Ambulatory Surgery Unit Closing Time

[Suziei1701]

Hello,

I work in a Outpatient/Same Day/Ambulatory Surgery Unit of a hospital facility. In the past 5 years, there has been an enormous shift in the number and type of surgeries now being done in the outpatient setting. We discharge patients after Total Joint Replacements, Total lady partsl or supracervical hysterectomies, SI Joint Fusions, and cardiac ablations, just to name a few of the major procedures now being done on a same day basis. As our unit has changed, the hours seem to have gotten longer and longer. We do stagger some of our staff with the charge RN coming in at 4:30am, opening staff coming at 5:30 am, and additional RNs coming in between 7am and 9am to work the later shifts. There are no set shift times (some nurses work 8 hours, some work 10 hours, some work 12 hours). As of late, there have been several nights where the "closing shift" who typically starts at 8am, has been required to work up until as late as 2 am, with no incentive pay for working past their shift. All that to say, it is not uncommon to be short hours at the end of the week, because other days can run early due to scheduling. Sometimes, lunch or dinner breaks are non-existent. Our unit technically closes at 8pm, however, surgeries often run later than 8pm, patient's who are scheduled to go home require admission after arriving back to the post-op unit, or they simply take a long time to recover and be discharged. The question I am proposing to anyone who works in a hospital attached ambulatory surgery center is:

What time does the unit "Close", how is the unit staffed, and what are the protocols set into place when surgery times run late or complications occur requiring hospital admission? We have called a number of regional facilities and found that most all have some sort of protocol for a closing time or PACU takes over discharge after a certain time, etc. Any thoughts or suggestions as to how to develop a better solution would be appreciated.

We are trying to develop some sort of policy or protocol to maintain patient safety (as nurses are exhausted after 14+ hour days or patient's are being discharged late into the night) and for overall unit satisfaction.

Many thanks in advance for your thoughtful consideration of this challenging situation for our unit.

[Fiona59]

The hospital I work in has created an "extended day surgery" unit which is attached to the day surgery ward.

Day Surgery closes at 1900. Extended day surgery is staffed 24 hours a day. The patients are supposed to be discharged within 23 hours post op.

Anybody who works after the end of their shift is on overtime. Read your contract. Nobody should be working the hours you mention.

[brownbook]

First of all I don't understand, "we have called a number of regional facilities and found that most all have some sort of protocol for a closing time or PACU takes over discharge after a certain time, etc. "

The two facilities I have worked in PACU is where patients are discharged from? One facility recovered major surgeries in level I PACU, then the patient's were admitted to the hospital, or came to level II PACU and were discharged home. Minor surgeries came straight to level II PACU. So the level II PACU was where all same day patients were discharged from.

But anyway I don't think my confusion is an issue.

I was never in charge of staffing but we had a lot of per diem nurses. The staffing nurse always knew a day or two before what the surgery schedule would be for that day. She would plot out by hour to hour how many patients would be in PACU per each hour. She would plot out how late the cases would run. Of course she, and we, knew surgeries don't run like clock work! She knew, learned, which doctors, cases, always ran over their allotted time, etc. but at least we could get a ball park idea idea how the day should go.

As I said we had a lot of extra help, per diem, and had a handful of nurses specifically hired, told, they would be the late shift. When it was obvious cases would be getting out at 5 or 6 pm these nurses would be told to come into work at 4, 5, or 6, pm. The per diem staff would be staggered to come in anywhere between 11 am to 2 pm to cover busy times.

I don't know why the charge nurse is coming in at 4:30?????? The 5:30 opening staff should be quite capable to open the unit and getting ready for the day. The charge nurse should be coming in at 8, 9,or 10, if she knows it's going to be a late, hectic day.

Some per diem were okay with odd hours, staying late, sometimes only working only 20 hours a week. Some needed, wanted, to get more permanent regular hours and would eventually get better, more regular hours. Some couldn't handle getting less hours and pay, staying past midnight and quit.

I guess the bottom line is hire a lot of per diem staff. Of course there were some per diem who when called, asked if they could work the next day, would say no, that was their option when hired. Eventually they'd be off the call list and replacements would be looked for.

i don't know the details but there was some policy that if you were called in, showed up to work, but not needed, you still got a mandatory number of hours of pay. I don't know if you were told the day before to come in at 2 pm and called 1 hour before your shift that they didn't need you, how all that got worked out? Certainly with crazy OR schedules these things did happen.