Dealing with Late Cases

Kim O'Therapy, BSN, RN · Feb 21, 2007

That is such a great question. I am having a similar problem at work. I would love to hear some ideas on this.

Now, personally, my OB/Gyn was ALWAYS a good 2 hours late. I understand that emergencies will happen, but gosh, he was ALWAYS late. He even showed up late for my surgery. Eventually, I quit using him as my doctor.

monkeelouise · Apr 5, 2007

I work in a hospital endoscopy department and we have an on-going problem with late cases. One physician in particular consistently over-books cases and shows up 1-2 hours late on a regular basis but management refuses to do anything about his behavior. We are a small department with 3 endo suites, 4 FTE RN's and 4 PTE RN's. Our scheduled hours of operation is supposed to be 7:30AM - 4:00 PM but due to the large number of late cases we are now staggering shifts based on seniority, earlier shifts manned by higher senior nurses. Three RN's are now scheduled to work 7-3:30, two work 7:30-4:00 and one works 8-4:30. The 7-3:30 RN's leave every day on time and the later nurses are stuck staying late, sometimes til 6 PM or later, on a regular basis. Of course the 7-3:30 nurses see nothing wrong with this situation and are opposed to rotating the later shifts so resentment is building in our unit. I'd be interested in hearing how late cases are handled by other units.

We have the same problem in Louisiana. I did the same, scheduling staff to try to accommodate the cases and MDs, the only difference was, when it was time for the late shift to leave, the call team was notified, a RN and tech, to come in and finish the days cases. I suggest a time study, be sure to include all mds in the lab, apples to apples, so to speak, then take finite documentation to administration, being able to point out money saved in employee OT if only the md would show up on time, we also told the patient to ask the doctor why he was late and would notify the patient of our unsuccessful attempts to get the md to come. When a patient lets loose on a doctor because the staff hold the MD accountable, things change for the better, the md will check in with you and will give you his day's itinerary. Bottom line, administration looks at dollars, be able to show cost savings

shahall · Apr 5, 2007

Thanks for your suggestion. We tried that and administration did talk to the physician once. Our hospital endo unit has lost a lot of cases to a near by free-standing endo unit. The physician jumped up and down and threatened to take all his cases there and administration backed down. We only have one RN on call so she could not possibly do 8 cases or more plus recover them by herself. This particular physician has instructed us not to tell his patients anything if they question why he is late and he doesn't even answer our pages any more. It's not a problem administration is going to address so the late people are stuck staying late every day while the early people go home on time. It's causing a lot of bad feelings in our unit.

monkeelouise · Apr 7, 2007

Our administration responded the same way. Stick to your guns. Administrators are very aware that trained GI personnel do not grow on trees and you are not easily replaced.

GIRN · Apr 10, 2007

This is a problem the Administration has to address. You should document the numbers for a month. Document the nurses that had to work overtime or the nurses that had to change their budgeted hours to meet the doctor's late cases. When you provide these numbers to administration, they should realize that this doctor is costing them a lot of money! The doctor may threaten to take his business to a free-standing center but I bet the Center wouldn't allow him to practice there with those kind of business practices. A free-standing center with their eye on profit wouldn't allow a doctor to make their employees work two hours overtime on a regular basis to make up for his tardiness and inefficiency. This guy is just bluffing but your hospital is buying it at their employees' expense. Could you go to Human Resources about the fact that you were hired in to work a certain shift but show them how that shift has changed without your approval? Sad to say, your last option is to let your boss know that this practice is unacceptable to you. If they don't fix it, you'll have to find something else.