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- Jun 6, 2019
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Colleague came to me with this and I don't think it's quite cut and dry. Wanted to get the sense of the general sentiment of the populace.
Anesthesiologist is staffing 3 offsite locations - 2 GI suites (ERCP room, colonoscopy room) & 1 IR room. 3 CRNAs.
IR patient intubated and stable. ERCP intubated and stable. Colonoscopy for morbidly obese patient underway and going fine.
As far as logistics, these NORA locations are about a 3-5 minute walk from the main ORs/central scheduling area (where the board runner is). The 2 GI suites are in the same hallway, doors maybe 15 feet apart.
Because roughly 20% of the CRNAs called out that day (with a short staff to begin with), anesthesiologist is asked to give lunches to all the rooms. He goes into the intubated ERCP and sends CRNA to lunch. Minutes later, he's told that the patient in the room 15 feet away (morbidly obese colonoscopy) is desaturating, about to code.
Anesthesiologist calls for help (CRNA - I need you back from lunch now! Board Runner - I need help down here NOW). He walks over to the room 15 feet away, lends sets of hands to treat morbidly obese obstruction vs. laryngospasm. Sats come back up, patient recovering and moving great air. Eventually the help arrives from 3-5 minutes away to see situation is ameliorated. In the meantime, the CRNA who was on lunch ran back to the ERCP room that was left without a provider. Altogether, maybe 1.5-3 minutes where no anesthesia personnel was in the intubated ERCP room.
In the end, anesthesiologist gets lambasted by for abandonment, fireable offense, etc.
Is this as cut and dry as, "You left the bedside, you are wrong?" I think I would have done the same thing as him, due to the proximity of these two locations. We never know if that "immediate" help from the central location is going to be 5 minutes or more...And you can get from one place to the other in about the same distance as taking the long way around the OR table from placing a right sided IV.
Curious to hear everyone's thoughts and ethos. Thanks.
Anesthesiologist is staffing 3 offsite locations - 2 GI suites (ERCP room, colonoscopy room) & 1 IR room. 3 CRNAs.
IR patient intubated and stable. ERCP intubated and stable. Colonoscopy for morbidly obese patient underway and going fine.
As far as logistics, these NORA locations are about a 3-5 minute walk from the main ORs/central scheduling area (where the board runner is). The 2 GI suites are in the same hallway, doors maybe 15 feet apart.
Because roughly 20% of the CRNAs called out that day (with a short staff to begin with), anesthesiologist is asked to give lunches to all the rooms. He goes into the intubated ERCP and sends CRNA to lunch. Minutes later, he's told that the patient in the room 15 feet away (morbidly obese colonoscopy) is desaturating, about to code.
Anesthesiologist calls for help (CRNA - I need you back from lunch now! Board Runner - I need help down here NOW). He walks over to the room 15 feet away, lends sets of hands to treat morbidly obese obstruction vs. laryngospasm. Sats come back up, patient recovering and moving great air. Eventually the help arrives from 3-5 minutes away to see situation is ameliorated. In the meantime, the CRNA who was on lunch ran back to the ERCP room that was left without a provider. Altogether, maybe 1.5-3 minutes where no anesthesia personnel was in the intubated ERCP room.
In the end, anesthesiologist gets lambasted by for abandonment, fireable offense, etc.
Is this as cut and dry as, "You left the bedside, you are wrong?" I think I would have done the same thing as him, due to the proximity of these two locations. We never know if that "immediate" help from the central location is going to be 5 minutes or more...And you can get from one place to the other in about the same distance as taking the long way around the OR table from placing a right sided IV.
Curious to hear everyone's thoughts and ethos. Thanks.