Surgeons "go ahead" problem ?

[OR male nurse]

So... here's the rub.

You have an 8 am scheduled case. The patient is brought to the surgery holding area. The OR case is opened and counted. The anesthesiologist is ready. However, you haven't heard from the surgeon. No one has seen him/her, he/she hasn't called to let you know you can "go ahead" with the surgery.

How does your hospital handle this situation ? Do you automatically bring the patient back to the OR 15 minutes prior to the scheduled starting time and hope that the surgeon shows up? Do you wait in the holding area until you actually see or get the phone call from the surgeon that you can "go ahead" with the surgery.

Is it OK at your hospital for the surgeon to call you up from his cell phone and tell you that he/she is 10 minutes away at mile marker XYZ on the interstate and they will be there and you can go ahead? Or, does your hospital require that the surgeon actually be "on campus?"

I'm interested in knowing how you handle this situation and what the policy is at your hospital.

Thanks in advance

OR male nurse

[Chilly_hands]

Last year, our facility flooded on the ground floor. Surgery is on the main floor. Due to the problem, we used the holding area for storage and designated several of the pre-op rooms for holding. Now the anesthesiologist and the surgeons all meet the patient in the pre-op room and have them sign consents and also mark the patient if laterallity is a concern. Family is present.

This has worked well due to the fact that most patients are nervous and can't remember what the doctors discuss with them. At least now the family usually remembers. Oh, and nervous patients will sign any form the doctor hands them without reading it, thinking that the doctor would never make a mistake, so it's been good all around. The doctors write the consent and state it to the patient and the patient then signs. The docs aren't really held up with questions from the family either. They've trained themselves to waltz in and ask if they are ready and "let's get the show on the road" and surprisingly, everyone saves all the questions for the nurses.

[mikethern]

Now the anesthesiologist and the surgeons all meet the patient in the pre-op room and have them sign consents and also mark the patient if laterallity is a concern.

The problem with waiting until the last minute to sign a consent is that the anesthesiologist might drug the patient before the consent is signed. Has this ever happened?

[Chilly_hands]

Never once has the patient been drugged before consents has been signed. Usually the Anes. Coordinator speaks to the patients first, then sometime later the surgeon comes in right before taking the patient to OR. The nurse working in the OR and the CRNA or whoever is administering anes. comes to take the patient to the OR. The patient is wide awake as they are taken to the OR or a dose of versed is given just as they unlock the brakes and start wheeling them away. It's worked so far and it really is nice having the family present, even if it means that us preop nurses have to deal with the surgeons and the anes.

[OPCC]

It is REALLY nice to know that there are others out there with the same problems. I have been beating myself up for many things that happen in our OR dept and they really do not seem as bad as some of the things you all have talked about.

We do only Amb OP surgeries and simple things at that.. We are a very small rural hospital with a surgeon that flies in once a month for scopes, hernias, bxs.... The doctor is usually late (traffic was bad, nanny did not get to house on time, weather problem). When he arrives he interviews the patient and signs the consent with the patient. Our H&Ps & pre-op labs are done by the patients local physician within the week prior to the scheduled surgery. The CRNA then interviews the patient and then the patient is taken from the patient room to the OR. We have no holding area (like we need one - not!). The CRNA does not put the patient down until the doctor is either scrubbing or at cart side when doing a scope. My gripe like all of yours is the fact that they take their own sweeet time coming to the OR from the floor. As I have posted elsewhere it is really a lip bitting situation when we have a patient on the table and the doctor is standing outside the doors talking on his phone about his housing project or scheduling a trip. I wish I had some magic answer for all of us. I can do all the QI studies I want and prove that he is the problem but in the whole scheme of things I am wasting my time because things will not change. If we push too much he may just decide not to come to our facility and being rural it is very difficult to get any coverage and he is a very good surgeon.

[haras regnurps]

this really is a problem.

The hospital that I am at the surgeon must see the patient first. well fine they usually do, but the other day the surgeon saw the patient and then left the department without telling anyone including aneths. that he was going. We took the patient to the room, asleep on the table and find out that dr so and so, went to endo to do a scope and it took a little longer than expected 60min later he shows up. there was an ass-chewing in the doctors' lounge out of view of nursing staff but a patient was asleep alot longer than nessecary and the family/patient will never know. lucky for him that the procedure went well if it hadn't not sure what I would have done. I followed policy, but the surgeon did not and we all knew it.

[heather2084, BSN]

It all depends on the dr and/or specialty. Half of our ortho docs want to see the pt before we go back. One will cancel at the slightest hint of a pink spot so we dont even open until the area has been thoroughly inspected. Typically we are to head back to the room at 0715 for 0730 starts. The except with that is the dr's who want to see their pt's before going back, and the docs who are consistently late. One particular uro dr we wait until he's in the building to go back because you never know exactly when he'll show up. Others we go back close to the time they get there on average.

Our director really wants everyone in the room by 0715 with or without your anesthesia provider so that it doesn't look like our staff that is holding up the case. I however disagree with this entirely and find a reason to hold off until my CRNA can go back as well.

However, we DO NOT start any type of anesthesia until we have confirmation that the dr is in the building. We often call the dr to make sure they are on the way before going back, but in no way provide anesthesia without them present.

[haras regnurps]

we have a way to document delays, and this is done so you know why you are not in the room in a timely manner. Do you really think that being in the room is wise without all the players present. I think that it is just asking for trouble especially when you have a patient in the room for a long period of time before induction. It makes most patients more nervous.

[Nips]

I live in South Florida. I heard of an incident where a heart patient was brought to the OR and put under anesthesia before the surgeon arrived. Supposedly the surgeon was only a few moments away but died on the way to the hospital. That sent shockwaves through the community and it is considered a "no no" to ever head to the OR without seeing the doctor first.

Also, if I were a patient, I would not appreciate being rolled back to the OR just to wait for a doctor while being charged for the room and staff. At my hospital the anesthesiologists start charging the patients the moment we roll into the room.