When to bring a patient into the OR...

[brewerpaul]

I found out last evening at our perioperative holiday party that one of my favorite CRNAs will be leaving. The anesthesia group that she works for (the group is hired by the hospital, not individual CRNAs or anesthesiologists) has a policy of bringing the patient into the OR BY 7:30 AM, regardless of whether or not the surgeon is there yet. She refuses to do this for a number of reasons. It sometimes deprives the patient of the chance to see the Doc before the surgery and vice versa. Also, the OR atmosphere is hardly a relaxing place for an already nervous patient with all that scary looking equipment and sharp objects. Sometimes a Doc is late, so the patient has to lie on the OR table while all of the preparations go on around them. Anyway, this CRNA was given the choice: comply or seek other employment.

I'm with her-- I'd rather have my patients wait in the relatively calm holding area. Once the surgeon is announced, it's easy to bring the patient into the OR while he or she gets into scrubs.

Any thoughts on this? Are there AORN guidelines?

[ewattsjt]

I don’t know about AORN guidelines but there are several factors that can go wrong in waiting in the OR. What if the surgeon was in a car wreck and will not be there or delayed by a couple of hours and you have taken the patient back. What are the patient anxiety levels now? Surgery scares many people, so why bring them back and make them more scared? Not to mention that if the doc becomes a no-show (accident or emergency at another facility they practice at) the complete set up may be “wasted because the case has to cancel or the delay is too long.”

Because we have experienced the above, our policy is that the patient isn’t brought back until the doc is visible in the facility.

[goddesssue]

Where I work, the doctor must ID the patient before we can bring back.

[Uro-DaVinci]

In my facility the patient cannot be brought back to the OR until the surgeon is in the hospital AND the H & P is updatedon the day of surgery by the surgeon or the MDA.

[DNRme]

Kudos the the CRNA. The policy seems to go against standards. How can the patient be marked before going into the OR if the surgeon is not there? No one else is supposed to mark the site where I work (2 teaching hosp.) Is this a small MD centered community hospital?

[brewerpaul]

Kudos the the CRNA. The policy seems to go against standards. How can the patient be marked before going into the OR if the surgeon is not there? No one else is supposed to mark the site where I work (2 teaching hosp.) Is this a small MD centered community hospital?

It's a small community hospital, but not MD run. It's run by a Catholic organization.

[OR male nurse]

Hi,

This is one of the age old questions and is problematic for our specialty. I've worked at 2 different hospitals now and at both they had different guidelines. At my last hospital, it was as you said. You brought the patient back to the OR 15 minutes prior to incision time regardless. We had an instance where the patient was on the table, and put under. The surgeon was sitting at home and had no idea he was scheduled for surgery. After that instance the surgeons had to call the unit clerk and tell us that we had the "go ahead" and could take the patient back to the OR whether or not we saw the surgeon. Our guidelines said he just had to be "on campus" which meant he could be in one of several buildings.

At my new hospital, it depends on the surgeon. Some want to see their patient prior to bringing them back to the OR, some don't care. We have an electronic tv screen and all we do is look and see that the surgeon is checked in. Most of the time the surgeon is there and waiting for you. Of course, you still have to ID the patient, check for the H&P, look for labs, pregnancy test, etc. and Anesthesia has to do their part. Each hospital has their own set of rules but when it comes down to it, it's whatever the surgeon and anesthesia want. I've seen all the rules bent and/or broken in order to please the surgeon. As far as AORN guidelines.. they are just that, guidelines. We try to follow them as much as possible but from a practical standpoint you can't follow them all to the letter and you just have to do as best as you can. I've been circulating for 3 years now and have tried to be the best patient advocate as I can insofar as making sure all the I's are dotted and T's are crossed before bringing the patient back to the OR. I've had showdowns with surgeons and anesthesiologists and put my foot down on several occasions. I've even gone so far as to tell and MDA that I don't have to follow his verbal order if what he's telling me violates our hospital policy. They get all pissed off but they eventually get over it. Just remember that you are there as an advocate of the patient.

[lpnstudentin2010, LPN]

As a patient, I would much rather be kept in pre-op holding. At my hospital, the surgeon must get consent for the surgery (I am not sure if the resedent can but in my case it has always been the surgeon himself) and this happens day of surgery. Then someone on the surgical team needs to initial the area to be operated on, with you still awake (kind of wierd when it is your face which it is with me). I do not mind the OR but it would be more comfortable in the pre-op holding and also less chance to get hurt, I have never noticed (though I may be wrong) rails on the OR beds, thus more chance to fall of the bed if you move in the wrong way.

[bearsnurse]

My thoughts on this is that check your OR / hospital policy,the labs, H & P's, pre-op check lists etc... When you are charge nurse or have a patient under your care we have the duty and responsibility to give the best care and sometimes in the OR some situation requires our own judgement and discretion too. where is empathy in this situation? i salute those nurses that have this value it's very rare because i know sometimes (i am guilty of this too!) we are too busy to finish our tasks ahead that we don't stop and think about how our patient feel being in that narrow OR bed and cold too. No matter how much warm blankets and comfort measures we offer but just the thought of going under knife ??? hello i wouldn't want to be under too...i think the hospital has been unfair to fire her without looking through the situation unless they have other reasons already lined up and just waiting for opportunity to do it. I sure hope that some of this "paper pushers" policy makers and such ... (as I call them) do not end up becoming patients themselves then maybe they'll know...

[elcue]

i will not take a patient into my or till the surgeon has seen them. period.

1. patient must be marked.

2. patient and/or family, almost without exception, want to see the doc first.

3. ditto previous points about potential unforseen delay in doc's arrival.

4. i will not "start the meter" (charging the patient for or time) by bringing the patient into the room when the doc isn't even onsite yet. this simply seems wrong.

linda

[ebear, BSN, RN]

Exactly right elcue!!