on time for the or

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    We have had a lot of trouble with starting a first case of the day on time. Problems stem from the pt not being ready in the ambulatory department, anesthesia coverage or the surgeon using his own time zone. The administration is now asking that the first case of the morning be brought to the OR for the procedure to start ON time. (NO EXCEPTIONS) If a delay occurs then we as circulators are to fill out a form for the delay. I'm not comfortable with this decision for a number of reasons. Has your OR had this problem and handled in a successful mannor?
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    I'm not sure I understand why you're not comfortable. I am CQI director for my OR and we have a similar system for tracking delays. The point is to identify root causes and perhaps change the process so the patients get surgery in a timely manner. Surgical delays are bad for patient satisfaction. Remember the last time your cable repairman said he'd be out "around three" and showed up about 4:30? It may help to remember that the purpose is to correct the process, not to punish people. Hope I helped.
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    we have had a lot of delays lately, due to a shortage of beds for in patients. It always ends up, that we proceed after a long delay. Our manager has noe decided that we will start the procedure anyway, and deal with a no bed situation later. Not many of us are comfortable with this. Recovery is really upset, it may mean a back up in their unit, and subsequently, they will have to close for periods of time, causing us to recover our own patients, and hence, a delay anyhow.....a no win situation really
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    In the hospital where I am working, they really want to start the surgery on time and I believe most of the hospitals does. In case of delay which most of the times it happens, we have to document the cause of the delay. We are comfortable in doing this because documentation is an important part in patient's care and also for future reference.
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    I think there could be nothing better than for you to fill out the form, it gets the powers that be off your back and points the finger at the real problem. Why it has to be a form beats me however, where I used to work we had a delay code system, so you only had to enter the code and delay time, very simple very quick. Made us very compliant with the system as well, since it was so easy.
    Filling out the form might also help the poor people in ambulatory care who probably have to much to do in to little time, it souds they could do with an extra pair of hands.
    And remember, surgeons will always be surgeons, they might be well educated, but are disoriented to time and place. So it is extremely hard for most of them to show up at the correct place on the correct time.

    Marijke
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    why do they get to use that excuse? that is b.s.! sorry, but if you want to be a professional then act like one, and that includes starting your surgery on time. you scheduled it, so show up!
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    Oops....

    I didn't say I agree with the practice, I agree with you it is stupid and childlike behaviour. I just finished 6 evening shifts from hell and am willing to strangle a certain vascular surgeon, who is going to be late for his own funeral (which might be soon if he keeps behaving the way he does).
    There is no excuse for bad behaviour anywhere including the OR, but it does happen (and you know it).
    Most of our surgeons are well behaved, I am very lucky, the old place was terrible including verbal abuse, instruments being thrown etc. (and a lot of incident reports being filled out).

    Marijke
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    this is a little off of the topic, but my cousin is a police officer in chicago and she told me they had a case where a surgeon was convicted of assault and battery because he threw an instrument at a scrub tech. he got put on probation and was ordered not to practice until he completed like a month of anger management classes. about freaking time! i can't believe that wasn't bigger news when it happened. i bet a lot of his colleagues shaped up after that. un-professional behavior usually continues for as long as it is allowed to.
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    Starting O.R. cases on time is and will be a complaint that I am not sure there is a perfect answer for. I agree that fillng out a tracking paper as to why cases have been delayed is helpful if they are clearly and consistantly filled out. There are soooo many reasons for delay of start that in my opinion there is rarely a clear culpret that can be delt with. We sometimes forget that we are human and we are working with humans and not production lines. Some people need more time than others to get ready for surgery some people are late getting to the hospital some people have to wait until their preacher comes for prayer before surgery and some preachers pray longer than others some anesthesia have to be dragged kicking and screaming to the room away from the morning coffee and doughnuts crowd some surgeons are late to the hospital and some circulators are slow some patients do not have all the appropriate tests done pre op and then others need to have albuterol txs just pre -op. the list goes on and on. If you have three patients with three different and ligit reasons for delay in one day with one surgeon then you have a hornets nest unleashed on your department. Anesthesia will blame nursing or the surgeon nursing will blame anesthesia or the surgeon the surgeon will blame anesthesia or nursing and round and round it goes. The most important thing to remember in this whole secerio is taking care a the person who is recieving care from us. They don't want to feel like a number they dont want to feel rushed or ignored. We need to communicate to all involved and keep the lines of communication open. I do have a problem taking a patient into the O.R. with out the surgeon there because you never know what may happen I have had anesthesia put the patient to sleep and waited 30 mins for the surgeon! I hate to charge anyone the outrageous O.R. room fees while waiting for the surgeon. So I wait till the surgeon is there before I take the patient into the room but that doesnt mean I dont have the patient assessed, checked in and ready to roll.


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