How often do you draw the line?

Specialties CRNA

Published

Specializes in SICU.

A few questions.

I've read stories of times when the anesthesia provider will cancle or reschedule a surgery based on patient conditions. I'm curious as to how often a situation like this occurs. And I guess I'm wondering, at the end of the day, who is the one responsible for the patient, anesthesia or surgery? Who makes the final call?

I understand and trust that everyone is there for the patient safety, but when there is a discrepency about how to procede, how does the hierarchy fall? And if anesthesia really does cancle surgeries autonomously, how often does this actually occur?

Much appreciated.

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Specializes in psych, addictions, hospice, education.

I've heard the anesthesiologist is the one in charge of whether the surgery happens or not. It is considered his or her procedure at least until it's underway. Also, the anesthesiologist monitors how long the patient has been "under" and will hurry the surgeons along...

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Specializes in Med/Surg, Ortho, ASC.

I'm confused by your title....do you mean how often does Anesthesia draw the line?In answer to the other question - Yes, Anesthesia really does cancel surgeries. They are wholly responsible for the patient's health and well-being while under. If the patient is not an optimal candidate for anesthesia (or doesn't have the proper specialty clearances, i.e. cardiac, pulmonary) and the case isn't emergent, you can bet it will be cancelled. Post-operatively, I would say that Anesthesia and Surgery both share responsibility. The surgeon for the relative body part/function and anesthesia for proper recovery from the anesthesia.

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anesthesia does not cancel cases, they just cancel the anesthetic, if the patient has a comorbidity that will make the anesthetic unsafe or endanger the patient then anesthesia does not have to do the case. It is no diffirent then is a surgeon does not feel a patient is good enough for surgery, not like anesthesia can make them do it.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

Are you asking about anesthesia and their practices or about staff nurses and standing up for what is right?

As for standing up for what is right - I will call a "time out" in a code or crisis (not stopping CPR or anything detrimental) and review what is being done, why, who is doing what, what we need and ask for input and then we carry forward. It not "drawing the line" as much as collaborative practice.

But, if I saw something being done that was incorrect or would cause harm - I'd speak up in a half-second.

:angel:

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"Are you asking about anesthesia and their practices or about staff nurses and standing up for what is right?"

Your way off base, Mully is asking whether or not a crna can cancel a surgery if they feel that the patient's health will cause them to have a higher risk of not surviving the risk of surgery and/or anesthesia. Is the crna's license the one on the line if they feel the patient is not stable enough but proceeds with anesthetizing them anyway and the patient expires? Can they make this call prior to the start of the surgical procedure completely on there own or can the surgeon override the call the crna makes? I am curious about these details myself....

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Specializes in Hospital Education Coordinator.

CRNA or anesthesiologist? Really, though, if the person administering anesthesia does not feel the patient meets safety criteria they may cancel anesthesia, then the surgeon has the choice to find someone else if someone is available. I think in reality they are communicating and hopefully, no one is willing to push the envelope unless it is life/death matter.

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Specializes in psych, addictions, hospice, education.

Ff the anesthesiologist won't do the anesthetic, then the surgery would be cancelled unless another anesthesiologist or CRNA was found who was willing to do it. In that way the anesthesiologist or CRNA can effectively cancel the surgery. I bet if one cancels another won't do it. I also think surgeons will respect the professional opinion of the anest/CRNA in most cases.

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Specializes in Anesthesia.

If the anesthesia provider is not comfortable proceeding with the surgery because they feel that it is too great of a risk to the patient, then this is communicated to the surgeon. If the surgeon feels that the surgery is an EMERGENCY and it is needed in order to save the patients life then the surgery proceeds and is deemed an EMERGENCY whereby the surgeon assumes the risk and he acts in the patients best interest. If a trauma comes rolling through the door and the patient is 18 years old and shot 14 times with their chest already cracked open; nobody is comfortable or optimistic.......but it is an emergency and we proceed with the surgery.

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Specializes in SICU.

Sorry for any miscommunication. I think you all eventually understood what I was asking. Good answers. Very informative.

The only other question that didn't really get answered was how often does this actually occur. And by "this" i mean, the CRNA deciding he/she won't do a surgery due to patient conditions (in a non-emergent situation). This question, and the entire post really, is directed to the CRNA/SRNA's out there. Thank you!

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Specializes in CRNA.
Sorry for any miscommunication. I think you all eventually understood what I was asking. Good answers. Very informative.

The only other question that didn't really get answered was how often does this actually occur. And by "this" i mean, the CRNA deciding he/she won't do a surgery due to patient conditions (in a non-emergent situation). This question, and the entire post really, is directed to the CRNA/SRNA's out there. Thank you!

A few times a week in our OR (we do about 50 cases a day), the CRNA or anesthesiologist will bring something to the surgeon's attention and the surgeon will cancel/postpone the case. A few times a year the surgeon will want to proceed and anesthesia will not do the anesthetic. We have good rapport with the surgeons so it's uncommon.

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Specializes in CRNA, Law, Peer Assistance, EMS.

The anesthesia provider has the final say as to whether they will be providing anesthesia care for a patient. While technically an anesthesia cancellation is cancellation of only the anesthetic, few surgeons will attempt to find another anesthesia provider or put up much of a fight. A surgeon might proceed in some situations however. If a patient is canceled because they ate breakfast and the surgeon feels he can do the case under local then he might go ahead.

If a patient is canceled for medical reasons a surgeon proceeds at his own risk. These patients are often canceled not only due to the inappropriate risk of an anesthetic, but also the risk of surgery. An example would be a low hematocrit or the patient not having been taken off their blood thinner. Anesthesia itself is not the issue...the actual surgery is...and it is the surgery the anesthesia provider is declaring canceled. Should the surgeon proceed and some untoward event occur, he is in a rather indefensible position. Likewise, should an anesthesia provider proceed with an anesthetic when medically ill advised THEY are at risk for liability. Emergencies are the exception since by definition life or limb is immediately at stake and the case must proceed.

Cancellations happen on a near daily basis in a busy OR. Whether anesthesiologist or CRNA, the anesthesia provider has the final say as to whether, from their standpoint, a patient will be anesthetized for surgery and they cannot be overruled by ANYONE.

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