What's your scene like?

[teeva]

Do you push the stretcher to the OR? No

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? It’s easy enough to push myself, but I very very rarely use Versed preop. If really needed, I can give a verbal order and nurse can get it themselves and push it.

Are patients ever delivered to the OR before you meet with them? Rarely, only if I’m doing quick gyn or GI cases flip plop between rooms. Nurses seem to like it since there’s two crews so each one doesn’t have to rush. Patients just chill on the stretcher or table and don’t seem to mind shooting the **** with the nurse and tech while waiting for me and surgeon.

Do you choose the music in the OR? I could if I cared, but I don’t. Nurses or surgeon can play whatever they want.

Do you bring snacks or drinks into the OR? No

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

Will your PACU nurses remove LMAs? No

Will you PACU nurses remove ETTs? LOL, no

Do you wear hospital scrubs home? No, that’s gross. My cars and their supple white leathers won’t allow it. Except if I’m working on call after normal hours and just coming in for a quick epidural.

Do you wear home-worn hospital scrubs into the OR? That’s strictly prohibited. There’s unlimited supply of clean hospital scrubs in the locker room so no excuse to not change into them.

Are you allowed cloth (non-disposable) hair covers/caps? I wear whatever they provide. Couldn’t care less. I can’t figure out why some people vehemently care that they can wear their rags from home. It’s not like the box of disposable caps comes pre-treated with lice, crabs, and ringworm.

Must you cover your arms in the OR? They tried to make me. So far they have failed.

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? No. If I’m cold I’ll put on whatever disposable gown they have.

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

Are you allowed to use multiple-dose vials for multiple patients? Yes, but only per one OR per day. Opened vials are thrown out at the end of the day. I get my own fresh drug tray in every OR so I know my vials are uncontaminated.

What is your expected turnover time between cases? I’m always the fastest compared to everyone/everything else

What is your average turnover time between cases? Depends when the next case is. No one is gonna rush if the next case is in an hour with a different surgeon. Otherwise 7-15min if rapid turnover is needed. Depends on what type of cases are going on and how much staff is available. Robot room is a lot longer. It’s zero minutes if we have a free OR available and are bouncing between rooms with enough staffing.

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[kidthor]

As a preface - my place is pure peds, and is very academic...


Do you push the stretcher to the OR? Yes, or resident/fellow/crna does.

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 with my permission, and only for emergent or late hour inpatient cases.

Do you choose the music in the OR? No, and I don't care.

Do you bring snacks or drinks into the OR? Never.

Does anybody know that you bring snacks or drinks into the OR? Not at my hospital, but during residency some select few did.

Will your PACU nurses remove LMAs? No (they did at an outpatient hospital I worked at before, but it was an outlier).

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 - our hospital actually has people looking out for this - they are literally holding clipboards.

Are you allowed cloth (non-disposable) hair covers/caps? Bouffant cap must be worn over them but it's allowed.

Must you cover your arms in the OR? No. Not even with the regulators come to survey us.

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? Yes, in theory. But I never do this.

What is your expected turnover time between cases? 30 min

What is your average turnover time between cases? 20-60 min... academic medicine at its best.

 

[Psai]

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 but you have to stay with the patient

Are patients ever delivered to the OR before you meet with them? No. In an emergency they'll be brought to the OR hallway but can't enter without us

Do you choose the music in the OR? No but I think I can

Do you bring snacks or drinks into the OR? No

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? No

Will your PACU nurses remove LMAs? Don't leave em in

Will you PACU nurses remove ETTs? No

Do you wear hospital scrubs home? Not supposed to

Do you wear home-worn hospital scrubs into the OR? Not supposed to

Are you allowed cloth (non-disposable) hair covers/caps? With a bouffant over it but bouffants look stupid

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? 30 mins

What is your average turnover time between cases? 30-45 mins

 

[Twiggidy]

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.

That's utterly ridiculous and probably more 'third world' then just leaving the room. at the very least if it's "#1" tell the circulator you'll be back in a minute. if it's "#2 after a night of hot wings" phone a friend and if they're coming from home, pay them. no doctor (or nurse) should be excreting of any kind in the OR. that's gross.

 

[Twiggidy]

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.

that's interesting given that when you're on pump everything is literally turned off. at the point you're only role is to move the table. as a matter of fact, it may be argued by someone saavy that you billing should cease during this period, but the counter argument, and in defense of what you say, you're the physician overseaing the perfusionist, similar to a CRNA.....but no one is in the room with CRNA's 100% of the time, so.....

 

[Southpaw]

Community hospital physician only practice


Do you push the stretcher to the OR? Yes

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? Probably, never tried. I rarely give versed, but if needed I'd just give it myself and ask the pre-op nurse to keep a close eye on the patient for the next few minutes as I just gave them Versed.

Are patients ever delivered to the OR before you meet with them? Yes, in emergencies or when I ask for help.

Do you choose the music in the OR? Yes lots of the time. I take requests. I don't care who plays the music really, as long as it's not silence.

Do you bring snacks or drinks into the OR? No, but I'll occasionally have a cup of coffee in the OR on a busy call night.

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? Yes, if I have to go and there's no one available to relieve me, then I auto-pilot the patient as much as possible and tell the circulator that I'll be back in a minute. I consider this a personal physiologic emergency, take care of it, and move on with my day.

Will your PACU nurses remove LMAs? Yes, but I almost never ask them to

Will you PACU nurses remove ETTs? Probably, but I'd never ask them to.

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, I think people who do so are supposed to wear a bouffant over them

Must you cover your arms in the OR? No

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? I doubt it. Never tried. I normally but a paper gown on if I'm cold.

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? 10-30min

What is your average turnover time between cases? 20-25min

 

[narcusprince]

That's utterly ridiculous and probably more 'third world' then just leaving the room. at the very least if it's "#1" tell the circulator you'll be back in a minute. if it's "#2 after a night of hot wings" phone a friend and if they're coming from home, pay them. no doctor (or nurse) should be excreting of any kind in the OR. that's gross.

I have never heard of this happening to a physician. I have known a nurse anesthetist to do this. Legend has it Pgg had an “incident “ but his genius level IQ worked it out.

 

[nimbus]

I have never heard of this happening to a physician. I have known a nurse anesthetist to do this. Legend has it Pgg had an “incident “ but his genius level IQ worked it out.

We need a poll.

“Who has shat themself in the OR?”

 

[skypilot]

We need a poll.

“Who has shat themself in the OR?”

lol, I have definitely been doubled over in pain with a pending bowel emergency, but it never came to that.

 

[pgg]

I have never heard of this happening to a physician. I have known a nurse anesthetist to do this. Legend has it Pgg had an “incident “ but his genius level IQ worked it out.

I don't think I'm familiar with that legend.

 

[ZzzPlz]

Someone JO in the OR. Then I’ll be impressed

 

[narcusprince]

I knew a fellow who was busted for inappropriate behavior during a block......

 

[deleted162650]

Someone JO in the OR. Then I’ll be impressed

I know 2 people (residents at the time) who had sex during a case.

 

[narcusprince]

I know 2 people (residents at the time) who had sex during a case.

In the OR...... thats crazy......

 

[Twiggidy]

I know 2 people (residents at the time) who had sex during a case.

 

[Carabas]

Still a resident but figured I'd take a stab:

Do you push the stretcher to the OR?
Yes. At our VA the circulator brings the patient back.
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?
No
Do you bring snacks or drinks into the OR?
Not allowed. I'll still sneak in a juice or water. Have snuck in a donut before.
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?
Outside the OR yes. Not further than that. In ob, once they're on skin I'll sneak off and do an epidural if somebody needs it. Or use the bathroom. Attendings probably wouldnt be happy but maybe if they were around more they could help...
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, I put on a clean pair when arrive.
Are you allowed cloth (non-disposable) hair covers/caps?
Supposed to be covered by a bouffant. Don't do it though.
Must you cover your arms in the OR?
No
Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs?
Yes, but probably not allowed to.
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?
40 minutes
What is your average turnover time between cases?
See above
If you have CRNAs, do you let them do blocks? A-lines?
Blocks occasionally (a newer development for the pain team), a-lines/IVs when working with attendings.
Do you do nerve blocks after induction?
TAPs and peds
Do you do nerve blocks in the pre-op/holding area?
Yes, always due to presence of a pain team.
Do your L+D nurses remove labor epidural catheters for you?
Technically no. I bribe them with goodies and they do it for me.
Do you fill out your PACU note "ahead of time"?
Attendings do it.
Does your hospital provide you with free food? 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?
Yes
Does your group get a stipend?
Academic hospital, no.
Do you do elective cases on the weekend?
Yes.
Can members of your group opt out of call?
Seniors can.
Do you keep all of your startup units, a fraction of your startup units, or none of your startup units?
Not sure
Are cases done after hours any more lucrative than the same case done at 0730? (Call stipend, RVU bonus, time multiplier...)
No
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. Depends on whatever the surgeon books.

 

[pgg]

Someone JO in the OR. Then I’ll be impressed

I used to work with a guy who got the hospital system sued and himself fired for that.

 

[cthrowaway]

I see this is an old thread, but Covid-19 has changed a lot, so variations among different shops might be more illuminating than ever. Here are my answers:



Do you push the stretcher to the OR? In one surgical center where I work, I am required to push the stretcher with the cirulator. At three others, the circulators bring the patient to the OR without me.

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

Are patients ever delivered to the OR before you meet with them? Only on OB if the floor is hopping and a scheduled C/S is otherwise healthy. I would like to see that process spread elsewhere/return. My older partners tell me that used to be the way it was in 90% of scheduled cases (in the main OR, not just OB).

Do you choose the music in the OR? Only on the rare occasions that the surgeon and circulator have elected not to. Less than 5% of the time.

Do you bring snacks or drinks into the OR? Everywhere I work (except OB). Surgeons join me with aromatic coffee in topless cups at maybe 1/3 of the sites. Circulators only rarely. (When I was interviewing for jobs, the very most attractive places invited me to grab a cup of coffee to accompany on my rounds through the OR. Vigilant places where the nurses were in a position to pooh-pooh anesthesiologists' routines in such a manner were summarily dismissed to the bottom of the pile.)

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

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom? Yes. I know a couple of surgeons who disapprove, but in no facility where I work is it out of the ordinary.

Will your PACU nurses remove LMAs? Before Covid, Yes. Now: to encourage patient throughput and minimize the time patients are in recovery with other patients, we are asked to deliver them to the PACU "conversive." So, technically, asking the PACU nurses to remove the LMA is a no-no. Additionally, one facility now mandates that I am alone in the OR for LMA insertion, then again for removal.

Will you PACU nurses remove ETTs? I'm unsure about this one. Probably yes, though it would raise eyebrows.

Do you wear hospital scrubs home? Do you wear home-worn hospital scrubs into the OR? I never did, though surgeons did all the time. That seems to have changed now post Covid.

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? Only at a single facility, and only when a certain nurse is in charge.

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? Everywhere except the single facility referred to above, when the militant charge nurse is on duty. Since Covid, I am less likely to wear home any clothes that have been in the OR with me.

Are you required to account for every vial of propofol? No. I have colleagues at HCA facilities where this is the norm, and now every (EVERY!) chart shows 200 mg propofol given, no matter the patient's age, size, or pre-or physiology or pharmacology. That's just interesting, is all.

Are you allowed to use multiple-dose vials for multiple patients? Absolutely. In fact, we are encouraged to. (But the majority of my work anymore is at surgicenters, which are (obviously) much more cost-conscientious than hospitals.)

What is your expected turnover time between cases? Thirty minutes in the hospital. Ten minutes in surgicenters.

What is your average turnover time between cases? See above. In one well-oiled GI center, we can have a 1-minute turnover from PACU signout to wheels in the OR. It's a pleasure to work there, besides the constant hussle.

If you have CRNAs, do you let them do blocks? A-lines? N/A, though I personally would frown on that.

Do you do nerve blocks after induction? I do not, no. Some of my partners will do sciatic and femoral nerve blocks after induction so that they don't have to back out the block placement time from their anesthetic bill. I don't care for that practice, but I blame it on CMS presenting my partners with bad incentives.

Do you do nerve blocks in the pre-op/holding area? I go to the OR. Some of my partners will block in pre-op holding area.

Do your L+D nurses remove labor epidural catheters for you? Yes.

Do you fill out your PACU note "ahead of time"? I fill out the PACU note in the PACU, then sign and date (but do not time) the PACU discharge note.

Does your hospital provide you with free food? In the cafeteria or in a doctors' lounge? What about food for the staff? Yes in the hospital. And all but one of the surgical centers I work order food from local restaurants for us.

If the nurses have a potluck, do you bring a dish? Absolutely.

Does your group get a stipend? One for OB, one for trauma, and a "four-hour guarantee" for scheduled OR days. (We don't collect much on the four-hour guarantee, but it does encourage much more efficient OR scheduling than in the days before we negotiated it.)

Do you do elective cases on the weekend? Our main OR grants surgeons wide latitude on weekends. At our ambulatory centers, only the fertility clinic works on weekends, and even then we are told about it by Thursday or Friday before.

Can members of your group opt out of call? After age 55. Most don't, however.

Do you keep all of your startup units, a fraction of your startup units, or none of your startup units? All of our startup units.

Are cases done after hours any more lucrative than the same case done at 0730? (Call stipend, RVU bonus, time multiplier...) No, but taking call does come with a very minimal stipend (which itself comes from the trauma stipend and a little from the our collective billing), so we very painlessly shunt a little of our M-F 07:30-17:00 revenue to ease the burden of after hours and weekend cases.

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? Only one general surgeon boards appies for middle of the night. Our orthopods are no happier to be working late at night than we are, so only rarely. If anybody asked me, I would say that the standard ought to be to stabilize (hydrate, treat pain, begin antibiotics, evaluate and treat lab abnormalities) on all such patients (gall bladders, appendices, hip fractures), and I can't tell you how much more benign our call nights are since we ever so gradually got our surgical colleagues to agree with us. The young 'uns all arrive thinking that somehow from ER diagnosis to skin incision must never be more than 120 minutes or whatever milestone they learned in training...but within a couple of months, they all settle down, too. I understand that such a process is institutional and cultural, and I am in the very happy minority. But I think all my colleagues should aspire towards the goal.



New Questions Post Covid-19:

Do you have to have your temperature taken before reporting to work?
Are you utilizing every other bed in pre-op/PACU?
What are your OR procedures when you intubate? When you place an LMA?
How are your patients screened before elective procedures?
Are you employing Covid precautions for all patients, or only for patients under investigation?

 

[coffeebythelake]

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? Yes

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? Handoff to who? Only anesthesia staff do it in preop holding.

Are patients ever delivered to the OR before you meet with them? Rarely and under extenuating circumstances

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? N/a

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

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, but I dont wear them

Must you cover your arms in the OR? No. This was an AORN thing and ultimately not shown to make a difference

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? Depends. Anywhere from 20 min to 1 hr. Turnover delay rarely due to anesthesia.

What is your average turnover time between cases? 30 to 45 min probably

 

[AdmiralChz]

Do you have to have your temperature taken before reporting to work? Yes when you walk in.

Are you utilizing every other bed in pre-op/PACU? No, same setup now that electives have started. 2 of 3 hospitals have separate rooms though in pre-op.

What are your OR procedures when you intubate? When you place an LMA? Previously had to wait 10 minutes before folks without N95s could come in. As of today with some electives back that rule is gone, but those up at the airway still required to wear it. High risk like ENT/OMFS also require N95 for all staff.

How are your patients screened before elective procedures? Questionnaire, single COVID test within 72 hours. But we have very low prevalence here.

Are you employing Covid precautions for all patients, or only for patients under investigation? Only N95 for all airways. Full high risk precautions for PUIs and positives, but our census has been so low we have only had to do this a handful of times last month.

 

[Sleeplessbordernights]

Do you have to have your temperature taken before reporting to work? Yes when you walk in.

Are you utilizing every other bed in pre-op/PACU? No, same setup now that electives have started. 2 of 3 hospitals have separate rooms though in pre-op.

What are your OR procedures when you intubate? When you place an LMA? Previously had to wait 10 minutes before folks without N95s could come in. As of today with some electives back that rule is gone, but those up at the airway still required to wear it. High risk like ENT/OMFS also require N95 for all staff.

How are your patients screened before elective procedures? Questionnaire, single COVID test within 72 hours. But we have very low prevalence here.

Are you employing Covid precautions for all patients, or only for patients under investigation? Only N95 for all airways. Full high risk precautions for PUIs and positives, but our census has been so low we have only had to do this a handful of times last month.

Where are you Located?

 

[Block-Buster]

I know 2 people (residents at the time) who had sex during a case.

pics or it didn't happen

 

[AdmiralChz]

Where are you Located?

Mid-Atlantic.

 

[likewhatevs]

New Questions Post Covid-19:

Do you have to have your temperature taken before reporting to work? Yes for all our outpatient centers. Our hospital now allows us to "self screen."

Are you utilizing every other bed in pre-op/PACU? Yes

What are your OR procedures when you intubate? When you place an LMA? N95s for everybody who is in the room during any airway manipulation. Anybody who wishes not to wear N95 mask must wait three air-turnover times (~10 minutes) before entering the room after LMA/ETT placement and also after LMA/ETT removal. However, at one outpatient facility (surgeon-owned), none of that applies.

How are your patients screened before elective procedures? Questionaire about travel, symptoms, known contacts.


Are you employing Covid precautions for all patients, or only for patients under investigation? All patients, unless they have tested negative in the last 48 hours.



And, some new questions of my own (related to billing):

Do you fill out billing sheets (with codes), or do you just provide a copy of the anesthetic record?
Do you fax, scan/email, or snail mail billing paperwork?
Do you bill for U/S guidance for block placement even if the U/S can't print a picture?
Do you always have a separate note for the block placement, or do you make notations on the anesthetic record?
Do you bill for controlled hypotension for cases like shoulder scopes done without vasoactive drips and an art line?
Do you bill extra when the head of the table is rotated away from you?
Do you bill all weekend/evening cases as emergencies?
Do you ask your colonoscopy patients to sign a form promising to pay if their insurer denies the claim?
What percentage does your biller take?
Do you employ an in-house biller?
Do you bill for duramorph management on C/S day #2?
Do you bill for iv placements?
Do you bill for floor intubations? What about for responding to codes already underway (with airway already managed)?
Are you required to respond to the ER for trauma/stroke/blue codes, and do you bill for those encounters?

 

[Peterluger]

Wait a minute, why are anesthesiologists pushing stretchers to the room anywhere? I’ve never heard of such things. Does the circulator not have some sort of janitor to assist them with that? And/or the surgeon?

 

[turnupthegas]

Had to push them in residency. My first attending gig and current gig they'll buzz me when they're in the room with the monitors on, unless the patient is unstable coming from the ICU.

 

[pocafx]

In residency. Push the stretcher and set up drips,IVs, machine, arm boards..., and once in a while turn over the room myself.
I think we screen patients but don’t test, unless reason to.You can wear provided N100 ifyou want to. Surgeon is out of room for 5 minutes for intubation but doesn’t leave for extubation. We are doing hips/knees/backs. Still can’t get haircut though

 

[deleted171991]

Wait a minute, why are anesthesiologists pushing stretchers to the room anywhere? I’ve never heard of such things. Does the circulator not have some sort of janitor to assist them with that? And/or the surgeon?

Because anesthesiologists are the bitches of the surgical world, in the US.

 

[Peterluger]

Because anesthesiologists are the bitches of the surgical world, in the US.

Do anesthesiologists push stretchers to the OR where you work?

 

[deleted171991]

Do anesthesiologists push stretchers to the OR where you work?

Yep.

To me, it's the supreme form of disrespect.

 

[cthrowaway]

Do you use tape to secure LMAs?
(I had never heard of such a thing--not in training; not in practice--but as I've scrambled to keep busy the last couple of months I've been asked by more than one circulator (and even a surgeon) if I plan to tape the LMA. I don't suppose it's a bad suggestion, just unnecessary.)

Do you tilt/wedge parturients for uterine displacement?
(This was the absolute standard--every case, every chart--where I trained and where I practiced. Over the last two months I have done OB at two hospitals where it strikes the entire C/S OR staff (and OBs!) as new and bothersome. "Why is the bed tilted?" "What's under her hip? How long does that have to stay there? Is the baby all right?")

 

[nimbus]

Surgeon is out of room for 5 minutes for intubation but doesn’t leave for extubation.

How does that make any sense?

 

[deleted171991]

Do you use tape to secure LMAs?
(I had never heard of such a thing--not in training; not in practice--but as I've scrambled to keep busy the last couple of months I've been asked by more than one circulator (and even a surgeon) if I plan to tape the LMA. I don't suppose it's a bad suggestion, just unnecessary.)

Do you tilt/wedge parturients for uterine displacement?
(This was the absolute standard--every case, every chart--where I trained and where I practiced. Over the last two months I have done OB at two hospitals where it strikes the entire C/S OR staff (and OBs!) as new and bothersome. "Why is the bed tilted?" "What's under her hip? How long does that have to stay there? Is the baby all right?")

No (or maybe losely, on one side). Yes, standard of care for emergent C/S (probably not necessary for elective).

 

[jeesapeesa]

i work in 3 community hospitals, MD-only group

Do you push the stretcher to the OR?
- i can, but the nurses usually tell me that i can meet them in the room and they have it under control. kinda shocked me since i pushed the its to the OR all throughout residency.

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative?
- we can do whatever we want, I just give it in the room.

Are patients ever delivered to the OR before you meet with them?
- no, nurses look for us and ask us if we are ready before bringing the patient back.

Do you choose the music in the OR?
- i can, but I have no interest in it. Besides I like listening to new music. our new trauma surgeon listened to bagpipes and gaelic music and it was the only time i was really bothered.

Do you bring snacks or drinks into the OR?
- long surgeries i bring a dasani bottle and a breakfast bar.

Does anybody know that you bring snacks or drinks into the OR?
- our OR staff does not care as long as it is done discretely.

Do you leave the OR (with the patient anesthetized) to, for instance, go to the bathroom?
- no, i text my colleagues who are in between cases and they step in for a minute while i do my business.

Will your PACU nurses remove LMAs?
- we don't go to PACU with LMAs. i have never seen this even in residency.

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 one cares.

Must you cover your arms in the OR?
- nope. we have jackets provided by the OR that we can use. no sweaters from home can be used.

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs?
- you can, but that looks stupid.

Are you required to account for every vial of propofol?
- nope

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

What is your expected turnover time between cases?
- 15 minutes

What is your average turnover time between cases?
- 15 minutes

 

[DrZzZz]

Large community hospital, smaller community hospital, and a few surgicenters. Relatively uniform answers across each location. 100% supervision

Do you push the stretcher to the OR? CRNA's do, sometimes with help from the circulator

Are you allowed to handoff a Versed syringe to be administered as pre-op sedative? CRNA's are giving the preop meds

Are patients ever delivered to the OR before you meet with them? Only emergent traumas, stat C-sections, and often vented ICU patients coming for procedures

Do you choose the music in the OR? Usually surgeon's choice

Do you bring snacks or drinks into the OR? No, against policy

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? Always a CRNA or MD in the room

Will your PACU nurses remove LMAs? No. Personally don't see the need to be in such a rush that you can't safely remove it in the OR.

Will you PACU nurses remove ETTs? RT will be in PACU for any intubated patient that is expected to be extubated in PACU (which is rare). And usually an anesthesiologist would also be at the bedside for the extubation. So no, PACU RN's won't extubate alone.

Do you wear hospital scrubs home? No. Some of my partners do (though not currently with Covid situation).

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

Are you allowed cloth (non-disposable) hair covers/caps? Currently with Covid, they've allowed it. Otherwise, they would have to be covered with a bouffant. Not sure why Covid suddenly made it ok to not require the bouffant.

Must you cover your arms in the OR? No

Are you allowed to wear non-hospital long sleeve shirts beneath your scrubs? No. If you want sleeves, you can wear a hospital scrub jacket.

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

Are you allowed to use multiple-dose vials for multiple patients? Not "allowed to". But we do as long as we trust we're doing it in a sterile fashion.

What is your expected turnover time between cases? 20 minutes

What is your average turnover time between cases? 25-30 minutes

 

[bigdan]

OMFG.

Someone else brings patients to the room?!?!

Not only did I do this all thru residency, but we’re *just* getting to the point in 2020 where our circulating RNs will see the patients in PreOp. Our residents and CRNAs bring patients back.

We still transport ICU patients to the OR without any surgical presence. Drives me bonkers, but not worth my time to change: the elevators we use can’t fit our IV pole + Nitric + ECMO, so after disaster OHTxp, the NO rides separate.

Mess.

 

[jeesapeesa]

OMFG.

Someone else brings patients to the room?!?!

Not only did I do this all thru residency, but we’re *just* getting to the point in 2020 where our circulating RNs will see the patients in PreOp. Our residents and CRNAs bring patients back.

We still transport ICU patients to the OR without any surgical presence. Drives me bonkers, but not worth my time to change: the elevators we use can’t fit our IV pole + Nitric + ECMO, so after disaster OHTxp, the NO rides separate.

Mess.

if i'm not mistaken i think you're in an academic place? i work in 2 purely community hospital and 1 pseudo teaching hospital (medicine/FM residency) and i was in shock too when i was told that nurses bring the patients in the room; of course this has been the culture of these hospitals since before i was there. we have an older anesthesiologist who brings the patients in the OR but he's a wacky guy and loves to talk and is probably more outgoing than most, but he's the exception. during ICU transports we can easily find a transporter or an extra nurse to help me and the OR nurse push the bed....i usually just bag and keep an eye on the monitor.

i haven't really had any problems with the staff here. we have no anesthesia techs but let me tell you that the OR nurses i have now are way more competent that the anesthesia techs i had in residency. everything is stocked each morning, spinal trays and ultrasound probes/needles are in the room for total joints before i even get there in the morning. at around noon they ask me if i want lunch so they can wait to bring the patient in the room.

surgeons are surgeons but i can't complain. most are friendly. no particular subspecialty stands out as far as being terrible to work with.