Being on the flip side

[emtpbill, ASN, RN, EMT-P]

Not sure if this is under the correct forum...

So I work in the ER at a fairly busy suburban ER.  A couple of months ago I started having pain in my right hip area.  I had a feeling it wasn't going to be Avascular Necrosis as I had this two years ago and needed a hip replacement. So after getting X-rays and CT the Ortho confirmed I needed a new right hip.

Scheduled surgery for March 8th of 2023.  The night of March 7th I get a phone call from scheduling telling me to be at the hospital at 08:45 the next morning.  I'm all psyched as I can sleep in a little and get up properly.

It's now the morning of March 8th at 05:45. My phone rings and it's the hospital. RN from same day surgery asking me if I'm coming for surgery. Confused I tell her yes but that I was told not to be at the hospital until 08:45. Silence on the phone. The RN asks me to hold on a second. After about a minute she picks back up and says "No, you're supposed to be here at 05:45" the nurse then states " I know what happened, whoever they had call me the night before misread the time at 08:45 instead of what was written of 05:45".  She goes on to tell me to just get up, don't shower, just get to the hospital ASAP.  I live 50 minutes away!  So my wife, who so was not happy, gets up and throws on sweatpants.

I make it the hospital and 5 nurses simultaneously are getting me prepped for surgery.  Fortunately the surgery went off without a hitch. Recovery been a little rough but nothing I cannot handle.

So now my wife (who is an Xray tech) wants me to make a big deal out of it and state its a medical error.  While I agree to some point it was I did have the surgery and went home the same day. I guess if they didn't perform the surgery and made me wait another week I would be more onboard with reporting.  Especially since I am an RN in the same hospitals ER I don't want to draw attention to myself especially for when I go back. I love my job and I love my hospital and co-workers.

Can I get some opinions? I have only been working at this hospital for about 6 months now and plan on staying until I retire.

[NRSKarenRN, BSN, RN]

Definately report the issue to Patient Relations department so followup can be done regarding error in stating reporting time to hospital preop.  It may be a onetime issue or reoccurring problem which affects surgery start time = $$$ due to disrupted schedule affecting preop staff's whole day schedule AND patient annoyance/satisfaction.

 

[Rose_Queen, BSN, MSN, RN]

emtpbill said:

Can I get some opinions?

Speaking from the side of the OR:

Things can change a lot in just a short time. Surgeries have to be rearranged because "loaner trays" (these are instruments owned by the device company that come in to be sterilized the night before) arrive late, and to safely provide standard sterilization, we may move the first case to later in the day and the next patient gets to go first. Sometimes emergencies happen that bump a surgeon from one OR into another, where maybe they can actually start earlier if an additional room is staffed. Sometimes the first patient of the day gets cancelled (they ate, the blood sugar is sky high/way too low, etc) and we call in the next patient and expedite them. And sometimes, the person calling reads the schedule wrong and gives the patient the wrong time.

Unlike your wife, I would not call this a medical error. Nothing untoward happened beyond inconvenience and annoyance, and as long as standard patient care occurred just on an accelerated timeframe, there were no additional risks. I would follow up with the patient rep regarding the experience if the nurse on the phone was rude, but this is not truly a hill to die on in my opinion.

[emtpbill, ASN, RN, EMT-P]

Rose_Queen said:

 but this is not truly a hill to die on in my opinion.

  Exactly why I posted here to you good people, just to get some others point of view.  And while it was an annoyance I do not think care was compromised.  

 

    Also, right as they were pushing the propofol I heard the circulating nurse say everyone who was in the OR at that moment. One thing I remember is the Nurse stating the rep from the implant company was there.   Do any of my OR peeps know why this might be the case? Is it common to have rep's in the OR?

[Rose_Queen, BSN, MSN, RN]

emtpbill said:

Is it common to have rep's in the OR?

Yes! The reps are truly part of the team. They are there to support the staff and surgeon as they do their work. The reps are the experts in whatever company they work for- and ortho/neuro reps where we are using implants spend just as much time in the OR as we do. 

[londonflo]

Rose_Queen said:

The reps are truly part of the team

No, they are there to provide advice on the device they are selling. The devices should never be in the transporting cardboard box from their car into the OR. 

[Rose_Queen, BSN, MSN, RN]

londonflo said:

No, they are there to provide advice on the device they are selling. The devices should never be in the transporting cardboard box from their car into the OR. 

Actually, the facility usually has already purchased what they're selling and has a long standing contract on it. The vendors physically present in the OR are there to assist in the procedure as a resource and provide education, which indeed makes them part of the team, albeit not one employed by the hospital. Those looking to bring something new in generally have to meet outside of the OR and with more than just a surgeon. They don't get free access to an OR with surgery in process.

Source: am an actual OR nurse who has worked in the OR with vendors and also with the purchasing evaluation and approval process.

[emtpbill, ASN, RN, EMT-P]

    So is it that the hospital, or surgeon, is using a new design or manufacturer necessitating a rep to be in the OR?   Or is it a regular thing for them to be there 'just in case' the OR team have a question?

[Rose_Queen, BSN, MSN, RN]

emtpbill said:

    So is it that the hospital, or surgeon, is using a new design or manufacturer necessitating a rep to be in the OR?   Or is it a regular thing for them to be there 'just in case' the OR team have a question?

Our ortho reps are there pretty much every day, even though we've used their implants for years. They assist with ensuring the proper implants are recorded (seriously, a small fragment fracture tray can have a dozen or more different plates, and 3-5 different types of screws, all in different lengths), support staff who maybe aren't as familiar with one set or another (each surgeon has a preference, and the hospitals often don't say no to them, so we may have 6 or 7 different types of total hips to choose from), they assist in refilling implants in trays that have been used, and if the hospital doesn't own the trays (“loaners”) are responsible for getting it to the hospital in a timely manner that it can be properly sterilized and then after we clean it taking it back so it isn't cluttering up our storage areas. That doesn't mean that everyone NEEDS the rep present to walk them through each tiny step of the surgery, but they are there if needed. I have never scrubbed ortho, but the reps I work with would be able to get me through the surgery. 

[emtpbill, ASN, RN, EMT-P]

Thanks for the explanation Rose.   As an ER nurse I had no idea.