Guidance needed.

[Boonietunes, MSN]

Counterparts,

I have an issue with a physician that left the facility prior to the patient going to PACU? Their First Assist was closing the patient, but the practitioner left prior to going to the Recovery Room. Is there a standard that I can bring to this physician to establish a rule with him and address this concern before it gets out of hand?

[Rose_Queen, BSN, MSN, RN]

Is there a facility policy, possibly on the medical staff side, that addresses this already? Did the physician sign out to a covering partner?

And was there a reason this happened? I worked with a surgeon whose son was killed in an accident while he was operating. His office staff called and said he needed to go to the office as soon as he was finished, where he learned the news. He then reported off to the other surgeon in the group and left while the PA was still closing to be with family. As this was an urgent situation and he gave report, the facility didn't have an issue with this.

[FurBabyMom, MSN, RN]

I have to agree with RoseQueen. Check your policies, protocols and procedures for guidance. I also think the "why" matters. Did they really leave or were they around?

Commonly our surgeons will leave the OR before the patients go to PACU. Usually they are on campus and immediately available at this time. We have residents, the attendings commonly let a senior resident close relatively independently. They know it doesn't change their responsibility to the patient. I've never had an issue with paging one of our attendings back to the OR if something changed or we needed them.

I don't know what kind of facility you work in but a strict rule without any leniency can set you up for more trouble. I don't think you can write "surgeon must be in OR during entire case" as that leaves no flexibility. Aside from a bathroom break, dealing with a blood exposure, etc, there are other reasons a rule like that is impractical. For example, sometimes there are no floor or ICU beds to be had, which means patients are held in the OR. PACU will board floor patients but hesitates to take an ICU patient as their changes their capacity unless they have to. If patient is being kept in the OR while waiting for an ICU bed - there is no reason for the attending surgeon to stay. They don't generally stay in house if their patient is in ICU.

We've also had situations where a surgeon had a family emergency. More than one of the attendings I work with have had urgent family situations arise while they were still operating. Depending on the specifics they either leave and are relieved by a coworker, or they finish a critical part of the procedure and then leave.