OR rant

[Guest 1152923]

     My background; RN X 29 years with extensive experience in Burn, Cardiothoracic, EENT, General, Gyn, Neuro, Ortho, Plastics, Robotics, Transplant, and Urology.  I recently however decided to transition to a slower pace (and less stress) OR and took a job as a Circulating RN at a local 120 something bed hospital. This OR, due to the high volume of outpatient procedures, is more like a surgical center in many ways though there we also do a fair number of robotic and neuro (spine & DBS) surgeries . 

     While I understand the importance or expediency in room turnover times, the expectation here is more like an assembly line.  I feel that I am thorough (and quick) with my intraoperative documentation, but the only way to keep "one's head above water" in this scenario, is to be charting one, if not two, patients ahead (reviewing patient data, entering staff names and roles, equipment control numbers....).  I find this super rushed environment unnecessary and ripe for a serious error such as wrong patient/wrong side surgery or incorrect specimen labeling.  Thoughts? 

[Rose_Queen, BSN, MSN, RN]

There may actually be ways to streamline documentation, depending on the system and the customization. We use Epic and have the ability to assign staff and equipment to a room for the shift. This auto fills all of those fields. We also have the ability for each nurse to create macros that are essentially standardized documentation, specific to the surgeons and type of surgery that fill in the documentation at the click of a button. 

Unfortunately the theme seems to be that the smaller the department, the more focus there is on throughout to maximize revenue. And there may even be more emphasis right now due to COVID having led to many electives being cancelled that resulted in a massive loss of revenue as well as now a backlog that needs caught up. 

In my own experience, using the assign to room and macros has made it easier. We also have a patient story customized to periop where everything I need to know is in one place- I don’t have to click into 6-8 places in the chart. We also have scheduled turnover time based on complexity of the case. Most have 10 minutes tear down and ten minutes set up for a total of 20 minutes between cases. More complex such as spinal fusions and cardiac are built with 15-20 minutes tear down/set up. Little things like BMTs have 5 for set up and 5 for tear down  

You can only do what you can do. Personally, I would refuse to rush to the point of being unsafe. I’m still doing my thorough patient interview, verification, and so on with universal protocol. And part of that is the debrief, which involves verifying specimens. 

[Guest 1152923]

20 hours ago, Rose_Queen said:

There may actually be ways to streamline documentation, depending on the system and the customization. We use Epic and have the ability to assign staff and equipment to a room for the shift. This auto fills all of those fields. We also have the ability for each nurse to create macros that are essentially standardized documentation, specific to the surgeons and type of surgery that fill in the documentation at the click of a button. 

Unfortunately the theme seems to be that the smaller the department, the more focus there is on throughout to maximize revenue. And there may even be more emphasis right now due to COVID having led to many electives being cancelled that resulted in a massive loss of revenue as well as now a backlog that needs caught up. 

In my own experience, using the assign to room and macros has made it easier. We also have a patient story customized to periop where everything I need to know is in one place- I don’t have to click into 6-8 places in the chart. We also have scheduled turnover time based on complexity of the case. Most have 10 minutes tear down and ten minutes set up for a total of 20 minutes between cases. More complex such as spinal fusions and cardiac are built with 15-20 minutes tear down/set up. Little things like BMTs have 5 for set up and 5 for tear down  

You can only do what you can do. Personally, I would refuse to rush to the point of being unsafe. I’m still doing my thorough patient interview, verification, and so on with universal protocol. And part of that is the debrief, which involves verifying specimens. 

Thanks Rose_Queen, I appreciate your response.  I have used EPIC for years and consider myself proficient but have never used the micros or other customizations that you reference.  As I touched upon, I hate this frenzied approach and think it is a safety concern, but don't believe it will realistically change anytime soon.  That said, it is unacceptable to me and I fear for a future lapse or err when we're all rushing about so Dr. Jones can finish his six cases and make his 11:00 tee time.