What's your scene like?

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I'm curious about cultural differences among practices. I'll try to keep the questions yes/no to encourage easy answering. (Feel free to add questions, if you'd like.)

Do you push the stretcher to the OR?

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative?

Are patients ever delivered to the OR before you meet with them?

Do you choose the music in the OR?

Do you bring snacks or drinks into the OR?

Does anybody know that you bring snacks or drinks into the OR?

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom?

Will your PACU nurses remove LMAs?

Will you PACU nurses remove ETTs?

Do you wear hospital scrubs home?

Do you wear home-worn hospital scrubs into the OR?

Are you allowed cloth (non-disposable) hair covers/caps?

Must you cover your arms in the OR?

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs?

Are you required to account for every vial of propofol?

Are you allowed to use multiple-dose vials for multiple patients?

What is your expected turnover time between cases?

What is your average turnover time between cases?

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Do you push the stretcher to the OR? Yes.

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? Yes

Are patients ever delivered to the OR before you meet with them? Never

Do you choose the music in the OR? No

Do you bring snacks or drinks into the OR? Water bottle

Does anybody know that you bring snacks or drinks into the OR? No

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? On rare occasion. Many of my partners leave the room almost every case.

Will your PACU nurses remove LMAs? Yes, though I never ask them to.

Will you PACU nurses remove ETTs? I believe so; I've never asked them to.

Do you wear hospital scrubs home? No.

Do you wear home-worn hospital scrubs into the OR? I don't, but others do

Are you allowed cloth (non-disposable) hair covers/caps? Yes, but only if covered by a one-use only bouffant cap

Must you cover your arms in the OR? Not yet

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? I do, but I'm not sure it's kosher

Are you required to account for every vial of propofol? Not in our ASCs, but yes in our hospital.

Are you allowed to use multiple-dose vials for multiple patients? Not at our hospital, but yes at our ASCs

What is your expected turnover time between cases? 20 minutes

What is your average turnover time between cases?[/QUOTE] Under ten at ASCs, probably 25 in the hospital.
 
Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? On rare occasion. Many of my partners leave the room almost every case.

Just out of curiosity, how many people have died on the table in your practice in the last year?
 
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That's a lot of questions with some really weird ones, do you practice in the US?

Do you push the stretcher to the OR? Residents/Fellows so yes

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? No?

Are patients ever delivered to the OR before you meet with them? Emergencies only

Do you choose the music in the OR? 50% yes

Do you bring snacks or drinks into the OR? No!

Does anybody know that you bring snacks or drinks into the OR? Into the actual room? Not sure that's really a thing, at least in the US.

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? No, I don't think this is a thing either.

Will your PACU nurses remove LMAs? If only.

Will you PACU nurses remove ETTs? I wish.

Do you wear hospital scrubs home? Used to, not now.

Do you wear home-worn hospital scrubs into the OR? No.

Are you allowed cloth (non-disposable) hair covers/caps? I wish.

Must you cover your arms in the OR? No.

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? Roll the sleeves up, yes.

Are you required to account for every vial of propofol? Yes.

Are you allowed to use multiple-dose vials for multiple patients? No.

What is your expected turnover time between cases? 30-40 minutes (cardiac ORs)

What is your average turnover time between cases? 40 minutes
 
Do you push the stretcher to the OR? Orderlies deliver first patient of the day; Circulating nurse the rest of the day
Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? Yes
Are patients ever delivered to the OR before you meet with them? Cataracts, Endo only
Do you choose the music in the OR? Not any more
Do you bring snacks or drinks into the OR? Soft drinks or bottled water, all the time.
Does anybody know that you bring snacks or drinks into the OR? I don't hide it. The can sits on top of my cart. My partners bring in coffee.
Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? Yes, but never for more than 2-3 minutes at a time. Run to the PACU to sign orders, take a leak, tell the charge nurse something. (I'm surprised this is even a question. I thought part of being a partnership is the implicit understanding that we can be called on to help each other out on occasion.)
Will your PACU nurses remove LMAs? Yes
Will you PACU nurses remove ETTs? They can and do (for others), but I never ask them to
Do you wear hospital scrubs home? No, but I suppose I could.
Do you wear home-worn hospital scrubs into the OR? I don't, but others do.
Are you allowed cloth (non-disposable) hair covers/caps? Our surgeons are allowed. I suppose I could, if I wanted to.
Must you cover your arms in the OR? Not yet, but we are told it is coming.
Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? Yes.
Are you required to account for every vial of propofol? Yes in the hospital (every cc); no in the adjacent ASC.
Are you allowed to use multiple-dose vials for multiple patients? Yes.
What is your expected turnover time between cases? 20 minutes
What is your average turnover time between cases? 20 minutes is probably the average, but with a good team I'll have five minute turnovers. With a slow team, 30+ minutes.

A few questions of my own:

If you have CRNAs, do you let them do blocks? A-lines?
Do you do nerve blocks after induction?
Do you do nerve blocks in the pre-op/holding area?
Do your L+D nurses remove labor epidural catheters for you?
Do you fill out your PACU note "ahead of time"?
Does your hospital provide you with free food? In the cafeteria or in a doctors' lounge? What about food for the staff?
If the nurses have a potluck, do you bring a dish?
Does your group get a stipend?
Do you do elective cases on the weekend?
Can members of your group opt out of call?
Do you keep all of your startup units, a fraction of your startup units, or none of your startup units?
Are cases done after hours any more lucrative than the same case done at 0730? (Call stipend, RVU bonus, time multiplier...)
Do you have a night float?
Do you do appendectomies late at night (or are they boarded for the next morning)? What about hip fractures?
 
I'm curious about cultural differences among practices. I'll try to keep the questions yes/no to encourage easy answering. (Feel free to add questions, if you'd like.)

Do you push the stretcher to the OR? NO.

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? Allowed YES. Choose to NO.

Are patients ever delivered to the OR before you meet with them? NEVER

Do you choose the music in the OR? Never tested the matter.

Do you bring snacks or drinks into the OR? NO. But probably could if were discreet.

Does anybody know that you bring snacks or drinks into the OR?

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? Never. Exception for the small rural hospital that our group used to cover as solo. Would ask circulator to watch monitors for very brief bathroom break.

Will your PACU nurses remove LMAs? Don't do it. Could probably make it happen if so inclined. Not inclined.

Will you PACU nurses remove ETTs? Same answer as LMAs.

Do you wear hospital scrubs home? Rarely

Do you wear home-worn hospital scrubs into the OR? Nope. Some people do.

Are you allowed cloth (non-disposable) hair covers/caps? Yes.

Must you cover your arms in the OR? No

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? Yes

Are you required to account for every vial of propofol? Yes but as a charge. Not as a controlled substance.

Are you allowed to use multiple-dose vials for multiple patients? Ain't no multi dose vials in our universe no more.

What is your expected turnover time between cases? Doesn't matter. We are only rarely/never the limiting factor in room turnover.

What is your average turnover time between cases? Depends on OR personnel.
 
Do you push the stretcher to the OR?
Don't like it but yes

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? Yes but never do, i can technically ask a nurse to give it too.

Are patients ever delivered to the OR before you meet with them?
Yes but most will have been seen in pre op consult

Do you choose the music in the OR?
No but i could
Do you bring snacks or drinks into the OR? Yes

Does anybody know that you bring snacks or drinks into the OR? Yes

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom?
All the time :)
Will your PACU nurses remove LMAs?
No
Will you PACU nurses remove ETTs?
No
Do you wear hospital scrubs home?
No
Do you wear home-worn hospital scrubs into the OR? No

Are you allowed cloth (non-disposable) hair covers/caps? Yes

Must you cover your arms in the OR? No

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? Yes

Are you required to account for every vial of propofol? No way (not even opiods)

Are you allowed to use multiple-dose vials for multiple patients?
Yes
What is your expected turnover time between cases? No expected turnover

What is your average turnover time between cases? 15min
 
A few questions of my own:

If you have CRNAs, do you let them do blocks? A-lines? Most do spinals. Some do Epidurals and Alines. None do other blocks.
Do you do nerve blocks after induction? Zero. (Other than TAP blocks.)
Do you do nerve blocks in the pre-op/holding area? Almost always
Do your L+D nurses remove labor epidural catheters for you? Yes
Do you fill out your PACU note "ahead of time"? Only people who don't care about keeping their job do this. We have two.
Does your hospital provide you with free food? In the cafeteria or in a doctors' lounge? What about food for the staff? Bagels in am M-F doctors lounge. Once a month dialogue with administration meal in doctors lounge.
If the nurses have a potluck, do you bring a dish? Donate $20
Does your group get a stipend? Employed. Used to get a HUGE stipend.
Do you do elective cases on the weekend? In house semi elective only.
Can members of your group opt out of call? At GREAT cost. More common is to write personal checks to individuals to pick up some calls.
Do you keep all of your startup units, a fraction of your startup units, or none of your startup units? Not applicable
Are cases done after hours any more lucrative than the same case done at 0730? (Call stipend, RVU bonus, time multiplier...) We are paid for availability. Not productivity. Night work is significantly paid more than day work. I get paid the same whether I sleep all night or work all night.
Do you have a night float? Tried it 20 years ago. Was universally hated.
Do you do appendectomies late at night (or are they boarded for the next morning)? What about hip fractures? Yes to appys. No to hip fractures.
 
Answering for the PP group I'm set to shortly join.

If you have CRNAs, do you let them do blocks? A-lines? Never blocks or CVL. A-lines and OB epidurals yes. No spinals or CSEs.
Do you do nerve blocks after induction? Only TAP, which is done rarely.
Do you do nerve blocks in the pre-op/holding area? Yes
Do your L+D nurses remove labor epidural catheters for you? Yes
Do you fill out your PACU note "ahead of time"? No
Does your hospital provide you with free food? In the cafeteria or in a doctors' lounge? What about food for the staff? Yes - hospital buys lunch M-F takeout for anesthesiology group (MDs/CRNAs and surgeons in lounge).
If the nurses have a potluck, do you bring a dish? Sure, if asked.
Does your group get a stipend? Yes (trauma call).
Do you do elective cases on the weekend? No... but define "elective"
Can members of your group opt out of call? No, easily sold away.
Do you keep all of your startup units, a fraction of your startup units, or none of your startup units? N/A
Are cases done after hours any more lucrative than the same case done at 0730? (Call stipend, RVU bonus, time multiplier...) No - salaried plus call bonuses.
Do you have a night float? No, call person comes in the evening for trauma hospital home call for others.
Do you do appendectomies late at night (or are they boarded for the next morning)? What about hip fractures? Yes and yes.
 
I'm curious about cultural differences among practices. I'll try to keep the questions yes/no to encourage easy answering. (Feel free to add questions, if you'd like.)

Do you push the stretcher to the OR? No

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? No

Are patients ever delivered to the OR before you meet with them? No

Do you choose the music in the OR? Sometimes

Do you bring snacks or drinks into the OR? No

Does anybody know that you bring snacks or drinks into the OR? N/A

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? No

Will your PACU nurses remove LMAs? No

Will you PACU nurses remove ETTs? No

Do you wear hospital scrubs home? No

Do you wear home-worn hospital scrubs into the OR? No

Are you allowed cloth (non-disposable) hair covers/caps? No

Must you cover your arms in the OR? No

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? No

Are you required to account for every vial of propofol? No

Are you allowed to use multiple-dose vials for multiple patients? No

What is your expected turnover time between cases? 20-45m depending on case/gear set up

What is your average turnover time between cases? 30m




--
Il Destriero
 
A few questions of my own:

If you have CRNAs, do you let them do blocks? A-lines? No
Do you do nerve blocks after induction? Yes
Do you do nerve blocks in the pre-op/holding area? No
Do your L+D nurses remove labor epidural catheters for you? No
Do you fill out your PACU note "ahead of time"? No
Does your hospital provide you with free food? No
In the cafeteria or in a doctors' lounge? What about food for the staff? No
If the nurses have a potluck, do you bring a dish? No,but I don’t eat it either
Does your group get a stipend? Yes
Do you do elective cases on the weekend? No
Can members of your group opt out of call? Yes, with the associated financial penalty
Do you keep all of your startup units, a fraction of your startup units, or none of your startup units? None
Are cases done after hours any more lucrative than the same case done at 0730? (Call stipend, RVU bonus, time multiplier...)No, but we’re paid for call days/nights
Do you have a night float? No
Do you do appendectomies late at night (or are they boarded for the next morning)? What about hip fractures?depends on the surgeon and what we’re already doing. Appys usually go at night, fractures usually go the next day.




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Il Destriero
 
Just out of curiosity, how many people have died on the table in your practice in the last year?

I guess you are being snarky, but I can't be sure. To answer your question, we have had zero deaths on the table for the last year, probably for the last ten years. I guess I'm not sure where you are going with this. Perhaps you have had a death on the table in the last year--which is why you are so much more "vigilant" than I am--in which case--to follow the logic--you are recommending that my group (who has had none) should follow your lead.

But maybe that's not what you were thinking.

At my training program many years ago, the single most vigilant and conscientious attending would regularly leave the room to (and this should give you a hint of the kind of fastidious anesthesiologist he was) scrub his own laryngoscope handle and blade after its use. (He'd invite residents out into the hall with him so we could speak freely of the surgical team's skills and any missteps we should be on the lookout for.) I asked him wasn't he nervous to be outside the room (or to have the surgeon see him outside the room), at which point he pointed out that in probably 70% of the ICU beds at that moment and every moment, much more tenuous patients are run on very similar pharmacologic regimens (propofol, fentanyl, and muscle relaxant drips) on ventilators WITHOUT A PHYSICIAN IN SIGHT, so, yeah, a Board Certified Anesthesiologist should be able to manipulate the patient's physiology in such a manner as to render the patient stable for five minutes at a time.

Made sense to me then, makes even more sense to me now that I have a few thousand anesthetics under my belt. YMMV.
 
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My friend do you practice in the United States? Leaving the room to go to the restroom is very taboo. I have known a few folks who stayed in rooms and accidentally used the restroom on themselves. Would they be safe for a quick break with a circulator yes. This is not a safety issue its pure culture. We are just conservatives seeing the bubble from the opposite side.
 
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Sidestepping one's opinion of the medical issues related to leaving the room with an anesthetized patient unattended, let's talk about billing. Leaving the room while you are billing for anesthesia time is fraud. Getting caught (or getting whistle-blown) on one of these cases could lead to investigations/auditing of all of your cases. If this is as common as people are openly admitting, the damages from the federal government alone (not to mention private payers) would be astronomical. All it takes is a phone call or email to CMS. They can retroactively deny past payments and go after you for triple damages for fraud. Here's a little primer on the rules:

http://www.anesthesiallc.com/images/webinar/tulane_webinar_slides.pdf

There have been a number of multi-million dollar verdicts against anesthesiologists/hospitals/groups in the past few years for these kinds of issues. Local culture or not, it's your butt on the line.
 
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I have personally never done this. But what about the solo shops in austere locations? What makes more sense setting up a coms system that would allow you to have a bowl movement versus having one in the OR? What would you do if you had a longer stable case and u needed to BM?
 
Obviously bedside commode, per the all the heroes in this thread. If not available, hold it in your pants til case is over..
 
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Obviously, my partners and I occasionally have to go to the bathroom. You either do it between cases or someone comes in to relieve you for 2 minutes or whatever. And yes, I do recall a time on call where someone peed in a saline bottle. Skills to pay the bills, y'all.
 
Honestly with virtual technology we should be able to leave the room during rock stable cases for bathroom breaks. Open line vocera, have circulator stand in place tell surgeon dont cut anything big for 2 minutes. Doesnt this sound safer then exposing the OR environment to your feces? In addition would you redose antibiotics if you pooped in the OR? I cannot imagine a single patient who would want you to poop your pants especially if they are rock stable.
 
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I have yet to see a practice where everyone stays in the OR for the whole case. We step out all the time to check on previous patient, see next patient and start iv, do blocks in pre-op, chat in the hallway etc... and patients don't die on the table because of it.
 
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I have yet to see a practice where everyone stays in the OR for the whole case. We step out all the time to check on previous patient, see next patient and start iv, do blocks in pre-op, chat in the hallway etc... and patients don't die on the table because of it.

Not in the USA... It's illegal and billing fraud to leave the room while a patient is under an anesthetic and engage in any other activity. That's why they have CRNAs and AAs in some places to help out with breaks/lunches. My statement is for all MD/DO practices and not the ACT where clearly the staff members relieve each other routinely for breaks, lunches and dinner on a routine basis.
 
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Obviously bedside commode, per the all the heroes in this thread. If not available, hold it in your pants til case is over..

I've done my own cases previously and have left the room for 2-3 minutes to go to the bathroom. This would be an "emergency only" situation for me and not routine practice.
 
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Standards for Basic Anesthetic Monitoring

  1. STANDARD I
    Qualified anesthesia personnel shall be present in the room throughout the conduct of all general anesthetics, regional anesthetics and monitored anesthesia care.
 
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Do you push the stretcher to the OR?
Yes, with the circulator. I can ask the circulator to go back without me although I rarely do that.
Are you allowed to handoff a Versed syringe to be administered as pre-op sedative?
Yes, but I rarely use versed and even more rarely ask someone else to give it.
Are patients ever delivered to the OR before you meet with them?
No
Do you choose the music in the OR?
About 50/50. It's pretty laid back here. Some surgeons are picky. Sometimes the circulator or tech will pick something. I like playing OR DJ. It's fun to try an piece together a mix that keeps everyone happy.
Do you bring snacks or drinks into the OR?
Coffee in a spill proof travel mug daily.
Does anybody know that you bring snacks or drinks into the OR?
It sits on my cart so people notice. No one really cares, but I'm sure the clipboard mafia wouldn't like it.
Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom?
No, we will break each other.
Will your PACU nurses remove LMAs?
Yes, but I don't think any of us ask them to.
Will you PACU nurses remove ETTs?
No
Do you wear hospital scrubs home?
I wear clean scrub pants and T-shirt home everyday.
Do you wear home-worn hospital scrubs into the OR?
No, I put on a clean pair when arrive.
Are you allowed cloth (non-disposable) hair covers/caps?
Yes, but they must be covered by a bouffant.
Must you cover your arms in the OR?
Yes, despite my Constitutional 2A right to bear arms.
Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs?
Yes, but they must be covered.
Are you required to account for every vial of propofol?
No, thank God.
Are you allowed to use multiple-dose vials for multiple patients?
No.
What is your expected turnover time between cases?
We're never the rate limiting step.
What is your average turnover time between cases?
Highly variable from 10-40mins
If you have CRNAs, do you let them do blocks? A-lines?
What are these "C-R-N-A's" of which you speak??
Do you do nerve blocks after induction?
Only TAP's, ACB's, and iPack's. Nothing where I'm close to an actual nerve.
Do you do nerve blocks in the pre-op/holding area?
Yes, or in the OR depending on convenience.
Do your L+D nurses remove labor epidural catheters for you?
Yes, thank God.
Do you fill out your PACU note "ahead of time"?
No, it's check boxes and takes 3 seconds in PACU.
Does your hospital provide you with free food? In the cafeteria or in a doctors' lounge? What about food for the staff?
Yes, Drs. eat free in the cafeteria and lounge. Dose not apply to any other staff.
If the nurses have a potluck, do you bring a dish?
No, but our group pays for annual holiday party for them.
Does your group get a stipend?
Yes, covers trauma, OB, board-runner, and other admin duties.
Do you do elective cases on the weekend?
No, but in-house semi-elective I guess.
Can members of your group opt out of call?
We have 2 senior plan options which requires both a certain age and time with the group to be part of. Can also give away call. All options result in a concomitant decrease in income.
Do you keep all of your startup units, a fraction of your startup units, or none of your startup units?
We operate on a points system so this doesn't really apply.
Are cases done after hours any more lucrative than the same case done at 0730? (Call stipend, RVU bonus, time multiplier...)
Not specifically, but call shifts are worth more points
Do you have a night float?
No.
Do you do appendectomies late at night (or are they boarded for the next morning)? What about hip fractures?
Appy's yes, Hips no
 
My friend do you practice in the United States? Leaving the room to go to the restroom is very taboo. I have known a few folks who stayed in rooms and accidentally used the restroom on themselves. Would they be safe for a quick break with a circulator yes. This is not a safety issue its pure culture. We are just conservatives seeing the bubble from the opposite side.
Really? In physician only practices, this is the norm. Whether it’s taboo or not, well I am just not gonna pee or poop myself. Let the circulator know you are leaving and to call for help, If **** goes south, and this is life.
 
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Really? In physician only practices, this is the norm. Whether it’s taboo or not, well I am just not gonna pee or poop myself. Let the circulator know you are leaving and to call for help, If **** goes south, and this is life.

Others seem to be leaving the OR for pre and post op checks, blocks, etc. that’s quite different than telling the surgeon to chill for 2 minutes so you don’t take a dump in your scrubs.
I’ve never been anywhere that was done, except for a MD only practice in the heart room while on pump.


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Il Destriero
 
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I wonder if some of these folks that routinely leave the OR with an unattended anesthetized patient also balk at being asked to manage a sick newborn in OB becuse the mom getting the C-section is your responsibility, not the neonate?


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Il Destriero
 
Is whipping out your penis to piss in a bottle considered sexual misconduct or harassment, or is patient safety a valid excuse? At least self soiled underwear can be considered a medical condition protected from instant termination.
 
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Employment wise you may not be terminated. However socially you will be known as Dr mcsh$&y pants. True story a buddy of mine now a prominent coach in my home state had a bowl movement on himself during football practice and he got the nickname sh$thead which people still poke fun at today......
 
I wonder if some of these folks that routinely leave the OR with an unattended anesthetized patient also balk at being asked to manage a sick newborn in OB becuse the mom getting the C-section is your responsibility, not the neonate?


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Il Destriero
That doesn't make any sense you are confusing totally different scenarios
 
I cannot imagine being confined to an OR for a 3h+ operation. I'd rather supervise 5/1.
 
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Really? In physician only practices, this is the norm. Whether it’s taboo or not, well I am just not gonna pee or poop myself. Let the circulator know you are leaving and to call for help, If **** goes south, and this is life.

I call dibs on being the CMS whistleblower on this one.

"If the Justice Department enters the case begun by you the Whistleblower, and if the Government prosecutes the case and wins, the Whistleblower is entitled to a maximum of 25% and a minimum of 15% of any funds recovered by the Government as a result of the verdict or settlement."

It's fraud by both CMS and ASA guidelines by both letter of the law and intent of it. Guaranteed 7-8 figure payout if somebody can blow the whistle with good evidence on a big enough practice.
 
Is it fraud to bill for surgery when surgeon steps out?

Nope. They don't bill for time. But stepping out of an OR as the solo anesthesia provider definitely is. I really don't get all the arguing about whether one steps out to pee, eat, start IVs, see patients, or simply because they can't imagine being in one room for three hours. At least in the United States, doing so constitutes patient abandonment (from a clinical side) and billing fraud (from a financial side). There is an allowance made for "emergency of short duration" which allows a supervising physician to be "not immediately available" for a short period of time (with a CRNA, resident or AA in the room, of course). The definitions of "emergency" and "short duration" are vague. I am honestly not sure if this applies to solo MD (or CRNA for that matter) practice. I have done this on occasion where I have a case going in one room with CRNA and I start a stat c-section or whatever by myself. I document "emergency of short duration" on both charts and note the time that I called backup in and when they arrived. Are people who are going tho **** their pants documenting this on the chart as an emergency of short duration? Because that might actually be kosher!
 
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I'm curious about cultural differences among practices. I'll try to keep the questions yes/no to encourage easy answering. (Feel free to add questions, if you'd like.)

Do you push the stretcher to the OR? No.

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? Yes.

Are patients ever delivered to the OR before you meet with them? Never.

Do you choose the music in the OR? Sometimes.

Do you bring snacks or drinks into the OR? Nope.

Does anybody know that you bring snacks or drinks into the OR? See above.

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? Don't sit cases. But no.

Will your PACU nurses remove LMAs? No.

Will you PACU nurses remove ETTs? Definitely not.

Do you wear hospital scrubs home? No.

Do you wear home-worn hospital scrubs into the OR? Nope.

Are you allowed cloth (non-disposable) hair covers/caps? Yep. Would wear it anyway.

Must you cover your arms in the OR? No.

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? Yes. Plain color.

Are you required to account for every vial of propofol? Nope. Probably should though.

Are you allowed to use multiple-dose vials for multiple patients? Yes.

What is your expected turnover time between cases? Inpatient 30 minutes. Outpatient 20.

What is your average turnover time between cases? 40 minutes I bet.



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I’m not confusing scenarios. Both involve not monitoring the patient that you’re being paid to anesthetize, though for very different reasons.
I’m wondering if they’re ok with a quick ham sandwich in the locker room but demand a peds NP present for every delivery in case the baby needs more than a blankie.


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Il Destriero
 
At my previous practice (All physician, East coast), I only left the room while the pt was on pump (technically is the pt under the anesthetic care of me or the surgeon/perfusioninst?)

I now work in the NE (I do my own cases 90% of the time) and the mentality is different. Even when the pt is on pump, my group wants a physician in the room. Different folks, different strokes.
 
At my previous practice (All physician, East coast), I only left the room while the pt was on pump (technically is the pt under the anesthetic care of me or the surgeon/perfusioninst?)

I now work in the NE (I do my own cases 90% of the time) and the mentality is different. Even when the pt is on pump, my group wants a physician in the room. Different folks, different strokes.

Careful. Surgeons are opening and concentrating on a repair. Perfusionists aren’t licensed independent physicians or physician extenders - by definition, they are technicians. Totally understand there are many practices out there where the anesthesiologist leaves on pump, but it wouldn’t be my suggestion going forward in our litigation-happy society.

I’ve never seen or heard of someone leaving an anesthetized patient alone like this, even in the most rural of settings. Call a colleague or wait it out folks, don’t fall on that sword. You’d be such an easy target I could write the legal brief in my sleep. In fact, might want to go ahead and write that blank plaintiff check now.
 
I really don't get all the arguing...
It’s because one bad apple spoils the bunch and forces common sense out the window. It can be argued it’s statistically safe to leave a room with a stable patient for a few minutes (say 4.5 min between NIBP measurement) to run to the PACU to make sure your postop bleeder isn’t crashing and has IV access and nurses know what your orders/plan are. Or to urinate so you’re not accused of sexual misconduct, because if we’ve learned anything recently, multiple men with power and money do actually drop their pants in front of random people and masturbate or walk around the office naked. Or to release explosive diarrhea from that gas station hot dog you ate last night on your way home from a busy day at work. Or to blow your nose so you don’t contaminate the sterile field. Or to step immediately outside the OR and keep an eye on the monitors through a clear glass window to discuss/debrief with your resident/medstudent any mistakes that were just made or things to improve upon. Or to hand a nurse a syringe of ephedrine to give to a hypotensive pt who just had a labor epidural because you can draw up a syringe and dilute it faster than they can get it out of whatever drug machine they use.

But not to run to the cafeteria for food. Or put IVs in the next patient to improve turnover time (besides that being a nurse’s job if turnover time is a concern). Or do a block (blows my mind that that’s allowed).
 
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But not to run to the cafeteria for food. Or put IVs in the next patient to improve turnover time (besides that being a nurse’s job if turnover time is a concern). Or do a block (blows my mind that that’s allowed).
Tolerated outside of the US
 
This discussion is a beautiful example of how US medical culture has become so ugly.
 
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I've never argued that common sense is involved in this issue. Merely that leaving your patient unattended (for any reason) violates federal law (by defrauding CMS/medicare and/or private payers) and opens you up to the legal and financial consequences. By all means, keep doing what you're doing. Remaining ignorant/indignant about it doesn't change the law.
 
So if you split bill your time from say 08.00 to 1035 and then 1039- 11.45 on a case to exclude the time when you had to go take a leak, would that be kosher then?


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So if you split bill your time from say 08.00 to 1035 and then 1039- 11.45 on a case to exclude the time when you had to go take a leak, would that be kosher then?


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I'd just call up CMS, tell them how you practice, and ask how they'd like you to bill it. What could go wrong?
 
So if you split bill your time from say 08.00 to 1035 and then 1039- 11.45 on a case to exclude the time when you had to go take a leak, would that be kosher then?


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maybe from a billing point of view, but you are still legally required to be with the patient at all times during the anesthetic
 
I work in a small practice with 5 ORs plus a Cesarean room and 2 endo rooms. I do 90% of my own cases and often am the only Anesthesiologist in the hospital at 3 am.

Do you push the stretcher to the OR? Sometimes
Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? Yes
Are patients ever delivered to the OR before you meet with them? Has happened in L and D, or in a hemorrhaging patient once or twice
Do you choose the music in the OR? No
Do you bring snacks or drinks into the OR? No.
Does anybody know that you bring snacks or drinks into the OR? Candy bar in pocket
Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? Yes, to go across the hallway for less than an minute and grab something. I can hear the pulse ox from there.
Will your PACU nurses remove LMAs? No
Will you PACU nurses remove ETTs? No but ICU will (of course)
Do you wear hospital scrubs home? No
Do you wear home-worn hospital scrubs into the OR? No
Are you allowed cloth (non-disposable) hair covers/caps? Yes if they are laundered by the hospital
Must you cover your arms in the OR? Not yet
Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? No
Are you required to account for every vial of propofol? No
Are you allowed to use multiple-dose vials for multiple patients? It is discouraged
What is your expected turnover time between cases? 20 min
What is your average turnover time between cases? 20 Minutes
If you have CRNAs, do you let them do blocks? No A-lines? No
Do you do nerve blocks after induction? No
Do you do nerve blocks in the pre-op/holding area? Yes usually
Do your L+D nurses remove labor epidural catheters for you? Yes almost always
Do you fill out your PACU note "ahead of time"? No
Does your hospital provide you with free food? Never
If the nurses have a potluck, do you bring a dish? Sometimes
Does your group get a stipend? Yes
Do you do elective cases on the weekend? No
Can members of your group opt out of call? Yes, but they have made prior arrangements Now the answer is "No" because we are desperate for people to take call.
Do you keep all of your startup units, a fraction of your startup units, or none of your startup units? NA
Are cases done after hours any more lucrative than the same case done at 0730? (Call stipend, RVU bonus, time multiplier...)
Do you have a night float? No
Do you do appendectomies late at night (or are they boarded for the next morning)? Yes What about hip fractures? Sometimes
 
Large academic center for reference

Do you push the stretcher to the OR? Residents, yes

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? No

Are patients ever delivered to the OR before you meet with them? Only in emergencies

Do you choose the music in the OR? No, surgeons do

Do you bring snacks or drinks into the OR? Never

Does anybody know that you bring snacks or drinks into the OR? NA

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? Never

Will your PACU nurses remove LMAs? Never

Will you PACU nurses remove ETTs? Never

Do you wear hospital scrubs home? Not me, but others do

Do you wear home-worn hospital scrubs into the OR? Not me, but others do

Are you allowed cloth (non-disposable) hair covers/caps? Only if covered by a bouffant

Must you cover your arms in the OR? We have to wear jackets with that idea, but many roll up the sleeves anyway

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? No

Are you required to account for every vial of propofol? No

Are you allowed to use multiple-dose vials for multiple patients? No

What is your expected turnover time between cases? 30 min

What is your average turnover time between cases? 30-40 min
 
Large academic center for reference

Do you push the stretcher to the OR? Yes

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? Yes

Are patients ever delivered to the OR before you meet with them? Not supposed to. But sometimes happen in emergencies.

Do you choose the music in the OR? No, surgeons do

Do you bring snacks or drinks into the OR? No

Does anybody know that you bring snacks or drinks into the OR? NA

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? Never

Will your PACU nurses remove LMAs? Never

Will you PACU nurses remove ETTs? Never

Do you wear hospital scrubs home? Some people do

Do you wear home-worn hospital scrubs into the OR? Never. No one does this

Are you allowed cloth (non-disposable) hair covers/caps? Allowed no. Some people do it

Must you cover your arms in the OR? I always do because its freezing. But we don't have to

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? No

Are you required to account for every vial of propofol? No

Are you allowed to use multiple-dose vials for multiple patients? No, but some people do it anyway.

What is your expected turnover time between cases? As fast as possible

What is your average turnover time between cases? 30-40 min
 
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