Surgeons "go ahead" problem ? - page 2

So... here's the rub. You have an 8 am scheduled case. The patient is brought to the surgery holding area. The OR case is opened and counted. The anesthesiologist is ready. However, you haven't... Read More

  1. by   rn/writer
    I'm not an OR nurse, but I know from all the JCAHO prep stuff flooding our hospital that there is a huge emphasis on site marking and taking a time-out to make sure everyone is in agreement about what is going to take place. Doesn't the surgeon have to be there for that?

    I've been extremely fortunate with the surgeries I've had to have docs who were prompt. Unnecessary and extended waiting in the holding area can really get to you.
  2. by   lindaloo51
    Most of our patients are out pt or am admits. Our policy is that the surgeon must sign and date an updated H&P the day of surgery. In patients are covered by a note in the progress notes for that day. If all of that has happened, our 0800 is to be on the table at 0730 to assure our surgeons have an 0800 cut time. We have been told that this is a JCAHO standard that the H&P must be updated the day of surgery.

    There are a few kinks in the system. We have 1 doc who dictates the H&P the morning of OR. (We all know he didn't see the pt at 0500) But it meets the letter of the policy if not the intent. We also had one who faxed a predated H&P to the pre-op area but his staff did it the day before and of course there was the fax time date stamp for all to see.

    The bottom line is anesthesia is not started until the surgeon is in the building.
  3. by   Marie_LPN, RN
    Quote from OR male nurse
    So... here's the rub.

    You have an 8 am scheduled case. The patient is brought to the surgery holding area. The OR case is opened and counted. The anesthesiologist is ready. However, you haven't heard from the surgeon. No one has seen him/her, he/she hasn't called to let you know you can "go ahead" with the surgery.

    How does your hospital handle this situation ? Do you automatically bring the patient back to the OR 15 minutes prior to the scheduled starting time and hope that the surgeon shows up? Do you wait in the holding area until you actually see or get the phone call from the surgeon that you can "go ahead" with the surgery.

    Is it OK at your hospital for the surgeon to call you up from his cell phone and tell you that he/she is 10 minutes away at mile marker XYZ on the interstate and they will be there and you can go ahead? Or, does your hospital require that the surgeon actually be "on campus?"

    I'm interested in knowing how you handle this situation and what the policy is at your hospital.



    Thanks in advance
    OR male nurse
    Surgeon has to be physcially present and speak to the pt. before they go in the room, and at this time, he/she will mark the operative site.

    (We also document a delay and the reason for the delays. We had one surgoen who was notoriously an hour late every day he was there, and he was coming form home to the OR. Yet here's the nursing staff catching the heat for the room being behind all day, until the nurses decided to leave a "paper trail" of reasons for the delay. Enough evidence to fix the problem.)
    Last edit by Marie_LPN, RN on Sep 23, '06
  4. by   NurseRoRo
    I came from a facility that would page the doc right before we went to see the patient in holding to see where they were, and if they need to see the patient, etc. Then I went to another OR where every doctor sees their patient before the circulator takes the patient anywhere. However, we do have a few docs who like to A: see the patient in the OR and ask them if there are questions (this usually happens when they're on the table, being preoxygenated with a mask over their face...I'd freak if I were the patient!).

    And then there's scenario B: One of our docs insists that his cut time be exact, so he insists that all his first patients of the day be in the room, asleep, prepped and draped before he makes his grand appearance. Granted, he may have seen them the day before, or early in the AM, but either way, you'll never see me in his office! If he doesn't see the pt that day, how does he know who's under the drape? And like everyone else has said, what if he gets into an accident right outside the hospital and the patient is asleep and ready just to be awakened to a cancelled case? And yes, he is usually late, so his exact cut time isn't exact, and he complains about turnover time...TO YOUR FACE AS YOU ARE TRYING TO CLEAN AS FAST AS YOU CAN. Then he goes wherever he goes and by the time the next patient is on the table and ready, you have to page him...he shows up 10 minutes later.
  5. by   scrubnurse
    We have a rule that we do not take patients back to the OR until we "see the whites of the DR's eyes". In other words, he/she must be in the hospital. Of course there are patient safety issues, but another thing that hasn't been discussed is cost. Patients are charged OR time, usually in 15 minute increments. If they are being brought to the room before the doctor even arrives, that can be a huge unnecessary expense. We all know Doctors run on their own time clocks. Their "5 minutes away" can somehow take 30 minutes.
    It is funny to hear others talk about late MD's complaining about turn over. It is nice to know this happens everywhere. Same BS, different OR! :wink2:
  6. by   RNOTODAY
    Well, yes, our pts are brought back without the surgeon actually being in the room, but in the hospital.... most of the time we send a page that the "pt is in rm 10"..... but we have an id policy where nothing can be done, no anesthesia, until the attending id's the pt in the or with the circulator and the anesthesia provider.... so.... we are not allowed to go ahead with anything.but occasionally we have waited 5-10 minutes for the surgeon to show up after being paged......
  7. by   oneillk1
    We have the patient in the anaesthetic room until the surgeon arrives in the OR, then they are brought into the theatre. I would never advocate going ahead with something before the surgeon is there..... you know how fate likes to spring things on us! Had a case where a patient was anaesthetised for a total oesophagectomy (the two part thoracic and abdo kind) when the surgeon phoned to say the whole list was cancelled due to a personal problem. We spent the best part of the next 2 hours waiting for the patient to metabolise the relaxants and wake up, and who knows how many thousands of dollars of disposables.
  8. by   Snowshooz
    We wait until the surgeon has arrived in the OR...I like to see the whites of their eyes before bringing their patient in the room..
    The surgeon must also initial the correct side of the procedure etc before the patient enters the room...
  9. by   Texasaggie43
    I am A twenty year vet in the OR. I have never worked with a CRNA or an Anesthesiologist that would sleep a patient without the surgeon being in house. Never bring a patient back to the OR without co-oordinating with the entire surgical team. If any legalities were to ever arise, you would find yourself out on a limb by yourself. Doctors will lie to cover their own butts. JUST REMEMBER THAT!
  10. by   Owensaunt
    Personally it all depends on the doc. A habitual offender gets written up by me for delay. I usually don't take them back until I see their smiling face unless Anes needs to do lines and stuff.
  11. by   passionate
    I don't bring the patient into an operating room until I have seen the eyes of my surgeon. I did that once because anesthesia was having a cow and one of the surgeons was not in the arena when the spinal was finished and I ENDED UP WRITING MYSELF UP!!! Follow your policy and your heart. Don't ever be bullied!!!! That is the best advice!:trout::uhoh21: I felt like a fool and wasn't happy that I hadn't advocated well for my pt. I am sure she would have wanted to see the doctor first as well.
  12. by   passionate
    Quote from passionate
    I don't bring the patient into an operating room until I have seen the eyes of my surgeon. I did that once because anesthesia was having a cow and one of the surgeons was not in the arena when the spinal was finished and I ENDED UP WRITING MYSELF UP!!! Follow your policy and your heart. Don't ever be bullied!!!! That is the best advice!:trout::uhoh21: I felt like a fool and wasn't happy that I hadn't advocated well for my pt. I am sure she would have wanted to see the doctor first as well.
    The road to Hell is paved with good intentions
  13. by   BloodNGuts
    We never transport a patient into the OR until we see the whites of the surgeon's eyes. Even if we receive a call from the parking lot, we still do not transport until the surgeon is physically in house. Why have the patient under anesthesia any longer than necessary???

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