Who gives the breaks…

[urge]

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when medically directing 2 to 4 rooms?

Is there specific people assigned to give breaks other than the attending of the rooms?

Which part of the country are you in if you don’t mind.

 

[aneftp]

Depends who is running the board and who is paying the bills for anesthesia.

It’s ridiculous unless it’s a super high acuity case if u are covering 1:3 or less. The attending should be able to give their own breaks even with high fast turnover

But we know there are lazy attendings out there who just want to play candy crush and than complain they need to have carpal tunnel surgery and put the next 6 weeks on Paid medical leave outside their usual pto time or even sick time that is not deducted

 

[CubsDynasty]

Experience both on East and West coast, docs do breaks for their rooms, float CRNA’s help those who are 4:1 or higher acuity cases.

 

[TheLoneWolf]

when medically directing 2 to 4 rooms?

Is there specific people assigned to give breaks other than the attending of the rooms?

Which part of the country are you in if you don’t mind.

Where I am, the attending is expected to give the breaks. 15 min morning, 30 min lunch, and 15 min afternoon break; even if 1:4 or even 1:3 while carrying the OB and airway pagers.

CRNAs will text you to ask about their breaks.

Was much easier when sat own cases. Make time during turnover.

 

[MirrorTodd]

Highly dependent on practice. I've worked as a preop monkey where the crna board runner gave the breaks or directed free crnas to give breaks. I've worked at places where there is one or several break people designated for the day (academic army center), and I've worked at places where there's no one to give breaks just whoever is available. Anecdotally, I have noticed that when docs and crnas are combined, it's the crnas that complain about breaks and the docs tend to figure things out depending on how the day is going. Personally, I've never asked for a break unless it was an urgent bathroom situation cause there is almost always time to go between cases and generally enough time to eat something between cases.

 

[nimbus]

What’s a break?

 

[aneftp]

People need breaks. Even 10 min breaks. The good crnas know how to break themselves. But there are quite a few who will play stupid or milk their in between times and claim they don’t have time to break themselves

We all got to work together in this. Unfortunately this isn’t the way the world works.

 

[MirrorTodd]

What’s a break?

A piece of kitkat bar.

 

[psychbender]

East coast. The directing physician does not give breaks or lunches, as it makes one not immediately available for the other rooms. Breaks and lunches are provided by other CRNAs or physicians that have large gaps in schedule or are already done.

 

[FatKid]

East coast. The directing physician does not give breaks or lunches, as it makes one not immediately available for the other rooms. Breaks and lunches are provided by other CRNAs or physicians that have large gaps in schedule or are already done.

This is correct. The Directing MD can not legally give breaks to CRNAs/AAs/Residents (unless only covering 1 room of course...)

Medical "supervision" with QZ billing on the other hand......wild wild west

 

[dabears505]

Supervise 4 give 15 min morning and 30 min lunch as attending.

 

[aneftp]

This is correct. The Directing MD can not legally give breaks to CRNAs/AAs/Residents (unless only covering 1 room of course...)

Medical "supervision" with QZ billing on the other hand......wild wild west

If u really want to interpret the letter of the Medicare medication direction law.

U better be in the room for every extubation in addition to induction. Or else you don’t meet the requirements.

Let’s stop being lazy here folks. I only covered two rooms today. My crnas are good getting their own breaks and even lunches in between cases. But they do appreciate me even offering. I did give one crna lunch break. The other said she would finish the case at 130pm and take her own lunch.

The goal in my practice is to peel off and let docs go home. And as soon as lunches are close to being accounted for. Docs can go home early. We look stupid and lazy as heck if we try to leave before lunches are accounted for.

But some of my colleagues have to be medically directed themselves to give their crna lunch breaks because they are use to having free crnas give lunches breaks. But there are days we don’t really have anyone free to do it. It’s really a lack of accountability or hate to say it. Laziness. The latter is likely true.

 

[rick roller pump]

Supervise 4 give 15 min morning and 30 min lunch as attending.

That is 3 hours of breaks. How do you find time to do that? Are you present for induction of your rooms?

 

[deleted1183938]

Depends who is running the board and who is paying the bills for anesthesia.

It’s ridiculous unless it’s a super high acuity case if u are covering 1:3 or less. The attending should be able to give their own breaks even with high fast turnover

But we know there are lazy attendings out there who just want to play candy crush and than complain they need to have carpal tunnel surgery and put the next 6 weeks on Paid medical leave outside their usual pto time or even sick time that is not deducted

Technically attending giving breaks can lead to problems. It then ties you up and if there is an emergency in one of the other rooms you aren’t available. So technically this violates TEFRA. I do know however that it’s common practice. The CRNAs give each other breaks at my current and recent past work place.

 

[deleted1183938]

Where I am, the attending is expected to give the breaks. 15 min morning, 30 min lunch, and 15 min afternoon break; even if 1:4 or even 1:3 while carrying the OB and airway pagers.

CRNAs will text you to ask about their breaks.

Was much easier when sat own cases. Make time during turnover.

Yeah this is way too much. Y’all need an extra CRNA for this. What if your other room has an emergency during all these 15 and 30 minute breaks?? And honestly 15 minute breaks should be had in between cases unless we are talking of very fast turnovers.

 

[deleted1183938]

If u really want to interpret the letter of the Medicare medication direction law.

U better be in the room for every extubation in addition to induction. Or else you don’t meet the requirements.

Let’s stop being lazy here folks. I only covered two rooms today. My crnas are good getting their own breaks and even lunches in between cases. But they do appreciate me even offering. I did give one crna lunch break. The other said she would finish the case at 130pm and take her own lunch.

The goal in my practice is to peel off and let docs go home. And as soon as lunches are close to being accounted for. Docs can go home early. We look stupid and lazy as heck if we try to leave before lunches are accounted for.

But some of my colleagues have to be medically directed themselves to give their crna lunch breaks because they are use to having free crnas give lunches breaks. But there are days we don’t really have anyone free to do it. It’s really a lack of accountability or hate to say it. Laziness. The latter is likely true.

Two rooms and 30 minutes breaks?? Doable. But you have to have someone else cover your other room in case of emergency. But people here are talking 4 15 minutes and 4 30 minutes breaks. Come on. CRNAs can break themselves on the 15 minutes in between cases. 4 30 minute breaks can really tie up a doc in a busy practice.

 

[Arch Guillotti]

CRNA's give each other breaks essentially 100% of the time. Only exceptions are a quick bathroom break or a spell in some crappy middle of the night case, etc.

 

[narcusprince]

This is correct. The Directing MD can not legally give breaks to CRNAs/AAs/Residents (unless only covering 1 room of course...)

Medical "supervision" with QZ billing on the other hand......wild wild west

Where is this stated legally? At my practice docs often give the breaks and sometimes lunches.

 

[psychbender]

If u really want to interpret the letter of the Medicare medication direction law.

U better be in the room for every extubation in addition to induction. Or else you don’t meet the requirements.

When I directed, I was in the room for every extubation, as well as induction. It was rare, but not unheard of, for a colleague to tell the CRNA to go ahead and extubate, then meet them in PACU. This was usually if it came when the attending was placing a block or epidural. In general here, CRNAs should be able to break themselves, since they don't have to preop or consent the patient, do blocks or lines, and techs change circuits, wipe down machines, and can grab most equipment needed. Demanding breaks when they have 15-30 minutes of downtime between cases is lazy, unless it's a day with really long cases (redo backs), or ultra-fast turnovers (T&A, peds dental).

 

[osumd]

Is anyone else’s favorite break request the post intubation “ready for a coffee break”

 

[NitroS]

CRNAs. We have 2-3 CRNAs who are here just to give breaks. They do 7-3 shifts and they give morning, lunch and afternoon breaks

 

[pocafx]

prior academic job had 5 crna who work 9-2. Just give breaks and lunches then go home. Good job for those with kids.
Current job no defined breaks. Go when u can. Ask board runner if really long case or emergency.

 

[TheLoneWolf]

CRNAs. We have 2-3 CRNAs who are here just to give breaks. They do 7-3 shifts and they give morning, lunch and afternoon breaks

You hiring?

 

[TheLoneWolf]

Yeah this is way too much. Y’all need an extra CRNA for this. What if your other room has an emergency during all these 15 and 30 minute breaks?? And honestly 15 minute breaks should be had in between cases unless we are talking of very fast turnovers.

You are correct. They use the excuse that we are short staffed and everyone is working. But even when we were fully staffed, the CRNA expectations were the same.

I find it funny because attendings and day docs doing solo cases get no expectation of a break or a lunch.

I use to work 7am-5pm in the EP lab with zero downtime, lunch or breaks. Maybe a 30 second washroom break between cases tops. Those rooms are now exclusively staffed by locums.

I'm even semi-ok with 1:4 if they are on the same floor and don't give breaks. But with doing all the pre-ops, and giving each room breaks and lunches, you are always moving with no downtime.

The bigger issue is what to do if another room has an emergency while breaking another CRNA? Call them back and run over? That could be 5-10 minutes later

 

[deleted1183938]

You are correct. They use the excuse that we are short staffed and everyone is working. But even when we were fully staffed, the CRNA expectations were the same.

I find it funny because attendings and day docs doing solo cases get no expectation of a break or a lunch.

I use to work 7am-5pm in the EP lab with zero downtime, lunch or breaks. Maybe a 30 second washroom break between cases tops. Those rooms are now exclusively staffed by locums.

I'm even semi-ok with 1:4 if they are on the same floor and don't give breaks. But with doing all the pre-ops, and giving each room breaks and lunches, you are always moving with no downtime.

The bigger issue is what to do if another room has an emergency while breaking another CRNA? Call them back and run over? That could be 5-10 minutes later

We physicians also need to stop being martyrs. Surgeons have plenty of time to eat and yet we sacrifice ourselves without any lunch breaks and think this makes us special? Nah. It makes us pushovers. People need to eat. Why does everyone expect anesthesiologists get to eat in the OR?? This is one of the things I respect about nurses. They insist on their breaks.

To your second point. Better hope your partners are available to help in an emergency or the patient could die. And if your partners run to help it will be a blind situation as they know nothing of the patient but hopefully it’s something that can be fixed.

 

[POW16]

CRNAs give breaks. Some days (maybe once a month or less I would guess) we are extra short so attending is asked to give one of the breaks.

 

[nimbus]

We physicians also need to stop being martyrs. Surgeons have plenty of time to eat and yet we sacrifice ourselves without any lunch breaks and think this makes us special? Nah. It makes us pushovers. People need to eat. Why does everyone expect anesthesiologists get to eat in the OR?? This is one of the things I respect about nurses. They insist on their breaks.

To your second point. Better hope your partners are available to help in an emergency or the patient could die. And if your partners run to help it will be a blind situation as they know nothing of the patient but hopefully it’s something that can be fixed.

Just skip breakfast and you have compulsory intermittent fasting. That is why we all look so good! 😉

 

[deleted1183938]

Just skip breakfast and you have compulsory intermittent fasting. That is why we all look so good! 😉

So, one meal a day??? That’s it??
Now that you mention it there was this one anesthesiologist I used to see around one of the hospitals in town at the nurses station always sitting. Always. Dude was about 400lb. It made no sense to me how one can be an anesthesiologist and weigh that much. I mean yeah still sitting can be sedentary but there is still pushing and moving patients and walking around the hospital. Not at all like a small clinic.
And of course the missed meals!! Dude did not miss a meal clearly. He stashed his snacks and ate behind the drape or something. Like Dr Now says, he has eaten a whole year’s worth already. Very sad. Wonder if he’s still alive.

 

[DocVapor]

Hospital (Medical Direction 1:3) - CRNAs do the breaks during daylight hours. I have given a handful of very fast "I'm about to pee my pants" breaks for the CRNAs as long as I have nothing imminent.

ASC (Solo Docs) - Docs grab a snack/pee break between cases and keep the room rolling. Most of us keep it moving quickly (i.e. consent pt, do any blocks, pee, scarf down a few crackers all before room is turned over). There are a couple that will drop off in pacu/phase II, see their next, then go sit in lounge sitting coffee until they get called to the room for the 2nd time. Miraculously they speed up if they know they are next on the list to get relieved for the day.

 

[deleted1183938]

Hospital (Medical Direction 1:3) - CRNAs do the breaks during daylight hours. I have given a handful of very fast "I'm about to pee my pants" breaks for the CRNAs as long as I have nothing imminent.

ASC (Solo Docs) - Docs grab a snack/pee break between cases and keep the room rolling. Most of us keep it moving quickly (i.e. consent pt, do any blocks, pee, scarf down a few crackers all before room is turned over). There are a couple that will drop off in pacu/phase II, see their next, then go sit in lounge sitting coffee until they get called to the room for the 2nd time. Miraculously they speed up if they know they are next on the list to get relieved for the day.

Good for the docs that go sit in the lounge to try and get some food. We all need food.

 

[Ronin786]

East coast. The directing physician does not give breaks or lunches, as it makes one not immediately available for the other rooms. Breaks and lunches are provided by other CRNAs or physicians that have large gaps in schedule or are already done.

It's definitely a regional mentality. In the Midwest at two jobs I had, attending gave breaks as long as they reasonably could (usually less than 1:3). East Coast it's anathema to give breaks even if you have two incredibly slow rooms.

Honestly, the days I was supervising and had to give breaks to three rooms was absolute hell. Even two fast paced rooms can be incredibly tiring.

 

[urge]

For places where there is dedicated break staff, wouldn’t it be more cost effective to pause the room between cases for breaks and lunch?

Seems silly to me that we don’t pause between cases for lunch break.

 

[DocVapor]

Good for the docs that go sit in the lounge to try and get some food. We all need food.

Yes... To a point. I'm talking they'll grab a coffee and snack... Do an EGD... Go grab another coffee and snack... Do a colonoscopy... Then another coffee and snack.

Edit: it's used as a delay tactic so they don't have to relieve one of their partners in a different room.

 

[dizzy21]

People need breaks. Even 10 min breaks. The good crnas know how to break themselves. But there are quite a few who will play stupid or milk their in between times and claim they don’t have time to break themselves

We all got to work together in this. Unfortunately this isn’t the way the world works.

Current place i do locums, one savvy Crna unless specifically directed will not take a break. The turnover is slow there, like hour plus. Also is clever enough to only ask for breaks during induction and emergence.

And some of you complain that CRNAs don’t take orders. Well there is an opposite extreme to that.

 

[aneftp]

Current place i do locums, one savvy Crna unless specifically directed will not take a break. The turnover is slow there, like hour plus. Also is clever enough to only ask for breaks during induction and emergence.

And some of you complain that CRNAs don’t take orders. Well there is an opposite extreme to that.

Put them in the longest room. That’s how you handle them.

 

[deleted1183938]

Yes... To a point. I'm talking they'll grab a coffee and snack... Do an EGD... Go grab another coffee and snack... Do a colonoscopy... Then another coffee and snack.

Edit: it's used as a delay tactic so they don't have to relieve one of their partners in a different room.

That’s a lot it snacking. People are eating too much. I just need a good 30 minutes lunch break. Sometimes I work so much that it’s almost 2pm by the time I get to actually eat and hell at that point it’s going home time.

 

[deleted1183938]

For places where there is dedicated break staff, wouldn’t it be more cost effective to pause the room between cases for breaks and lunch?

Seems silly to me that we don’t pause between cases for lunch break.

Surgeons don’t like to pause in general and neither do the people running the rooms.
Your question makes no sense. Do you mean in places where there AREN’T dedicated break staff why do people not pause? Because the other way is not computing to me.

 

[deleted1183938]

Current place i do locums, one savvy Crna unless specifically directed will not take a break. The turnover is slow there, like hour plus. Also is clever enough to only ask for breaks during induction and emergence.

And some of you complain that CRNAs don’t take orders. Well there is an opposite extreme to that.

I am not understanding your last comment. In any case why aren’t these CRNAs taking a break between cases if its this slow? That’s a bad culture. What are they doing for the entire hour? I mean even w ICU drop off in Timbuktu that’s gotta leave at least 30 minutes free.

 

[abolt18]

Mostly solo cases with a little AA direction. Break between cases when doing solo cases. AAs also break between cases or whatever AA is free will walk around give breaks to other AAs. I never give them breaks other than a super long case and they ask for a quick pee break.

 

[psychbender]

Surgeons don’t like to pause in general and neither do the people running the rooms.
Your question makes no sense. Do you mean in places where there AREN’T dedicated break staff why do people not pause? Because the other way is not computing to me.

Some of the neurosurgeons here will actually do total room break for lunch between cases. It wins them points with the OR staff, they can have a leisurely lunch and see a patient or two, and we know we don't have to get someone to break that CRNA. It's great.

 

[medicine2wallstreet]

Where I am, the attending is expected to give the breaks. 15 min morning, 30 min lunch, and 15 min afternoon break; even if 1:4 or even 1:3 while carrying the OB and airway pagers.

CRNAs will text you to ask about their breaks.

Was much easier when sat own cases. Make time during turnover.

You need a new job. This is horrific.

 

[TheLoneWolf]

You need a new job. This is horrific.

Outside of the county hospital (flush with anesthesia staff because of a great state pension), this is the norm for the jobs in the city I am in. The usual response I get from the heads of the different groups is...."who is gonna pay to have a CRNA around giving breaks, it's a ton of money for no service." Same reason they give to the hospitals for refusing to start up a preop clinic.

 

[deleted1183938]

Some of the neurosurgeons here will actually do total room break for lunch between cases. It wins them points with the OR staff, they can have a leisurely lunch and see a patient or two, and we know we don't have to get someone to break that CRNA. It's great.

Sounds lovely. I worked in a po dunk hospital where one of the old timey eye surgeons did that. I was in shock!!! Shock!!

 

[2buckchuck]

Outside of the county hospital (flush with anesthesia staff because of a great state pension), this is the norm for the jobs in the city I am in. The usual response I get from the heads of the different groups is...."who is gonna pay to have a CRNA around giving breaks, it's a ton of money for no service." Same reason they give to the hospitals for refusing to start up a preop clinic.

What state is this?

 

[dizzy21]

I am not understanding your last comment. In any case why aren’t these CRNAs taking a break between cases if it’s this slow? That’s a bad culture. What are they doing for the entire hour? I mean even w ICU drop off in Timbuktu that’s gotta leave at least 30 minutes free.

The crna won’t do anything unless specifically told to. Meaning the crna won’t take the initiative to go get lunch even if it’s a 2 hour case delay. You gotta specifically tell this person to go get lunch. The attitude is not terrible during cases. Doesn’t do anything that was not discussed previously.

 

[urge]

Surgeons don’t like to pause in general and neither do the people running the rooms.
Your question makes no sense. Do you mean in places where there AREN’T dedicated break staff why do people not pause? Because the other way is not computing to me.

Get rid of the break staff. Save that salary money. I think it is cheaper to pause the room.