"Abandonment" to help with adjacent emergency

[nimbus]

The California break thing is just too much sometimes. We could be doing active CPR on a patient in the cath lab and the charge nurse will pop her head in the middle of the chaos asking one of the staff if they want to take their lunch break.

Sounds about right.

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[coffeebythelake]

I know a locums guy who works in one hospital while "supervising" CRNAs in another hospital a hundred miles away. Very proud of himself. And obviously making a lot of money. I wonder how his life will be in 10 years? Retired or in prison?

 

[Dr. Rude]

Retired or in prison?

Why not both?

 

[repititionition]

Why not both?

Why retire? He can probably still supervise from prison.

 

[neutro]

I know a locums guy who works in one hospital while "supervising" CRNAs in another hospital a hundred miles away. Very proud of himself. And obviously making a lot of money. I wonder how his life will be in 10 years? Retired or in prison?

Prison.

 

[abolt18]

I know a locums guy who works in one hospital while "supervising" CRNAs in another hospital a hundred miles away. Very proud of himself. And obviously making a lot of money. I wonder how his life will be in 10 years? Retired or in prison?

Just think of the whistleblower money you can make off of reporting that crap...

 

[BlueRug]

I know a locums guy who works in one hospital while "supervising" CRNAs in another hospital a hundred miles away. Very proud of himself. And obviously making a lot of money. I wonder how his life will be in 10 years? Retired or in prison?

No way

 

[dannyboy1]

Some rural departments hire one doc “just to consult” their (independent)CRNA’s or something like that. He is likely not billing the patient but getting a small salary from the hospital. Similar to a primary care doc “supervising” PA’s by being available by phone and reviewing charts. What his involvement is in the event of a malpractice claim is up to the courts I would guess….

 

[coffeebythelake]

Some rural departments hire one doc “just to consult” their (independent)CRNA’s or something like that. He is likely not billing the patient but getting a small salary from the hospital. Similar to a primary care doc “supervising” PA’s by being available by phone and reviewing charts. What his involvement is in the event of a malpractice claim is up to the courts I would guess….

It really depends on how the arrangement is made and whether he works in an opt out state. But if he is billing for supervision then I imagine this consistutes fraud

 

[neutro]

Some rural departments hire one doc “just to consult” their (independent)CRNA’s or something like that. He is likely not billing the patient but getting a small salary from the hospital. Similar to a primary care doc “supervising” PA’s by being available by phone and reviewing charts. What his involvement is in the event of a malpractice claim is up to the courts I would guess….

Depends on the state

Medicare makes it a requirement for hospital anesthesia services in non opt out states to have an immediately available anesthesiologist.

The term immediately available is not defined purposely in terms of building, time, floor. Then focus becomes on case by case basis.

But good luck trying to explain to a common person that immediately available in anesthesia means 60 minutes away or sleeping at home while CRNA does whatever they wish.

To me, immediately available means “time it takes to prevent death due to airway loss”.

 

[timpview]

Does the ERCP room have a RN in the room who is sedation credentialed? I mean its an emergency, asking that person to watch vital signs and come grab the anesthesiologist if something is wrong and/or give them a stick of phenylephrine and tell them to push it is an imperfect but better solution than leaving the patient with nobody watching them.

Agree situation was untenable and dangerous, exposed issues in staffing that need to be fixed, not a problem with the provider.

Yea how would that be any different than a cath lab where all sedation and intubated patients are managed by an RN? I guess sometimes we have RT for intubated patients.

Our RN/MD are “sedation” credentialed only- or basically one online module a year.

 

[makemoney2024]

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.

And that is why we should NOT be the ones providing lunches to CRNAs when we are supervising. Isn’t that illegal? Isn't t it going against TEFRA? It’s a grey area that many traverse. I refuse to do it in any practice I am at.