Dallas Jury awards $21M for anoxic brain injury under anesthesia at BUMC

[nimbus]

Apparently CRNAs are not happy with part of the plaintiffs argument.

PEA? And no code called? So… no BP, No sats, an EKG rhythm, ashen patient, brought back to life with phenylephrine and no compressions and no one notices?
This one sounds very, very, highly unlikely. I don’t know what happened but it’s probably not this.

Just gloss it over. Nothing to see here folks…

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[coffeebythelake]

1). Seems it was not an airway event. Those can’t be covered up (room nurses are involved)
2) so we are looking at hypotension. This is a healthy 27 year old. Do we know the dosages and meds used for induction/maintenance? Would have to be a lot to tank a 27 year old and keep him down long enough for encephalopathy. (Remember, the more you give, the more CMRO2 decreases). I do a lot of neuro cases with monitoring and the monitoring doesn’t change much even with pretty significant hypotension.
We do alot of cerebral angiography at my shop as well and the brain seems to perfuse regardless of the BP. the only explanation I can think of is that there was something tight around the neck (gown, EKG cable) which compressed carotid or jugular
3. Paper records are all bull$hit. Everyone who uses a paper record is guilty of “train tracking” (some more than others) Every anesthesia lawsuit I have seen accuses the providers of coverup with regard to charting. It’s an easy target for attorneys when things go bad, but we all know it is widespread and prevalent. It is what it is.

Max CMRO2 decrease by 50% unless you add hypothermia to the mix.

 

[chocomorsel]

Apparently CRNAs are not happy with part of the plaintiffs argument.






Just gloss it over. Nothing to see here folks…

I am confused. Gloss over what?

 

[nimbus]

I am confused. Gloss over what?

I was joking. The PEA arrest if it happened.

 

[chocomorsel]

I was joking. The PEA arrest if it happened.

Ahh. I thought you had a link you forgot to attach. Sorry. These things go over my head sometimes.

 

[vector2]

1). Seems it was not an airway event. Those can’t be covered up (room nurses are involved)
2) so we are looking at hypotension. This is a healthy 27 year old. Do we know the dosages and meds used for induction/maintenance? Would have to be a lot to tank a 27 year old and keep him down long enough for encephalopathy. (Remember, the more you give, the more CMRO2 decreases). I do a lot of neuro cases with monitoring and the monitoring doesn’t change much even with pretty significant hypotension.
We do alot of cerebral angiography at my shop as well and the brain seems to perfuse regardless of the BP. the only explanation I can think of is that there was something tight around the neck (gown, EKG cable) which compressed carotid or jugular
3. Paper records are all bull$hit. Everyone who uses a paper record is guilty of “train tracking” ( morewhy than others) Every anesthesia lawsuit I have seen accuses the providers of coverup with regard to charting. It’s an easy target for attorneys when things go bad, but we all know it is widespread and prevalent. It is what it is.

If you were to do intraop neuromonitoring and cerebral angiography on someone say undergoing beach chair who was currently infarcting secondary to hypotension those tests would also be unrevealing and/or equivocal.

EEG can be burst suppressed or isoelectric from just anesthesia even before any hypoxia, and angiography in people who are in distributive shock is normal since the insult is occurring at the arteriole/capillary level.

 

[Planktonmd]

So... Baylor did not have electronic anesthesia records in the OR in 2017?
If vitals were recorded electronically there wouldn't be all that confusion about what the BP really was.

 

[nimbus]

Not saying I would use it for a 27yo getting ORIF tibial plateau fracture but NIRS/cerebral oximetry can be useful. Guess what’s happening here.

 

[sethco]

Not saying I would use it for a 27yo getting ORIF tibial plateau fracture but NIRS/cerebral oximetry can be useful. Guess what’s happening here.

View attachment 361682

Carotid or Aortic repair?

 

[teacher2md]

I think airway event (laryngospasm) is possible, maybe even likely in this scenario of global anoxic injury. It can definitely be 'covered up' from the OR nurses. I've seen plenty of CRNAs turn off alarms on the monitor.

Patient doing fine with LMA, CRNA pre-charts train-track vitals for the on paper chart (I've seen this too), looks up from phone after several minutes to realize sats are in the 40's because of laryngospasm or LMA not seated well, etc. CRNA slams 200 of propofol and turns up gas to fix laryngospasm, sats improve but by this point damage is done and patient now requiring doses of phenylephrine. Anesthesiologist is called in; surgeon and OR staff are asking "what's going on??";

"Oh nothing-- just dealing with a little hypotension. Not sure why". BP comes up, rest of case goes OK, patient doesn't wake up again.

 

[nimbus]

Carotid or Aortic repair?

Bingo. Cerebral saturation declined with carotid crossclamp, then returned to baseline after shunt was inserted and opened.

We routinely use it for pump cases and carotids. I use it for higher risk beach chair shoulders, mostly for my own reassurance.

This shows later in the case. Saturation declines again when the shunt is removed, then climbs back to baseline when the carotid is unclamped.

 

[MirrorTodd]

So... Baylor did not have electronic anesthesia records in the OR in 2017?
If vitals were recorded electronically there wouldn't be all that confusion about what the BP really was.

How long is data stored in the actual monitors? Cause it would've been very easy for someone to do an after action review and browse through the vitals trend on the machine to figure out how long this pt was hypotensive and to what degree.

 

[coffeebythelake]

How long is data stored in the actual monitors? Cause it would've been very easy for someone to do an after action review and browse through the vitals trend on the machine to figure out how long this pt was hypotensive and to what degree.

Unless a review of the vitals history was done immediately and intraop a quick reset button would erase all that data.

 

[deleted1147063]

That's one of my rules: do not have anesthesia where the anesthesia record is on paper.

 

[stonemd]

Reminds me of those beach chair shoulder cases. They don’t happen often but they have happened.


Anybody routinely use cerebral oximetry?

I do for sitting shoulder cases
Also spontaneous ventilation and pressers if needed.

 

[jwk]

Typically the jury assigns percentage of blame to each defendant based on the nature of the case. One defendant is not liable for the other defendants inability to pay.

That depends entirely on the state. The concept of "joint and several liability" means that each party is independently liable for the full extent of the injuries stemming from the act. Some states tort reform actions abolished joint and several liability in medical malpractice - some did not.

Under Texas law (Tex. Civ. Practice & Remedies Code § 33.013), a defendant is jointly and severally liable for an accident if they are found to be at fault for more than 50% of the victim’s injuries. Put another way, a defendant who is liable for at least 50% of an incident can be held liable for the full extent of the victim’s injuries on the grounds of joint and several liability.

 

[jwk]

I had an attending during residency that would chart ahead vitals while I was on a break. Come back and he's already charted perfect vitals for the next 30 minutes...

LOL - One of my favorite anesthesiologists in my first practice, and one who was very well known and widely respected at the time, would often do his paper anesthesia record in PACU.

 

[dannyboy1]

I think airway event (laryngospasm) is possible, maybe even likely in this scenario of global anoxic injury. It can definitely be 'covered up' from the OR nurses. I've seen plenty of CRNAs turn off alarms on the monitor.

Patient doing fine with LMA, CRNA pre-charts train-track vitals for the on paper chart (I've seen this too), looks up from phone after several minutes to realize sats are in the 40's because of laryngospasm or LMA not seated well, etc. CRNA slams 200 of propofol and turns up gas to fix laryngospasm, sats improve but by this point damage is done and patient now requiring doses of phenylephrine. Anesthesiologist is called in; surgeon and OR staff are asking "what's going on??";

"Oh nothing-- just dealing with a little hypotension. Not sure why". BP comes up, rest of case goes OK, patient doesn't wake up again.

Usually patient will brady and arrest if hypoxic to the point of brain damage.

 

[vector2]

Usually patient will brady and arrest if hypoxic to the point of brain damage.

Except for the multiple case reports of beach chair surgeries where the pt never woke up again despite normal HR, O2 sat, and ETCO2 the entire case...

 

[coffeebythelake]

Usually patient will brady and arrest if hypoxic to the point of brain damage.

Yes that's why we think it is much less likely hypoxemia and much more likely from profoumd hypotension.

 

[dannyboy1]

Except for the multiple case reports of beach chair surgeries where the pt never woke up again despite normal HR, O2 sat, and ETCO2 the entire case...

That’s because they are not hypoxic they are hypotensive with the head elevated and not perfusing the brain. Heart is being perfused just fine.

 

[Harpoon1]

I think airway event (laryngospasm) is possible, maybe even likely in this scenario of global anoxic injury. It can definitely be 'covered up' from the OR nurses. I've seen plenty of CRNAs turn off alarms on the monitor.

Patient doing fine with LMA, CRNA pre-charts train-track vitals for the on paper chart (I've seen this too), looks up from phone after several minutes to realize sats are in the 40's because of laryngospasm or LMA not seated well, etc. CRNA slams 200 of propofol and turns up gas to fix laryngospasm, sats improve but by this point damage is done and patient now requiring doses of phenylephrine. Anesthesiologist is called in; surgeon and OR staff are asking "what's going on??";

"Oh nothing-- just dealing with a little hypotension. Not sure why". BP comes up, rest of case goes OK, patient doesn't wake up again.

Unfortunately such an all too likely possibility. It is astounding the degree to which CRNAs (and I hesitate between the word some or many) hide or downplay events that they do not have a distinct answer for, whether minor or major.

 

[aneftp]

Electronic charting can hurt u as well. A lot of people do not realize. Every “edit” can be combed through by someone looking even if it’s a simple mistake (say u administer epi at 1330 and originally charted it at 1340. And went back and put it at 1330 to match the decrease bp at 1330)

So do not paint a rosy picture electronic charting can save u. It can be used against u. And it was used against one of my former colleagues in the south to point blame at them when the real
Blame should
Have been the surgeon nicking a major artery and patient bleeding to death.

 

[UscGhost]

Electronic charting can hurt u as well. A lot of people do not realize. Every “edit” can be combed through by someone looking even if it’s a simple mistake (say u administer epi at 1330 and originally charted it at 1340. And went back and put it at 1330 to match the decrease bp at 1330)

So do not paint a rosy picture electronic charting can save u. It can be used against u. And it was used against one of my former colleagues in the south to point blame at them when the real
Blame should
Have been the surgeon nicking a major artery and patient bleeding to death.

Generally the chart is considered extremely strong evidence. So a paper chart showing good viral signs will protect you and help your case significantly.

A EMR with a couple random drops in BP can be easily spun against you when you have lawyers speaking to a jury.

Paper chart all the way. You will be sued for something that isn't your fault far more often than you will be sued for a major personal error.

 

[deleted1147063]

Generally the chart is considered extremely strong evidence. So a paper chart showing good viral signs will protect you and help your case significantly.

A EMR with a couple random drops in BP can be easily spun against you when you have lawyers speaking to a jury.

Paper chart all the way. You will be sued for something that isn't your fault far more often than you will be sued for a major personal error.

Translation: one can lie on a paper chart, but the electronic chart will catch ones's mismanagement.

As a patient, there is no way in hell I let somebody paper chart my anesthesia except for an awake case. It comes right after the no CRNA rule.

 

[vector2]

Generally the chart is considered extremely strong evidence. So a paper chart showing good viral signs will protect you and help your case significantly.

A EMR with a couple random drops in BP can be easily spun against you when you have lawyers speaking to a jury.

Paper chart all the way. You will be sued for something that isn't your fault far more often than you will be sued for a major personal error.

Juries are pretty dumb but they're not that dumb. It'd take an expert witness for the plaintiff 30 seconds to explain how incredibly unreliable a paper chart (made by someone with an overwhelmingly strong incentive for it to look good) is in comparison to an EMR.

 

[Dr. Rude]

Juries are pretty dumb but they're not that dumb. It'd take an expert witness for the plaintiff 30 seconds to explain how incredibly unreliable a paper chart (made by someone with an overwhelmingly strong incentive for it to look good) is in comparison to an EMR.

Agree, but nobody paper charts if an EMR is available. If an EMR is not available, “paper is all I had counselor.”

 

[vector2]

Agree, but nobody paper charts if an EMR is available. If an EMR is not available, “paper is all I had counselor.”

Which, if the pt has a bad outcome, becomes essentially worthless since a paper record is so fungible. As what's occurring in the suit in question in the OP. It's just not true that "a paper chart showing good vital signs will protect you and help your case significantly" as the other poster was saying.

 

[psycho-matic]

I

-per the WFAA article
"Despite written policies by U.S. Anesthesia Partners, the suit alleged, Rojas was not informed that he had “the right to choose” whether to have an anesthesiologist or CRNA."

If that is, indeed, a written USAP policy, then they (and any medical direction/supervision group that offers patients an option) should send a reminder bulletin to their providers of said policy. In fact, failure to do so in light of this would be (intentionally?) neglectful to the physician(s) as well as the patients. This could set a precedent while increasing demand for physicians to be available and/or offered as an option.

I'm a psych NP and normally just read this forum out of personal interest (and amusement at times😀). I had 2 surgical procedures at BUMC in Dallas, in 2018, and was never told I had a choice. The anesthesiologist spent less than 30 seconds talking to me. I definitely had the impression the CRNA was the one in charge of my anesthetic.

 

[deleted1147063]

I

I'm a psych NP and normally just read this forum out of personal interest (and amusement at times😀). I had 2 surgical procedures at BUMC in Dallas, in 2018, and was never told I had a choice. The anesthesiologist spent less than 30 seconds talking to me. I definitely had the impression the CRNA was the one in charge of my anesthetic.

Of course you don't have a choice. It's not like a practice with an Anesthesia Care Team can just assign you a solo anesthesiologist on the day of surgery. Your surgery would be rescheduled. And you are not told this ahead of time.

If you want a solo anesthesiologist, you'll have to ask for it, through your surgeon, weeks ahead, and even then it may or may not happen.

Btw, your charge would be exactly the same, whether it's an anesthesiologist or a CRNA in the room. That's exactly why big corporations like to cut corners and not use solo MDs.

In anesthesia, seconds/minutes can matter, so you want the best anesthesia provider in your room. It's not like in most other specialties, where it's no big deal if the MD is a minute away.

 

[gunnershow]

Of course you don't have a choice. It's not like a practice with an Anesthesia Care Team can just assign you a solo anesthesiologist on the day of surgery. Your surgery would be rescheduled. And you are not told this ahead of time.

If you want a solo anesthesiologist, you'll have to ask for it, through your surgeon, weeks ahead, and even then it may or may not happen.

Btw, your charge would be exactly the same, whether it's an anesthesiologist or a CRNA in the room. That's exactly why big corporations like to cut corners and not use solo MDs.

In anesthesia, seconds/minutes can matter, so you want the best anesthesia provider in your room. It's not like in most other specialties, where it's no big deal if the MD is a minute away.

Not to mention that the hubris of CRNAs is such that they will never call for help until they are in deep, deep ****. I've had major aspiration events, laryngospasms with NPPE, etc etc happen all without the CRNA ever informing me. I only found out when I made rounds in the PACU and asked why the sats were in the gutter. They will usually try to paper over these events by lying in the paper chart and hoping nothing comes of it.

 

[amyl]

Of course you don't have a choice. It's not like a practice with an Anesthesia Care Team can just assign you a solo anesthesiologist on the day of surgery. Your surgery would be rescheduled. And you are not told this ahead of time.

If you want a solo anesthesiologist, you'll have to ask for it, through your surgeon, weeks ahead, and even then it may or may not happen.

Btw, your charge would be exactly the same, whether it's an anesthesiologist or a CRNA in the room. That's exactly why big corporations like to cut corners and not use solo MDs.

In anesthesia, seconds/minutes can matter, so you want the best anesthesia provider in your room. It's not like in most other specialties, where it's no big deal if the MD is a minute away.

Yes you do have a choice. Md only anesthesia is a request we always honor. I was just telling the nursing supervisor in the gi lab that this is a request we will 100% always honor. It’s much easier if we have advance notice, like the day before instead of last minute so please inform the drs to give their patients the option

 

[rickylafleur]

I

I'm a psych NP and normally just read this forum out of personal interest (and amusement at times😀). I had 2 surgical procedures at BUMC in Dallas, in 2018, and was never told I had a choice. The anesthesiologist spent less than 30 seconds talking to me. I definitely had the impression the CRNA was the one in charge of my anesthetic.

Are you inpatient or outpatient?
Do your patients know they have an only MD option?

If you want amusement pursue the Psychiatry forum and see their opinions on Psych NPs
A real laugh riot for ya

 

[nimbus]

Yes you do have a choice. Md only anesthesia is a request we always honor. I was just telling the nursing supervisor in the gi lab that this is a request we will 100% always honor. It’s much easier if we have advance notice, like the day before instead of last minute so please inform the drs to give their patients the option

Seems like it depends on the practice. There have been posters here who say they would not/could not honor such a request, especially if on the day of surgery. Do you offer MD only care as an option to every patient or do the patients have to initiate that request?

 

[nimbus]

I

I'm a psych NP and normally just read this forum out of personal interest (and amusement at times😀). I had 2 surgical procedures at BUMC in Dallas, in 2018, and was never told I had a choice. The anesthesiologist spent less than 30 seconds talking to me. I definitely had the impression the CRNA was the one in charge of my anesthetic.

I bet your experience is more common than not. I don’t think it is standard practice in ACT models to offer a choice to every patient during the preop interview. The patient needs to be proactive and ask for it. If the option is offered to every single patient, and 20% of the patients opt for MD only care, it would blow up their schedule. The patients would need to be directed to CRNA/ACT care with a “this is the way we usually do it and it works very well” or “nurse so and so is really excellent” spiel so the patients don’t overwhelmingly choose MD only care.

 

[chocomorsel]

I bet your experience is more common than not. I don’t think it is standard practice in ACT models to offer a choice to every patient during the preop interview. The patient needs to be proactive and ask for it. If the option is offered to every single patient, and 20% of the patients opt for MD only care, it would blow up their schedule. The patients would need to be directed to CRNA/ACT care with a “this is the way we usually do it and it works very well” or “nurse so and so is really excellent” spiel so the patients don’t overwhelmingly choose MD only care.

Exactly! You gotta sell the lie you are living. Or the truth. Some people love the ACT model and swear by the CRNAs while putting physician only models down.

 

[chocomorsel]

I think airway event (laryngospasm) is possible, maybe even likely in this scenario of global anoxic injury. It can definitely be 'covered up' from the OR nurses. I've seen plenty of CRNAs turn off alarms on the monitor.

Patient doing fine with LMA, CRNA pre-charts train-track vitals for the on paper chart (I've seen this too), looks up from phone after several minutes to realize sats are in the 40's because of laryngospasm or LMA not seated well, etc. CRNA slams 200 of propofol and turns up gas to fix laryngospasm, sats improve but by this point damage is done and patient now requiring doses of phenylephrine. Anesthesiologist is called in; surgeon and OR staff are asking "what's going on??";

"Oh nothing-- just dealing with a little hypotension. Not sure why". BP comes up, rest of case goes OK, patient doesn't wake up again.

Jesus. I encountered the turning off of alarms in Vegas back in the day where it was Physician only anesthesia.
Annoyed the crap out of me because who does that right? The circulators told me it was not in common. But a CRNA turning off alarms under someone else’s license? And the physicians don’t immediately fire them and report them to the board? You have encountered this?
I really hate supervising.

 

[psycho-matic]

Of course you don't have a choice. It's not like a practice with an Anesthesia Care Team can just assign you a solo anesthesiologist on the day of surgery. Your surgery would be rescheduled. And you are not told this ahead of time.

If you want a solo anesthesiologist, you'll have to ask for it, through your surgeon, weeks ahead, and even then it may or may not happen.

Btw, your charge would be exactly the same, whether it's an anesthesiologist or a CRNA in the room. That's exactly why big corporations like to cut corners and not use solo MDs.

In anesthesia, seconds/minutes can matter, so you want the best anesthesia provider in your room. It's not like in most other specialties, where it's no big deal if the MD is a minute away.

Interesting that you bring up charges. USAP billed the same charge twice for the anesthetic. I thought it was a mistake, so when I called, I was told one charge was for the anesthesiologist and one charge was for the CRNA, that they each did something different for the anesthetic. I felt it was a fraudulent billing practice, but what do I know? I've only seen USAP do that.

As far as wanting the best qualified person in the room, I realize the training differences and that seconds matter. I've asked for an anesthesiologist before at another facility, weeks ahead, and was told they couldn't do it. I once had a solo anesthesiologist by stroke of luck, but reality is that where I live, I will end up with a CRNA or a resident. Now back on the east coast (NJ, Baltimore), a solo anesthesiologist at ASCs seemed to be more the norm.

 

[psycho-matic]

Are you inpatient or outpatient?
Do your patients know they have an only MD option?

If you want amusement pursue the Psychiatry forum and see their opinions on Psych NPs
A real laugh riot for ya

Ha! Touche. I'm outpatient. I do in fact spend a lot of time reading the psych forum and I've learned a lot from the discussions there. I will tell you that the well-respected CAP of 40 years I trained under told me he thought I was better than most of the residents coming out of our local psychiatry program. He wouldn't say that lightly. But, I don't claim to be "equivalent" to an MD nor do I need to. In my opinion, such ego slinging has no place in medicine. I'm good at what I do and my patient outcomes speak for themselves. I manage patients with bipolar disorder and schizophrenia and they are generally stable. Granted, it's a lot harder to kill someone in psychiatry than in anesthesiology.

I did consider med school but chose to be present in my kids's lives over medicine. That meant more to me. Having a biology degree does help with understanding neurobiology, but I am always reading literature or books. I go to conferences to stay up to date. Mostly importantly, I take the time to listen so I can figure out what is really going on. When I come across patients who received sh*tty care from a psychiatrist, it's usually because they didn't listen to the patient (this goes for APRNs too, I used to work with one who had several patients fire her and came to me, and I heard the same thing over and over... "she doesn't listen to me" or "she blew me off." The kind of poor care she gave her parents was self-evident.)

I do realize the vast experience that med school and residency provide and I often wish I had that experience. I try to make up for it by reading and staying up to date, and I'm good at what I do, but I still lack the breadth of exposure that residency provides. I don't hesitate to discuss complex cases with a physician or refer out when necessary (for example, complex dementia, it's just not my comfort zone), and I hate inpatient. I believe I can learn a lot from physicians and I don't let my ego get in the way of doing what's right for the patient by asking for help when I need it. Now, we're getting majorly off topic. I don't want this thread to become another MD vs NP match.

 

[GassYous]

Interesting that you bring up charges. USAP billed the same charge twice for the anesthetic. I thought it was a mistake, so when I called, I was told one charge was for the anesthesiologist and one charge was for the CRNA, that they each did something different for the anesthetic. I felt it was a fraudulent billing practice, but what do I know? I've only seen USAP do that.

As far as wanting the best qualified person in the room, I realize the training differences and that seconds matter. I've asked for an anesthesiologist before at another facility, weeks ahead, and was told they couldn't do it. I once had a solo anesthesiologist by stroke of luck, but reality is that where I live, I will end up with a CRNA or a resident. Now back on the east coast (NJ, Baltimore), a solo anesthesiologist at ASCs seemed to be more the norm.

Sounds fishy

 

[2Fast2Des]

Visiting from EM to agree and add, unlimited healthcare in general has ended. It is real scary. I couldn’t find an open PICU bed in my state despite living in a decent sized state with 8-10 PICUs.. so I got to be a peds intensivist for a very sick 2 year old a few days ago, despite working at the decidedly non peds hospital in my city. A few weeks ago a colleague couldn’t place an aortic dissection anywhere in our state, he died waiting for the heli to take him two states over. I’m spending 80% of my shifts trying to practice medicine in the waiting room. The malpractice laws are going to need to be modified to accommodate the new standard of care, or there will be no insurable ER doctors in my state in 10 years.
I feel for you guys esp those who work in ACT model. There’s probably no going back, right? Could even 80% of the current caseload be covered by anesthesiologists solo?

Uhh where in America do you work....? Sounds like a 3rd world nation

 

[Arch Guillotti]

Yes you do have a choice.

Not at the places I have worked.

 

[coffeebythelake]

Yes you do have a choice. Md only anesthesia is a request we always honor. I was just telling the nursing supervisor in the gi lab that this is a request we will 100% always honor. It’s much easier if we have advance notice, like the day before instead of last minute so please inform the drs to give their patients the option

Very much dependent on availability and how lean the practice is run. When the default is 1:4 you can bet they don't have a solo MD to take that request

 

[chocomorsel]

Uhh where in America do you work....? Sounds like a 3rd world nation

America is so not uniform as you know. I worked in Texas small towns and yeah, it’s like the third world. Marginalized communities with an inordinate amount of end stage everything at early ages. And no insurance.

 

[Southpaw]

Yes you do have a choice. Md only anesthesia is a request we always honor. I was just telling the nursing supervisor in the gi lab that this is a request we will 100% always honor. It’s much easier if we have advance notice, like the day before instead of last minute so please inform the drs to give their patients the option

I have to imagine there’s no choice most of the time. In an ACT model there aren’t free MDs sitting around in case someone requests MD only. Even in a hybrid practice (some MD only, some supervision) where do you get MDs? It seems they’re either working, or off, but not sitting around waiting on a potential request case.

 

[pgg]

I had an attending during residency that would chart ahead vitals while I was on a break. Come back and he's already charted perfect vitals for the next 30 minutes...

I've seen people paper chart extubation with a narrative of PACU transport, awake alert and no pain/nausea, prior to incision. Same kind of people put the monitors in CPB mode to globally silence all alarms. And of course the vitals were train tracks.

I love EMRs. Hate paper.

 

[pgg]

How long is data stored in the actual monitors?

Think it depends on the monitor.

The ones at my last job would wipe the memory when you hit the end case / discharge button, but would retain data if you hit standby.

I've seen some that let me scroll back to yesterday ... assuming they'd been left on overnight.

 

[UscGhost]

Juries are pretty dumb but they're not that dumb. It'd take an expert witness for the plaintiff 30 seconds to explain how incredibly unreliable a paper chart (made by someone with an overwhelmingly strong incentive for it to look good) is in comparison to an EMR.

So given that the majority of anesthesia charts are paper, especially in ASCs..are you saying the courts throw it out?

 

[CoolDoc1729]

America is so not uniform as you know. I worked in Texas small towns and yeah, it’s like the third world. Marginalized communities with an inordinate amount of end stage everything at early ages. And no insurance.

I work in a poor but not particularly underserved area. There are 7 PICUs within 90 minutes by ground transport. Even a year ago it would have taken me less than ten minutes to get that kid accepted to any one of them. It’s bad right now.

Third world resources, plus EMTALA and malpractice hanging over our heads .. working on an ulcer TBH

 

[vector2]

So given that the majority of anesthesia charts are paper, especially in ASCs..are you saying the courts throw it out?

I'm saying at best it's neutral and at worst it hurts you.

As I said, just look at the case in question in this thread. Does anyone, layperson or not, actually believe the pristine vitals that were documented are accurate?