Reconfiguring Our Pain Cases (ESI's)

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    Our facility is currently trying to streamline our pain cases. All patients are MAC's and go directly to phase II. Here is an example of how our cases went yesterday.

    10 patients-

    2 Pre-op nurses- on the 10 cases (8 ESI's and 2 discograms), those same nurses would recover the 8 ESI's and radiology nurses recovered the 2 discograms.

    2 PACU nurses circulating in the OR- both working one OR, neither have ever circulated and feel they need 2 nurses to handle the cases, in case they need anything.

    22 patients-

    3 Pre-Op nurses- for the 22 other surgeries. Pre-op has a unit secretary and a PCA (patient care assisstant).

    3 PACU nurses to come in and cover 22 other general patients to come out, all 22 to start in phase I, some would then go to Phase II and be DC'd and some to go from phase I to the floor. These 3 nurses do phase I, Phase II of recovery and Discharge. 2 PACU nures coming in at 0800 and 1 coming in at 0930. PACU has a unit secretary and NO PCA.

    We had a doctor who started his cases at least one hour early, so needless to say, 2 generals came out before the PACU nurses arrived at 0800, leaving one of the pre-op nurses on the pain cases to begin recovery on the 2 generals.

    And it only got crazier. At our facilty we do a lot of nerve blocks. Our Block nurse was one of the nurses circulating in the OR, so they had to do a block in the PACU, at the time I had 2 generals and the other PACU nurse had 2 generals, no way we could do it and had to have anesthesia wait till the 3rd nurse came in and we could monitor patient per moderate sedation protocols. Anesthesia asked me if they could just do it by thereself...WHAT!!!....not doing it on my patient without a nurse to assisst and monitor patient. By the time all the pain cases were done, PACU had recovered 14 generals. It was a crazy morning.

    If you work at a facility that does pain cases and regular surgeris, how do you do it? And if you do it well, tell me how, PLEASE?!?!?!?!!!!!

    1. How many OR's are going?

    2. How many nurse's pre-op, and recovery those patients?

    3. Who gets your patients dressed (family or the nurse)?

    4. Whats the average time in recovery?

    5. What kind of charting paper or computer?

    6. Do you have ancillary staff?

    7. Who does your EKG's?

    8. Do you ave a unit secretary?

    9. Does it sound like were staffed adequately?

    We really need to get an idea of how to do this better, how to staff accordingly, and how to make it flow? More cases means more money but you can't do it without the staff.

    Bottom line, if you do it well, tell me how, so I can contribute some ideas. Thank you in advance....
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