Studies on rushing anesthesiologists (ie, pushing for faster and faster turnovers) leading to increased morbidity/mortality?

[anesussy]

Intuitively, makes sense - but I'm sure the suits won't budge unless they're presented with hard data that production pressure leads to worse patient outcomes.

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[aneftp]

It’s like the stand a lone outpatient centers doing bmi greater than 40/45 for real general cases. We all know the answer. No one wants to address it. As long as no studies. They will continue doing it.

I don’t think turnover times per se (the average turnover time at most tertiary hospitals) is close to 27 min after moderate case (orthopedics/general surgery). 12-15 min with minor cases (eyeballs)
42 min with major cases (crani/hearts)

 

[Simba1711]

Yeah this makes sense. I’m also not surprised we still do 24 hour call when studies show that sleep deprivation is bad for patient care.

 

[Dr. Rude]

A Case Report From the Anesthesia Incident Reporting System | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and

pubs.asahq.org

this piece is right on the money.

 

[drmwvr]

I feel like I'm the one trying to get everyone else moving....

 

[Katheudontas parateroumen]

A Case Report From the Anesthesia Incident Reporting System | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and

pubs.asahq.org

this piece is right on the money.

This will always be the least favorite part of anesthesia. I always tell Med students etc and that anesthesiologist is generally perceived as a good one based on how fast they are. Not how smart or safe or whatever. I understand efficiency is part of competence but the moment that we are delaying something because of safety/more work up or because some art line/central/block needs to be done that take a while everyone starts complaining and talking crap. Anesthesiologists are consultants but treated like henchmen. Respect for our craft is certainly lacking. Definitely one of the reasons I’ve preferred ICU time.

 

[vector2]

Production pressure on its own is not necessarily a pure negative. Wrt to that ASAHQ article, the biggest issue there is that administration was not willing to cough up money for anesthesia techs plus anesthesia RNs (like some MD only practices have) who can set up all the parts of the anesthetic that techs may not be able to touch like controlled meds, hanging blood etc. If you want to rush me, fine, but cough up some money for salaries for ancillary staff who can help me.

It's bizarre to me that surgeons have scrub techs, circulators, and first assists - I.E. all they have to do is literally see the pt pre-op, walk to OR, start cutting - but yet anesthesiologists are supposed to do all the menial preparation and administer the anesthetic solo in some practices.

 

[Guillemot]

Always there is a balance. Ive definitely worked with some lazy, slow, and incompetent anesthesiologists whose lines of cases would run 60+ mins behind schedule most of the time. Pay was salary and therefore they were incentiveized financially to do as little as possible since others would need to pick up the slack.

 

[anaesthetic]

This will always be the least favorite part of anesthesia. I always tell Med students etc and that anesthesiologist is generally perceived as a good one based on how fast they are. Not how smart or safe or whatever. I understand efficiency is part of competence but the moment that we are delaying something because of safety/more work up or because some art line/central/block needs to be done that take a while everyone starts complaining and talking crap. Anesthesiologists are consultants but treated like henchmen. Respect for our craft is certainly lacking. Definitely one of the reasons I’ve preferred ICU time.

I agree on all points.

On the opposite end of the spectrum, I’ll occasionally hear complaints from different circulator RNs across different surgical teams about the same 2-3 anesthesiologists who are consistently slow, unreliable, and disruptive to the flow of certain ORs.

I’ve been in their rooms to help start some of the bigger cases. I think some of us are better able to balance expediency and vigilance based on patient condition. I don’t need to spike epi/norepi/propofol/insulin or draw up heparin/TXA to start a normal EF CABG, but some people do it every single time; you can argue that having epi/norepi/heparin drawn up and ready to go for a cardiac case is “standard” (especially in academics), but I can’t remember the last time having these things ready pre-induction was essential to patient care. For heart/lung transplants, I’ll usually warn the circulators/surgeons that my lines may take longer since we replace all pre-existing lines in OR, so expectations for a longer “anesthesia eff-around time” are set.

 

[jwk]

Ever notice how it's the slowest surgeons that complain the most about slow turnover time?

We are fortunate to have anesthesia techs that turn over our rooms. Anesthesia delays at our place are fairly unusual. I'm sure it's not for lack of data - the clipboards want to know a time in/out for every little thing. We're typically waiting in pre-op for the circulating nurse to come do the handoff with the pre-op nurse so we can take the pt to the OR.

 

[Beeftenderloin]

Production pressure on its own is not necessarily a pure negative. Wrt to that ASAHQ article, the biggest issue there is that administration was not willing to cough up money for anesthesia techs plus anesthesia RNs (like some MD only practices have) who can set up all the parts of the anesthetic that techs may not be able to touch like controlled meds, hanging blood etc. If you want to rush me, fine, but cough up some money for salaries for ancillary staff who can help me.

It's bizarre to me that surgeons have scrub techs, circulators, and first assists - I.E. all they have to do is literally see the pt pre-op, walk to OR, start cutting - but yet anesthesiologists are supposed to do all the menial preparation and administer the anesthetic solo in some practices.

From the time I hit the room with the patient til I say they’re good to start prepping it’s my patient, my room. Nurses and techs know that the faster I get done what I need, the sooner the case gets underway, so they do what they can to help me. Anes techs are aIso awesome, set up majority of what I need and will even stick around and be an extra set of hands for starting bigger cases. All I ever have to do is draw induction meds and stylet a tube.

Surgeon is rarely in the room while I’m getting underway. Usually paged to the OR once I say they’re good to start prepping.

Not saying this to rub it in peoples faces. Just to say that anesthesia practices exist where you aren’t rushed and get treated like a physician. But it requires some serious institutional buy-in.

 

[Simba1711]

I had a surgeon who came at least 2 hours every time he was scheduled to operate. He would then rush everybody and have them open 3 rooms for him so he could just bounce around. He started rushing me so I told him he should show up on time. He flipped out on me and tried to get me fired. Needless to say I left that practice voluntarily soon after for this and other reasons for a better job. The level of entitlement of surgeons always surprises me.

 

[nimbus]

I had a surgeon who came at least 2 hours every time he was scheduled to operate. He would then rush everybody and have them open 3 rooms for him so he could just bounce around. He started rushing me so I told him he should show up on time. He flipped out on me and tried to get me fired. Needless to say I left that practice voluntarily soon after and found a better job for this and other reasons. The level of entitlement of surgeons always surprises me.

We had a plastic surgeon like that at one of our surgicenters. He would show up 1-2hrs late, then say stuff like, “let’s move people! Time is money!” He also owed us tens of thousands in unpaid anesthesia fees. It got so bad that we wouldn’t proceed with his cases unless he paid up front.

 

[drmwvr]

The recognition of the critical nature of the anesthesia 'resource' (us) is, generally speaking, directly proportional to the time-in-grade of the OR crew/surgeons. If they're new or they don't know you, you're a little more than a play thing to them. It's a perverse relationship where no one really knows what we do but they know they can't operate without us. The prevailing culture allows them to treat us like a cog in the process no different from the nice eastern European ladies that mop the OR floor between cases..

There is a choice...spend decades working with them and maybe placing a few labor epidurals for their wives, putting their kids to sleep for their tonsils, putting them to sleep for their afib ablations and then receive the deference from them that you deserve...or suck it up and get paid. Your choice...

 

[narcusprince]

In the ASC world rush is the name of the game. My turnovers when running 2 ORs by myself is 5-7 min including block time. I move efficiently. The preop process of filtering the right patients is what makes or breaks the system. However if I was in a hospital setting with asa 3-4s all day I need that time to preop and intervene if necessary.