No one dies in OR

GadgetRN71, ASN, RN · May 25, 2008

I'm going to get flamed for this I'm sure, but sometimes, patients receive absolutely terrible care post-op, on whatever floor they are on. Do you not think that perhaps this may contribute to a poor outcome?

It makes no sense to think that just because someone has a poor outcome from surgery that the surgeon or the OR did something wrong. Many of these patients are not healthy specimens to begin with and if you work in a level one trauma OR, you get people many times who have almost zero chances to start with. Also, we do have people die in the OR-most recently, a young man shot by his neighbor. That surgeon did everything in his power to save that guy and it was very upsetting for all involved.

I find the title of the original post to be quite snarky actually and it is very obvious that there is a real ignorance of the OR and the people that work there. If I sound angry, I am. My coworkers and I work our tails off on a daily basis to save people who many times have no interest in saving themselves. I have seen surgeons, nurses and other OR staff in tears because we just couldn't save someone. So excuse me if I think that your complaint is petty, childish and just plain uninformed. I can assure you, we don't try to pull someone through just to make more work and aggravation for nurses on other units.

ukstudent · May 25, 2008

i am not yet an rn (hopefully in a month or two). i work in the icu as a tech, and have for close to a year. it seems that the or doesn't let anyone die. when someone is headed south the quickly send them to the icu so we can code them and deal with the aftermath.
every part of the hospital apart from hospis tries to stop pt's from dieing. if they do fine in the or, and most do, they go to pacu and then either to the floor or home. icu's are meant to deal with the very sick, it's not a dump.
i really hate this. maybe because it is a teaching hospital and residents to quite a few procedures and don't want to take the blame? i know patients sign consents about all the possible risks and such, but i feel that i have seen way too much of botched procedures.
i very much doubt that surgeries are being botched on a regular basis. just because it's a teaching hospital does not mean that first year residents are allowed to operate without suppervision. what it does mean that pt's that are too sick, or too advanced in their illness that all the other surrounding communities hospitals have declined to operate and even give the pt a chance of living. teaching hospitals give them that chance even if it doesn't always work.
am i just jaded because of the area i work in and don't see the "good surgical procedures"? i was petrified when my dad told me of his colonoscopy (which did go fine thankfully) because of my experience with several patients that was perferated and went septic in the same procedure.
it is because of the area that you are working in. the icu's get a very small percentage of all the operations done. i have had pt's that have come in for out patient surgery and ended up in the icu. and no the surgery was not botched at all, there is always a risk of death/major problem with any type of surgery.
if a patient comes out of the or septic, he went in septic.
in some ways i feel like i have lost a bit of faith in surgery/other procedures.
am i alone in this feeling?

if you are feeling this jaded even as a tech maybe you should look for a different work environment when you graduate and become a nurse. the icu is not for everyone.

RNOTODAY, BSN, RN · May 25, 2008

DNR orders are non existent in the OR. So, that statement means something if you think about it. And I would like to re iterate what was previously said: A bad outcome does NOT equal a bad surgeon, botched procedure, or substandard care in the OR. You have a very vague understanding of what the OR "is".

2006RNCS · May 25, 2008

I have seen hundreds of successful procedures and lives improved by us in the OR. The few that we have taken to ICU knowing that they were going to die, came from ICU knowing that surgery only improved their chance of survival by a small percent, and yes, we rushed them back to the UNIT to die with their family. As for a Lap Chole going bad....that is a whole other story that you may want to find out what was really wrong with the procedure/surgeon.

First of all, I have the utmost respect for OR nurses. It is something I could not do. I think you are the bravest of us, and save so many lives. You are saints in my eyes. The lap chole pt that I had was incredibly healthy prior to surgery, and something bad did happen. I don't know what. The family wanted an autopsy at death, and the hospital talked them out of it. Maybe it could have answered some questions for the family that they needed answered.

We had so many cases where pts were returned to us to pass with family at their sides, and I am so completely for that. The unit is a much more private, quieter area for families to say their goodbyes. I in no way meant to say anything in my earlier post to upset anyone. It was just a case that I will never forget. I cared so much about that pt. I always asked to be assigned to him, and he was not an easy pt. to care for.

Good bless ALL you nurses. I have much respect for all in the profession, and would never mean any harm.:heartbeat:heartbeat:heartbeat

shock-me-sane · May 25, 2008

wow. I never meant to be offensive, but I guess I was. I don't think I am exactly jaded as a bit more paranoid about surgical procedures than I would have been in the past. No disrespect to anyone, I actually love the ICU and would like to work there.

I do think that everyone does do a great job for the most part. It was just an observation on my part and an emotional reacation to seeing the things that I have.

Anyhow, thanks to all that replied and I sincerely apologize for stepping on anyone's toes. It had been a rough day at work and I just let it out here.

CVICURN2003 · May 26, 2008

Bad things happen to healthy and unhealthy patients. It's a risk we all take every breath you take. As an ICU nurse (or a nurse at all) we know how fragile life can be. People code when they have been hemodynamically fine for no apparent reason. All of us have seen it. Surgeries go bad. Not becasue of the surgeon or the care, it just happens. We do get patients back that "don't die in the OR" but most of those times our surgeons and the OR team have worked their tail off to get them off bypass in order to get them with their family in the ICU. As heartbreaking it is to see as a human, at least the family can say goodbye and give them a little closure. And if causes me a little hard work...well that's ok. It's the right thing to do. The C-Diff patient yelling at me causes me hard work too. It's my job. It's nursing. It's Life. BAD THINGS HAPPEN and it's no one's fault. Do people make mistakes...oh yeah. And if you think you won't as a nurse you are sadly mistaken. :cry:

Maybe you need to REALLY think about what kind of nursing you would like to do. Good Luck in your career.

woody62, RN · May 26, 2008

I'm going to get flamed for this I'm sure, but sometimes, patients receive absolutely terrible care post-op, on whatever floor they are on. Do you not think that perhaps this may contribute to a poor outcome?
It makes no sense to think that just because someone has a poor outcome from surgery that the surgeon or the OR did something wrong. Many of these patients are not healthy specimens to begin with and if you work in a level one trauma OR, you get people many times who have almost zero chances to start with. Also, we do have people die in the OR-most recently, a young man shot by his neighbor. That surgeon did everything in his power to save that guy and it was very upsetting for all involved.
I find the title of the original post to be quite snarky actually and it is very obvious that there is a real ignorance of the OR and the people that work there. If I sound angry, I am. My coworkers and I work our tails off on a daily basis to save people who many times have no interest in saving themselves. I have seen surgeons, nurses and other OR staff in tears because we just couldn't save someone. So excuse me if I think that your complaint is petty, childish and just plain uninformed. I can assure you, we don't try to pull someone through just to make more work and aggravation for nurses on other units.

You will not get flamed by me. I worked both out on floors and in ICU's. I have sent patients to the OR that we didn't give them a snowballs chance in h*** to return to ICU alive. And they did. Every unit, from the ER to the OR to ICU has to turn in their statistics. And I rarely saw one unit ship a patient out to another unit to avoid having to record a death.

I remember a patient I had, on one to one, who was admitted at the beginning of my shift. The house staff and I busted our butts trying to help this man. At 10PM they finally decided to ship him to the OR. Since it was nearly the end of my shift and I was a student (I was already an LPN), I asked if I could observe from the attending and was given permission. You can imagine both my surprise and that of the OR staff, when he coded as he was being opened. And died. The attending turned, looked at me and said (with a twinkle in his eye) he would write the death up as having happened when I transferred him, then I would have to do the paperwork. He meant it as a joke and I took it as one. The patient didn't have a chance of making it, after we opened him up and found everyone of his major arteries was chocked with clots.

Deaths occurred every where. And I have seen some very poor medical, surgeons and other specialists botched their jobs. And I have seen nurses who have made mistakes and caused patient's death. We are all human beings, capable of making mistakes.

Woody:twocents:

Fiona59 · May 26, 2008

I've seen families who have insisted on surgery on patients that the surgeons didn't want to work on. But no, they know best. "It's in Gods hands", well the patient died three weeks later, in hospital with the family at the bedside and for two of those weeks, the family kept asking the staff "will he die to night". If they had taken the advice of the surgeons their parent could have died at home, in one piece, without the trauma of surgery.

Just because they can do the surgery doesn't mean they should.

There are good surgeons and bad, just as their are good surgical candidate and bad. What bothers me as a lowly "floor nurse" is how difficult it can be to send a geriatric patient who is doing badly back to ICU, it can be like pulling teeth. We work our butts off to keep them alive to get to ICU, in many cases it could all be avoided if ICU had kept them an extra day before sending them to the floor.

Having said that, the bed crunch hits every unit. We've had patients taken off ventilators by ICU (at the family's request) and sent to other units to die because ICU need the bed for somebody else to have a chance at life.

Dolce, RN · May 26, 2008

I work in outpatient surgery. It is rare that our patients end up in the ICU. I can remember a couple off hand. One of them coded in the PACU. I just heard a statistic the other day that I thought was quite profound. In the 1950s the chances of dying under anesthesia was 1 in 8,000. Now it is 1 in 250,000. Those are a lot better odds than the 50s but they still tell you that people do die in the OR. Just a few months ago a teenage died from malignant hyperthermia after getting breast augmentation. There are risks and benefits that must be weighed but I don't work with anyone who would ever dump a patient going south on the ICU. In fact, a lot of the time the patients end up having a prolonged PACU time because anesthesia is there and the PACU nurses don't feel comfortable transferring the patient until they are stable. Just another way to look at things from the OR perspective.