Case Scheduling

suzanne4, RN · May 22, 2005

Many of the smaller facilities had to get approval from the administrator on call, which meant having a good rationale for calling in a crew to work. Not that they were leaving the next morning on vacation, etc.

Some hospitals tried having a late crew until 8pm or even 10 pm for regularly scheduled cases, some two days per week, and others more frequently.

I think that a lot has to do with the types of cases that you usually do, the type of patient population, and how strong that your anesthesia dept head is to stand up to the surgeon. I remember one surgeon at a facility in Mi, who decided that he was going to declare all of his lap choles as emergencies so that they could be done in the main hospital, instead of the surgicenter that the hospital also runs. This was for his convenience......it only lasted a short time as everyone was aware of it.

DNRme · May 22, 2005

We have been having a real problem with scheduling of cases especially after hours. The surgeons think they should be able to schedule what they want when they want it. Anesthesia is caught between a rock and a hard place, do they let the surgeons get away with it or do they try to preserve a sense of control. Staff, on the other hand, doesn't want to work themselves to death and have people, who are not on call, stay over to finish up rooms.
My question is: how do all of you schedule your after hour cases? I think this is restricted to hospitals that don't run 24/7 and usually close the department at 11pm and nothing on the weekends.
1. Who is ultimately responsible for making decisions on scheduling
2. What kind of cases are allowed to be added on
3. How is your on-call staff utilized
4. Are staff constantly asked to stay over to finish rooms
5. Are there certain days of the week that are designated late days.
I just wanted to get a feel of what other ORs do that try to alleviate this constant problem. Thanks, Mike

We have the same problem. Fri. night, 5/20, we ran the add ons until 2:30am. Our last 2 cases were emergency diabetic podiatry cases :angryfire

I work at a trauma center, so we have 24 hour staffing. I had to have the call team here, though, in case we had a trauma. We have been told that there is nothing that can be done. If the physician (or podiatrist) says the case must be done, it goes. If the OR were to put the case off and the pt. had a complication, we would be in deep doodoo.

We are constantly staying late. NJ has a mandatory overtime law, but it has no teeth. Emergency circumstances don't count, even if it happens daily. I don't understand why "call" is not considered mandatory OT. We have evening, night, and 24 hour w/e trauma call. If the in-house team is busy, the trauma team has to come in to stand by.

Take care,

Dawn

nellie_nurse812 · May 23, 2005

REgular cases run 0730-1700. After that they need to say its an emergency. We have day shift, then a 9-5 and evening shift.............

ShirleyM · May 25, 2005

Hi everyone,

Where I work we don't have an emergency dept. All of cases are scheduled Mon-Fri as elective. We have an on-call team for 11p-7a Mon-Fri, weekends and holidays. Patients in-house who need surgery then become our emergencies on nights, w/e and holidays. All our elective cases are supposed to be done by 5pm, that happens maybe 30-40% of the time. I work 10 hr shifts so by the time I leave there maybe anywhere from 4-5 rooms still going to having no cases going on. If more than 5 rooms are going, I'm usually stuck in my room until relief comes, that can be as little as 15 past 5 or like 7:30p. For the most part, cases that are added on that same day are usually emergencies, whether they are patients in-house who patients who are admitted in hospital after seeing the MD in clinic.

If we are short of staff, the nurse and anesthesiologist in charge will asses each case as to whether this is a case that can till the next working day. The majority of our staff work 6:30a-3p, we have two RNs(incl. me) from 6:30-5p, two RNs and techs who work 11a-7p, one RN from noon-8:30p, two RNs who do a combination of 8hr/12hr/16hr to equal 40hrs/wk and one tech on 3p-11p.

We've had a couple of instances where the call team was paged on weekend what was clearly a non-emergent case(one case where the patient was a VIP, and the surgeon took the patient into the OR without a scrub person), and s*** hit the fan on Monday.

Okay, I've rambled on long enough....Shirley

stevierae · May 25, 2005

Hi everyone,
We've had a couple of instances where the call team was paged on weekend what was clearly a non-emergent case(one case where the patient was a VIP, and the surgeon took the patient into the OR without a scrub person), and s*** hit the fan on Monday.
Okay, I've rambled on long enough....Shirley

LOL, I hear you, Shirley. I worked at a place where they utilized the call crew to do an "emergency" penile implant on one of the bigwigs in hospital administration, who thought he was too important to be on the "elective" surgery schedule during the week, and, of course, he would have been "embarrassed." Apparently he thought we'd all go broadcast it to the nightly news if he had it electively--as if we cared. Wonder why he trusted the call crew, LOL!! Also, I wonder how he would have explained the lack of a call crew to the media had someone come in needing emergency surgery for a stab wound to the heart, or a ruptured AAA, or an epidural hematoma. I guess he's get his lackeys to put some creative spin on it, leaving himself out of the equation.

I miss the '80s, when we'd all get called in, anesthesia would come in (they always showed up last, at their leisure) take one look at the chart or the patient and say, "This is MediCal--I'm not doing it--turf him to the county" or, better yet, "This is not an emergency. Put him on the schedule."

Then we'd get to leave, and still charge our 4 hour minimum at time and a half for being called in.

I'm so glad not to have to deal with call headaches anymore.

carcha · May 27, 2005

I truly dident realise that this problem was so common!!!!. I once worked in a facility in the U.k. where this situation was so out of hand it was not funny. Almost every day of the week we were asked to stay late anywhere from a half to 2 hours. People felt pressurised to do so as not to meant a patient was cancelled and you felt rotten. However everything has a breaking point and after months of complaining and getting nowhere the stress, long hours, frustration got to the staff and the sickness rate went sky high, and I mean that one or two O.R.s would be closed an entire day as the entire crew were off sick. Then the management listened. After that a supervisor would visit each OR at 14.00 each afternoon and see what was happening with the list, what had to be done and how long each case would take. If there was a chance the list would overrun cases were cancelled at 14.00, the patient would be fed and re booked for another day. Our sickness rate plummeted and morale rose, end of problem. I truly believe that although nursing is a 24 hour profession, I do not work 24 hours a day, and should not be expected to sacrifice my personal life, my health and my freedom to leave my workplace when I am supposed to. In the past a nurse may be asked to stay overtime for a real emergency and I dident mind that but when my kids are waiting for me at home after I've worked a 10 hour shift, "mrs Jones" nose job comes low on my list of priorities.

ShirleyM · May 28, 2005

Hi everyone,
Where I work we don't have an emergency dept. All of cases are scheduled Mon-Fri as elective. We have an on-call team for 11p-7a Mon-Fri, weekends and holidays. Patients in-house who need surgery then become our emergencies on nights, w/e and holidays. All our elective cases are supposed to be done by 5pm, that happens maybe 30-40% of the time. I work 10 hr shifts so by the time I leave there maybe anywhere from 4-5 rooms still going to having no cases going on. If more than 5 rooms are going, I'm usually stuck in my room until relief comes, that can be as little as 15 past 5 or like 7:30p. For the most part, cases that are added on that same day are usually emergencies, whether they are patients in-house who patients who are admitted in hospital after seeing the MD in clinic.
If we are short of staff, the nurse and anesthesiologist in charge will asses each case as to whether this is a case that can till the next working day. The majority of our staff work 6:30a-3p, we have two RNs(incl. me) from 6:30-5p, two RNs and techs who work 11a-7p, one RN from noon-8:30p, two RNs who do a combination of 8hr/12hr/16hr to equal 40hrs/wk and one tech on 3p-11p.
We've had a couple of instances where the call team was paged on weekend what was clearly a non-emergent case(one case where the patient was a VIP, and the surgeon took the patient into the OR without a scrub person), and s*** hit the fan on Monday.
Okay, I've rambled on long enough....Shirley

I have to add this on...today the Chairman of Vascular Surgery called the weekend on-call anesthesiologist to say he wanted to do an emergency NAIS on Saturday...let me add that this MD does a NAIS EVERY HOLIDAY WEEKEND...emergency, I think not. He should've done the case the very same day if it was so emergent. I've come to the conclusion that it's a power thing that he can call everyone on a holiday weekend to his beck and call for a case....

sharann, BSN, RN · May 28, 2005

I too am amazed at how common this is. We have been dealing with similar issues Shodobe and it affects us all from the OR to anesthesia to techs to PACU. After hours is considered 7pm or weekends.We are a community hospital(not county) and have a 24 hour non trauma center ED. After a new Periop manager came in last year he has been working to stop these ABUSES of the staff by the surgeons. Not one of us have a problem coming in on call for a true emrgent case. After we had an emergency hemmorhoidectomy a few weeks ago the new rule was as such: If a doc has a case he/she deems a true life or limb emergency they must DOCUMENT this in the chart. If no, no go. They will be called to task when the chart gets reviewed and they will possibly lose priveleges. Our manager does not tell us to make the surgeons happy at our expense. When they cry "Im not going to bring any more pts here", he says good riddance. The anesthesiologists also have cracked down hard on these add on "emergency" cases. If a patient can wait, they refuse the case. Off hours, the house sup is in charge of scheduling and calling the team in. They know the rules. The doc must have SEEN the patient, and documented that the case was emergent. If not no go.

Hope this helps. The main thing is to have the managers and the anesthesiologists on the same page and not take abuse. The nurses will have higher morale and will also not be as exhauseted. Watch out, these docs are sneaky and malicious in order to get to cut.

grimmy, RN · May 28, 2005

we have 24 hour staffing in our or (level i trauma ctr), but our charge nurse walks around to check where our cases are at 1430, and re-arranges the board accordingly. late posts have to be emergent, or we have to have open rooms available. thankfully, we have a nice mix of 10 and 12 hour staff.

we also have a saturday elective crew that rotates through every 3 saturdays, but the schedule is typically light.

our anesthesiologists are pretty well stretched to their limit these days as we do not have enough crnas and residents to cover everything from radiology to ob to the main or. they are loathe to accept too much after 7pm that is not truly emergent.

we do have a few abusers who will get the big n-o when attempting to post late or...those docs that post so many that we're working through the night doing pneumonectomies or lung transplants in two rooms for the same surgeon! grrr... :angryfire and no one enjoys working with this guy. we do have folks available on call for different transplants, neuro, and cv.

shodobe · May 29, 2005

I am taking this all in and after 28 years the past 10 have been kind of, "the rules only apply if it doesn't help the one who is trying to circumvent the rules." I would say thay 90% of all cases we do on the weekend isn't emergencies. A lot of Lap Choles and such. We are no longer a TRAUMA center and all true traumas are stabilized and transferred. I do miss the GSW and stabbings we use to get. I know this sounds funny but after 15 years of it and suddenly the traumas are gone, you do kind of miss them. They have been trying to get rules in place for the past month or so, but when cases are done because it is OK with Anesthesia or the surgeon whines, these rules aren't worth the paper they are written on. I think all of this will stabilize over a period of time and it is fun to watch them struggle with this. I really think if Anesthesia had some b**ls this problem would be a mute point. Some of them will cite the rules but expect you, the nurse, to talk to the surgeon and enforce them. Others will abide by the rules, so the surgeons can get a little confuse, but they know which ones will let it slide. Management is a whole other story! Mike

sharann, BSN, RN · May 29, 2005

The thing is that one time, you will have that actual emergency and guess what? All teams will be busy doing lap choles and wart removals. Then the s&*t will hit the fan. Just sit back and emjoy the drama Mike, for eventually the ones doing the right thing will be on top looking down at the mess created.