in the other room before I finished the other room. Insane, and dangerous.

 

[dpmd]

Yeah, that was me. You know me way too well.
And you were one of those that did the 4 hour choles but were pissed off that the turnover times were 60 minutes instead of 30 and that we were taking too long to induce.
Damn anesthesiologists always trying to delay me.

Yeah, no. My average chole takes 15 to 20 minutes and when I am on call I often have several to do which makes it painful when I get the slow anesthesiologist instead of the quick ones because then I get to wait an extra hour in between operating instead of the more typical hospital turnover (which is always longer than the surgery center of course because of things like transport staffing).

 

[Southpaw]

That sucked and it was all about moving meat. They would have the patient in the other room before I finished the other room. Insane, and dangerous.

Interestingly poor setup. Why wouldn't they just have another anesthesiologist for the other room?

 

[chocomorsel]

Yeah, no. My average chole takes 15 to 20 minutes and when I am on call I often have several to do which makes it painful when I get the slow anesthesiologist instead of the quick ones because then I get to wait an extra hour in between operating instead of the more typical hospital turnover (which is always longer than the surgery center of course because of things like transport staffing).

And yeah, no.
I don’t do hour lunches as you can see above. I have worked hard out West with mostly men but realized my health, patient safety, and the lack of efficacy in whatever crappy procedure we were doing don’t sit right w me so I bounced.
And coming over to an anesthesiologist forum and trying to demean one of us when we often tend to be more concerned with the well being of the patients than many of you is really rich.
Glad I don’t have to deal with your kind in the ICU.

 

[chocomorsel]

Interestingly poor setup. Why wouldn't they just have another anesthesiologist for the other room?

Money, I guess. I don’t know. Poor reimbursement, trying to maximize money, didn’t have enough staff. Sometimes there were two but most times not.
I left. Took a huge pay cut and got to have pee breaks and sometimes lunch. With some of the nicest female cancer surgeons ever.

 

[Southpaw]

Yeah, no. My average chole takes 15 to 20 minutes and when I am on call I often have several to do which makes it painful when I get the slow anesthesiologist instead of the quick ones because then I get to wait an extra hour in between operating instead of the more typical hospital turnover (which is always longer than the surgery center of course because of things like transport staffing).

Just want to interject to mention that you and @chocomorsel are talking about setups on opposite ends of the spectrum. In one, an anesthesiologist is being asked to flip between two rooms with patients in one room before another finishes. You're talking about one room, and extremely variable turnover times dependent an how much one/a few anesthesiologist(s) screw around talking with patients about the weather and their weekend plans. I can understand both of your frustrations.

Also, an AVERAGE time of 15-20 minutes per chole is crazy fast. Good for you. 👍

 

[chocomorsel]

Just want to interject to mention that you and @chocomorsel are talking about setups on opposite ends of the spectrum. In one, an anesthesiologist is being asked to flip between two rooms with patients in one room before another finishes. You're talking about one room, and extremely variable turnover times dependent an how much one/a few anesthesiologist(s) screw around talking with patients about the weather and their weekend plans. I can understand both of your frustrations.

Also, an AVERAGE type of 15-20 minutes per chole is crazy fast. Good for you. 👍

Well that is just one example. I don’t only do spine. I did plenty of other Gen cases and the setup was the same. Two rooms sometimes two docs and sometimes not. Difference is they didn’t take all day, but the move the meat, don’t give a crap about the patient mentality w some general surgeons was the same. Wanting to cut as soon as the tube is barely in, pissed if you cancel a case, pissed if you take a break, pissed if you take too long to wake up, Lord forbid pee or don’t even think of pooping, etc.
Wild Wild West.
But these days, I often enjoy 30-45 minute lunches in the ICU. And no angry surgeons worried about just moving the meat.
And no, I don’t spend time talking to patients about the weather and their weekend plans as I don’t give a damn about anyone’s weekend plans but my own. Not the patients, not the surgeons, not the nurses.
I do love however when they try to push you to do a surgery because they have “cardiac clearance.” in the chart. Because they will be the first to throw you under the bus soon as a complication happens.
Yeah, don’t miss that.

 

[Southpaw]

Well that is just one example. I don’t only do spine. I did plenty of other Gen cases and the setup was the same. Two rooms sometimes two docs and sometimes not. Difference is they didn’t take all day, but the move the meat, don’t give a crap about the patient mentality w some general surgeons was the same. Wanting to cut as soon as the tube is barely taped, pissed if you cancel a case, pissed if you take a break to Lord forbid pee or don’t even think of pooping, etc.

I think you're right and it also explains many of my frustrations about American medicine. It also explains the large number of young phyisicans planning FIRE and early retirement. The surgeons here posting with us may be unwilling to acknowledge the point you're making, and its a valid one, that the 'move the meat' mentality exists in almost every aspect of American medicine because most everyone is ultimately paid by the volume, and not the quality, of the work accomplished. It's frustrating. It may be better in the ICU than the OR, maybe significantly, but my guess is if you pulled the covers back far enough and looked hard enough the 'move the meat' mentality is still there.

It's equally frustrating the erosion of the physician/patient relationship that has occurred because of production pressures, midlevels, and administrators. Many surgeons can't or choose not to relate to this because most of their wants and needs are still catered to and they have fewer midlevel issues. Again, look at the money. Surgeon's bring it to the facility in the form of their patients.

Whatever. I won't see age 60 in American medicine, which is probably a shame because it doesn't need to be like this. And just about all physicians acknowledge it'll get worse.

 

[chocomorsel]

I did work in a sleepy town where some of the surgeons believed in lunch breaks recently.
That was a nice change. I thought, Ahh this is how it must be in Europe. So nice.

 

[chocomorsel]

I think you're right and it also explains many of my frustrations about American medicine. It also explains the large number of young phyisicans planning FIRE and early retirement. The surgeons here posting with us may be unwilling to acknowledge the point you're making, and its a valid one, that the 'move the meat' mentality exists in almost every aspect of American medicine because most everyone is ultimately paid by the volume, and not the quality, of the work accomplished. It's frustrating. It may be better in the ICU than the OR, maybe significantly, but my guess is if you pulled the covers back far enough and looked hard enough the 'move the meat' mentality is still there.

It's equally frustrating the erosion of the physician/patient relationship that has occurred because of production pressures, midlevels, and administrators. Many surgeons can't or choose not to relate to this because most of their wants and needs are still catered to and they have fewer midlevel issues. Again, look at the money. Surgeon's bring it to the facility in the form of their patients.

Whatever. I won't see age 60 in American medicine, which is probably a shame because it doesn't need to be like this. And just about all physicians acknowledge it'll get worse.

I won’t see 50 in this country. In the ICU, the patients are often too critical to just move, move, move the meat obviously. And now that CMS is docking pay for bounce backs and infections, the administration is taking heed. They let us do our thing mostly. It’s a much slower version of the same song.
We in ICU try to “move the meat” because we have so many sick patients who need ICU and there never seems to be enough beds in some hospitals. Not because some bad attitude surgeons are pushing us to.
If it wasn’t for the damn antivaxxers making me question my love for the ICU, life would be sweet.

 

[ChiDO]

If you are talking about two rooms with two anesthesiologists, well that sounds reasonable. I have done spine cases like that where it was just me for all those rooms. Six to seven of them and I would get done around 5-6 pm.
That sucked and it was all about moving meat. They would have the patient in the other room before I finished the other room. Insane, and dangerous.

Ya definitely two anesthesia with flip rooms. We sometimes run 2 rooms one anesthesia, but never is the other patient in the other room before first room is out.

You'd be just fine at our asc with what you describe. Our anesthesia are awesome there and keep the flow going.

 

[nycitygas]

Choco, in so many places nowadays these people ARE cattle. Not in MY mind of course, and not in the minds of the nurses in our preop/PACU, but in the minds of administrators and surgeons. And crooked gastroenterologists. In my experience over the last five years gastroenterologists are the most crooked proceduralists that I work with.

I agree 100% about GIs. Its unbelievable what these guys are doing for money.

 

[dpmd]

Just want to interject to mention that you and @chocomorsel are talking about setups on opposite ends of the spectrum. In one, an anesthesiologist is being asked to flip between two rooms with patients in one room before another finishes. You're talking about one room, and extremely variable turnover times dependent an how much one/a few anesthesiologist(s) screw around talking with patients about the weather and their weekend plans. I can understand both of your frustrations.

Also, an AVERAGE time of 15-20 minutes per chole is crazy fast. Good for you. 👍

I am a big believer in eating (and bathroom). I am also a big believer in taking care of the patients. If wake up takes extra time because there are airways considerations or other reasons I have no problem with that (and often offer to stay in the room if they are worried things might escalate to need a surgical airway). If induction takes extra time because of patient health needs that is fine too. It is when stuff takes long without a rational reason that I push (like when the whole team is sitting in preop because the patient hasn't been brought there yet but no one considered getting the patient themselves so I have to go get them). Most of my anesthesia folks are skilled and efficient so they and I end up waiting for the rest of the staff to get a move on but there are some notoriously slow folks that drive me nuts because it takes for ****ing ever even when the nurse/tech are ready for the patient to go back (but they haven’t finished preparing themselves) and then once the patient is on the table it is forever before the patient is asleep. On a sick patient when that time is due to starting lines and giving pressors and stuff I get it, but on an ASA 1 or 2 patient getting their appy or chole out after being fluid resuscitated and given antibiotics overnight it is hard to be patient especially when I have 5 more cases to do after this one. Moving too fast I can see causing patient harm, but moving too slow does too when it delays other patients getting needed surgery and means the whole team has to stay later in the day than they would otherwise need to. A happy medium is all I ask for (same could be said for my colleagues who take hours to do cases where adhesions or severity of inflammation does not well explain things, but their tendency to dissect one cell layer at a time does)

 

[Neopolymath]

I am a big believer in eating (and bathroom). I am also a big believer in taking care of the patients. If wake up takes extra time because there are airways considerations or other reasons I have no problem with that (and often offer to stay in the room if they are worried things might escalate to need a surgical airway). If induction takes extra time because of patient health needs that is fine too. It is when stuff takes long without a rational reason that I push (like when the whole team is sitting in preop because the patient hasn't been brought there yet but no one considered getting the patient themselves so I have to go get them). Most of my anesthesia folks are skilled and efficient so they and I end up waiting for the rest of the staff to get a move on but there are some notoriously slow folks that drive me nuts because it takes for ****ing ever even when the nurse/tech are ready for the patient to go back (but they haven’t finished preparing themselves) and then once the patient is on the table it is forever before the patient is asleep. On a sick patient when that time is due to starting lines and giving pressors and stuff I get it, but on an ASA 1 or 2 patient getting their appy or chole out after being fluid resuscitated and given antibiotics overnight it is hard to be patient especially when I have 5 more cases to do after this one. Moving too fast I can see causing patient harm, but moving too slow does too when it delays other patients getting needed surgery and means the whole team has to stay later in the day than they would otherwise need to. A happy medium is all I ask for (same could be said for my colleagues who take hours to do cases where adhesions or severity of inflammation does not well explain things, but their tendency to dissect one cell layer at a time does)

I think Choco is mostly frustrated, like most in anesthesiology, about the noticeable number of surgeons that frankly aren't great and then bitch and moan about every little thing anyone else is doing or about their case getting bumped or about how they want to do something at a different time for a social reason. It's so tone deaf and it really does breed a culture of "we care about the patient and they don't." GI is particularly bad about this too in my experiences. It doesn't sound like you act that way and you two just had a miscommunication here.

And just for fun, I'll share an example. I worked with a total joints guy that worked harder than any surgeon I, or my coworkers, have ever seen. The guy was a total slave driver but you know what? He bought lunches for everyone working on his team, bought them gifts, and most importantly would mop the damn floor if that's what needed to be done to get the next case rolling. He expected everyone to work hard including himself and held everyone to the same standard. In the next room over we had a primadonna hand surgeon taking forever on every case and overbooking his OR days and demanding a flip room. Yelling at the staff was normal and he got angry when people were working in the room because he needed silence to dictate instead of going literally anywhere else. He constantly got mad about fast block docs doing blocks like that was the thing slowing things down. Then next door we have the typical "every gallbladder is the worst gallbladder ever" surgeon who whines all day when anesthesia needs to do typical anesthesia tasks for the patients as if that 10 minutes of mandatory anesthesia screwing around time is the reason their 3 hour lap chole is behind schedule.

So much of an anesthesiologist's day is based on so many other people not being douchebags or incompetent that I can see why someone like Choco decided to draw the line at eating lunch or taking a piss. The straw that broke the camel's back. I think most people hustling for the first surgeon I described wouldn't be worried. They would be getting paid well and feel like a team. The problem is that in my experience, and others, that's few and far between.

 

[dpmd]

I think Choco is mostly frustrated, like most in anesthesiology, about the noticeable number of surgeons that frankly aren't great and then bitch and moan about every little thing anyone else is doing or about their case getting bumped or about how they want to do something at a different time for a social reason. It's so tone deaf and it really does breed a culture of "we care about the patient and they don't." GI is particularly bad about this too in my experiences. It doesn't sound like you act that way and you two just had a miscommunication here.

And just for fun, I'll share an example. I worked with a total joints guy that worked harder than any surgeon I, or my coworkers, have ever seen. The guy was a total slave driver but you know what? He bought lunches for everyone working on his team, bought them gifts, and most importantly would mop the damn floor if that's what needed to be done to get the next case rolling. He expected everyone to work hard including himself and held everyone to the same standard. In the next room over we had a primadonna hand surgeon taking forever on every case and overbooking his OR days and demanding a flip room. Yelling at the staff was normal and he got angry when people were working in the room because he needed silence to dictate instead of going literally anywhere else. He constantly got mad about fast block docs doing blocks like that was the thing slowing things down. Then next door we have the typical "every gallbladder is the worst gallbladder ever" surgeon who whines all day when anesthesia needs to do typical anesthesia tasks for the patients as if that 10 minutes of mandatory anesthesia screwing around time is the reason their 3 hour lap chole is behind schedule.

So much of an anesthesiologist's day is based on so many other people not being douchebags or incompetent that I can see why someone like Choco decided to draw the line at eating lunch or taking a piss. The straw that broke the camel's back. I think most people hustling for the first surgeon I described wouldn't be worried. They would be getting paid well and feel like a team. The problem is that in my experience, and others, that's few and far between.

The taking a piss thing is crazy to me. While I might hold my own on occasion while doing stuff because I would rather get through what I am doing and then go (especially during a case) i would never deny someone else the opportunity (not that they need my permission). Eating I could see being potentially an issue since the surgeon might see you eating and say something if they are jerks, but slipping away to pee unnoticed shouldn't be hard (when the circulator is giving the premedication and rolling back seems like a perfect time but I have even had anesthesia leave the room briefly during a case because they really needed to go and the bathrooms were close enough that it didn't seem unsafe even if there wasn't an extra person to break them).
Funny thing about the eating thing. For me it is often the opposite. I want to eat so I ask about taking a break between cases and everyone else says no let's keep going so I have to try to get food really quick in between and sometimes end up having to leave half my meal because they are ready quicker than I ate. I have seen colleagues continue to eat or do whatever after getting called to the room and I think that is pretty rude to the patient who get longer than necessary anesthesia not to mention rude to the team.