Turnover times

[jskibis]

This concerns current CRNAs out there, our current MD/boss is wanting to use "incentives". One of the big items he wants to use to measure our "worthiness" for a cash bonus is to collect turnover times between cases for a year and then reward us next summer. For some background info, we are an MD/CRNA group at a Level I trauma center, we do an average of 90-100 cases a day, everything but transplants, & our Docs have to be in the room at induction time. I think this is bad policy since we aren't on an assembly line(it only feels like it).

What do other CRNAs out there think out something like this?

[kmchugh]

How can we be in control of turn over time? If I have cases in the same room, I wait until the current case is under way, and I am sure the patient is stable, then begin turning over for the next case. Generally, I will have the airway stuff out, as well as drugs drawn up for the next case before we even begin closing on the current case. By the time I leave the room with the patient, the only "turn over" I have left to do is changing circuits. Therefore, length of turnover time is largely a function of the nurses and scrubs in the room. Your situation sounds very similar to mine. It seems to me that bonuses based on what someone else, who is out of your control, does, is completely unfair.

I also think you are right. Assembly line surgery is not safe. If the patient you are with now is having problems, you need to be focused on that, not how the delay is costing you time and bonus money. Besides, given our busy schedule, some days the only time I get for breaks and lunch is during turnover. I'm guessing you are in the same boat.

I wouldn't like this policy on a number of levels.

Kevin McHugh

[jskibis]

Thanks for the input, at our place, we(CRNAs) are the ones who are responsible for putting the patient in the room. I drop off the first patient in PACU and go directly to holding to pick up the next patient. Not infrequently the next patient hasn't had an MDA interview(required) or the IV hasn't been started. So the CRNAs who hustle are able to keep turnover down to about 15 minutes between cases, but other people are able to screw it up!

What is your idea of incentives that are worthwhile?

[smogmatt]

I would agree with the above, i am not a CRNA only a wanta be

but when i worked as a Scrub and Anesthesia teck I found that it was the Surgeon or the Scrub or Nurse that slowed the turnover not the CRNA or MDA.

Good luck with everything

Matt

[ma kettle]

It sounds like a " quick fix" from the managed care supporters. They have this mentality to treat people and their health care problems like a fast food drive through. Just think, pay for your hip replacement then drive to the next window for the incert, thank you. Oh, and for those more complicated surgeries, do it your self shave kits, drive through CABG. And then come back daily so we can make sure you have an EKG with that pulse, and here is the significant other incision care kit.

And Kevin, for you, those more complicated endarectomies, your going to send them home with the nipride lower the b/p and maybe a little neo to boost b/p. OH yeah, sprinkle a little percocet jimmies over the top.

I realize this is a little off. BUt I am surprised that the CRNAs don't as a group say " these are patients, not things, we are specialists and individualize to treat custom patient care problems". It seems to me that you guys right now have the upper hand in this sittuation, or am I wrong? Your right though, I have yet to see any delays occur on the CRNAs side, unless there is an emergent intubation,ie cardiac arrest.

Just my 2 cents worth. NO not the change in the fast care drive through...:)

Sandy