Unimportant, but curious question

[veetz]

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...searched the forums, couldn't find the answer I was looking for...

For PP attendings, I'm curious how your practices manage preoping inpatients?

Do inpatients scheduled for the OR typically get preoped the day before or the day of surgery?

Is one anesthesiologist assigned to preops for the day?
Do you have a PA or NP who preops?
Do all the attendings share the responsibility?

Just curious how the process differs from residency...thanks🙂

 

[Planktonmd]

...searched the forums, couldn't find the answer I was looking for...

For PP attendings, I'm curious how your practices manage preoping inpatients?

Do inpatients scheduled for the OR typically get preoped the day before or the day of surgery?

Is one anesthesiologist assigned to preops for the day?
Do you have a PA or NP who preops?
Do all the attendings share the responsibility?

Just curious how the process differs from residency...thanks🙂

The on call anesthesiologist sees the inpatients and signs pre op orders.

 

[Consigliere]

CRNAs do it here....discuss the case with us afterward. Makes life much easier.

 

[JohnnyRock]

About 95% of the time we actually never see inpatients until the day of surgery, right in preop holding about 20 min prior to surgery.

I found it odd at first as I was so used to waking up pt's at 3am as a resident just to "get the preop and consent" but I have no problem with it now.

Many groups have an NP who does preops in the afternoons for the next day's cases.

 

[2ndyear]

We try real hard to preop everyone in house. If the surgeon calls to give us a heads up then it's a no brainer. I don't care what time I have free, the patient gets seen because they have given me the courtesy of a phone call. They then expect that any and all issues are resolved by the time they want to do the case.

If a CRNA is free during the day (they don't work nights here) then they will also help us out with preops, and discuss anything that needs discussing with us. I would really hate to dump a mess on someone else in my group, so the best route is to make sure the preops are done.

The good news is that in my smaller community hospital, the volume of preops is much much less than in residency. Not nearly the chore that they once were.

 

[Bertelman]

I found it odd at first as I was so used to waking up pt's at 3am as a resident just to "get the preop and consent" but I have no problem with it now.

I don't wake people up. I'll see 'em until midnight, but I think it's pretty f'in rude to wake someone up just to ask a few questions.

If it's not straightforward, I'll fill out all I can in the chart, leaving mostly the airway exam and consent for the next day.

 

[radslooking]

I don't wake people up. I'll see 'em until midnight, but I think it's pretty f'in rude to wake someone up just to ask a few questions.

If it's not straightforward, I'll fill out all I can in the chart, leaving mostly the airway exam and consent for the next day.

holy christ, someone with a heart and a brain. kudos!

 

[ncdoc1974]

we see all patients outpatients and inpatients preop in the holding room right before surgery and preop them there...the surgeons are responsible for making sure everything is set & ready to go...the surgeons who don't have everything ready will suffer a delay or cancellation...they know this and make sure the patient is ready to roll, usually 99% of the time...

 

[fakin' the funk]

I don't wake people up. I'll see 'em until midnight, but I think it's pretty f'in rude to wake someone up just to ask a few questions.

On the flipside, it's not like you're interrupting their honeymoon or a luxury cruise, is it?

 

[Bertelman]

On the flipside, it's not like you're interrupting their honeymoon or a luxury cruise, is it?

I get that, but remember I'm not the only one waking them up. They'll get aroused by their neighbor, the aides, the nurses, and the surgery intern rounding at 5 a.m. Poor sleep leads to delirium, and makes people pretty bitchy (or maybe that's just me). If the patient is in a crappy mood and half asleep, I find it far less likely that they will provide a complete and accurate history.

If I don't see 2 patients because it's after midnight, That means there are 2 more out of maybe 30 to be done the next day in between cases. Furthermore, these cases are added on all night long. Do you suggest I sit by the OR desk and wait for that 5 a.m. lap chole add-on? Should I wander upstairs at 5:30 to see them knowing they won't see a knife before 4 p.m.? Or should I just let that be handled by a team of providers who has gotten a full night's rest?

I wonder if you will feel differently in 2 years when it's your tired ass trudging around the hospital to wake people up at 2 a.m. for a 10 minute questionnaire. Would you personally want to be roused out of bed for a tired provider to ask you questions, and describe risks and complications, then demand you sign a paper stating you understand the life-threatening risks involving your surgery the following day?

 

[thegasman]

The on call anesthesiologist sees the inpatients and signs pre op orders.

same here. I usually don't bother the patient's, just preop the chart. Check labs, h & p meds etc. Order an ecg if necessary. The official preop interview is done prior to surgery by the anesthesiologist taking care of the patient.