Pts requesting Anesthesiologist

[anbuitachi]

Easily by doing a bunch of 12min gallbladders and 1hour total knees. And providing protocol driven care with clinical pathways.

these community hospitals are that fast??

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[nimbus]

these community hospitals are that fast??

Not every surgeon but some of them are. The gallbladders go home DOS and the knees often go home the next day. There are both upsides and downsides to having residents. But things can be VERY different from many academic places. Certainly my current hospital is nothing like where I trained, even though we do have a few residents and fellows coming through.

 

[anbuitachi]

Not every surgeon but some of them are. The gallbladders go home DOS and the knees often go home the next day. There are both upsides and downsides to having residents. But things can be VERY different from many academic places. Certainly my current hospital is nothing like where I trained, even though we do have a few residents and fellows coming through.

insane stuff. other day i worked from 630am to 720pm and only did 2 cases. (a 10 min CT scan, and a diagnostic lap) so infuriating. i wish our surgeons were that fast. And I wish patients would stop showing up IN the hospital after the scheduled surgery start time.

 

[teeva]

Not every surgeon is fast. But commonly there are operative times of:

7m cataract
7m appy
10m BTL
10m CTR
15m chole
20m cysto, litho, stent
20min TURP or TURBT
20m ERCP
20m C-section
20-25m hip nail or pin
20-30m hernias
20m knee or shoulder scope
25m septoplasty nasoplasty
25m AVF creation
25m TAH, BSO
25m BKA
30m thyroidectomy
60m mastectomy and ax LN
3h robot prostatectomy
Haven't done lap nephrectomy in a while but those are fast and not much EBL

A surgeon would be considered slow for most of those procedures for >2x time.

 

[pjl]

Not every surgeon is fast. But commonly there are operative times of:

7m cataract one guy, 15 min others
30m-1h appy
10m-15m BTL
7m CTR
1h chole
20m-45m cysto, litho, stent
45m TURP or TURBT
20m ERCP
30-35m C-section
1 hr hip nail or pin
20-30m hernias
30m knee
1hr shoulder scope (cuff repairs and the like)
30-90m septoplasty nasoplasty
1 hr AVF creation
1hr TAH, BSO
1.5 hr BKA
2 hr thyroidectomy
2 hr mastectomy and ax LN
2hr robot prostatectomy
Haven't done lap nephrectomy in a while but those are fast and not much EBL

A surgeon would be considered slow for most of those procedures for >2x time.

In my private practice there are only 3 of those cases that we match. I changed the numbers to our averages.
I waste almost 5 minutes just getting in room and positioned/induced...
Prep takes 3 min to dry...


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[anbuitachi]

Not every surgeon is fast. But commonly there are operative times of:

7m cataract
7m appy
10m BTL
10m CTR
15m chole
20m cysto, litho, stent
20min TURP or TURBT
20m ERCP
20m C-section
20-25m hip nail or pin
20-30m hernias
20m knee or shoulder scope
25m septoplasty nasoplasty
25m AVF creation
25m TAH, BSO
25m BKA
30m thyroidectomy
60m mastectomy and ax LN
3h robot prostatectomy
Haven't done lap nephrectomy in a while but those are fast and not much EBL

A surgeon would be considered slow for most of those procedures for >2x time.

25m avf creation? LOL wow.
The only there here we somewhat match is robot prostatectomy. how long are room turnovers?

 

[jthedestroyr]

Not every surgeon is fast. But commonly there are operative times of:

7m cataract
7m appy
10m BTL
10m CTR
15m chole
20m cysto, litho, stent
20min TURP or TURBT
20m ERCP
20m C-section
20-25m hip nail or pin
20-30m hernias
20m knee or shoulder scope
25m septoplasty nasoplasty
25m AVF creation
25m TAH, BSO
25m BKA
30m thyroidectomy
60m mastectomy and ax LN
3h robot prostatectomy
Haven't done lap nephrectomy in a while but those are fast and not much EBL

A surgeon would be considered slow for most of those procedures for >2x time.

Lol our surgeons get cranky at us if we are slow to place an aline (>5min), but our appy standard are 1-2hrs, TAH BSO 3hr, hernia 1hr at least. Hell i did one hernia that took 2.5hr and staff was doing the majority of the case.

We have 25min turn over times too. By 2nd or 3rd months pretty much any resident can hit that time easily. Ee are more often than not the rate limiting step.

 

[Psai]

Not every surgeon is fast. But commonly there are operative times of:

7m cataract
7m appy
10m BTL
10m CTR
15m chole
20m cysto, litho, stent
20min TURP or TURBT
20m ERCP
20m C-section
20-25m hip nail or pin
20-30m hernias
20m knee or shoulder scope
25m septoplasty nasoplasty
25m AVF creation
25m TAH, BSO
25m BKA
30m thyroidectomy
60m mastectomy and ax LN
3h robot prostatectomy
Haven't done lap nephrectomy in a while but those are fast and not much EBL

A surgeon would be considered slow for most of those procedures for >2x time.

The other day we had an ophtho take 2 hours for a cataract with minimal resident input. Kill me.

 

[IlDestriero]

Lol our surgeons get cranky at us if we are slow to place an aline (>5min), but our appy standard are 1-2hrs, TAH BSO 3hr, hernia 1hr at least. Hell i did one hernia that took 2.5hr and staff was doing the majority of the case.

We have 25min turn over times too. By 2nd or 3rd months pretty much any resident can hit that time easily. Ee are more often than not the rate limiting step.

You have to give it back and shut that BS down.
"I don't complain about a 2 hour appy, so please hold your constructive criticism until the end of the day and we can recap all the lowlights."


--
Il Destriero

 

[deleted162650]

"I don't complain about a 2 hour apply, so pleas hold your constructive criticism until the end of the day and we can recap all the lowlights."

I'm gonna hold onto that one for future use. Thanks.

 

[pgg]

I'm gonna hold onto that one for future use. Thanks.

Has a nice flow to it.

 

[MoMoGesiologist]

It's nice to do 2-4 cases a day as a resident. With those surgical times, and if you are running multiple rooms, how many cases/patients are you seeing per day? 10? 20? Is that miserable? How do you even spend five minutes talking to the patients in preop? Doesn't all of it just blur together and you stop caring or make mistakes? Or is PP somehow different?

 

[deleted171991]

It's nice to do 2-4 cases a day as a resident. With those surgical times, and if you are running multiple rooms, how many cases/patients are you seeing per day? 10? 20? Is that miserable? How do you even spend five minutes talking to the patients in preop? Doesn't all of it just blur together and you stop caring or make mistakes? Or is PP somehow different?

I think you're getting the gist of it.

 

[teeva]

In my private practice there are only 3 of those cases that we match. I changed the numbers to our averages.
I waste almost 5 minutes just getting in room and positioned/induced...
Prep takes 3 min to dry...

Yeah that's why I only specified operative time - incision to last suture/staple. Sometimes positioning and prep are as long or longer than the case.

 

[teeva]

It's nice to do 2-4 cases a day as a resident. With those surgical times, and if you are running multiple rooms, how many cases/patients are you seeing per day? 10? 20? Is that miserable? How do you even spend five minutes talking to the patients in preop? Doesn't all of it just blur together and you stop caring or make mistakes? Or is PP somehow different?

If solo community practice it's not bad. Bread and butter cases. Not many super sick pts or zebras. Not too many druggies or off the street pts or no prenatal care pts needing OR. H&P/labs/testing are readily in chart or on EMR for quick review, easy to eyeball pt preop and evaluate/consent. Pts are generally trusting and respectful, they just want to be assured they'll be alseep and not remember anything. Support staff do everything, IVs, set up machines, lines, flip flop ORs ready to go in advance. We don't run back to back for 8h straight. Plenty of time between surgeon blocks or add-ons to get food or break time. On busy days if surgeon or anesthesiologist want to pause for lunch it's cool, no big deal. Sometimes surgeon or equipment/vendor reps will buy lunch and everyone takes a break for lunch.

 

[MoMoGesiologist]

If solo community practice it's not bad. Bread and butter cases. Not many super sick pts or zebras. Not too many druggies or off the street pts or no prenatal care pts needing OR. H&P/labs/testing are readily in chart or on EMR for quick review, easy to eyeball pt preop and evaluate/consent. Pts are generally trusting and respectful, they just want to be assured they'll be alseep and not remember anything. Support staff do everything, IVs, set up machines, lines, flip flop ORs ready to go in advance. We don't run back to back for 8h straight. Plenty of time between surgeon blocks or add-ons to get food or break time. On busy days if surgeon or anesthesiologist want to pause for lunch it's cool, no big deal. Sometimes surgeon or equipment/vendor reps will buy lunch and everyone takes a break for lunch.

If it's bread and butter cases mostly lasting <30min on ASA1s and 2s, don't you get bored? Does the anesthesia become the same for each and every patient? I think I liked those cases as a CA1. If I'm doing those cases as a cA3 I feel like I'm rotting in the room. But maybe with the quick surgery times and turnovers it becomes fun again, like a race against myself.

 

[Ezekiel2517]

If it's bread and butter cases mostly lasting <30min on ASA1s and 2s, don't you get bored? Does the anesthesia become the same for each and every patient? I think I liked those cases as a CA1. If I'm doing those cases as a cA3 I feel like I'm rotting in the room. But maybe with the quick surgery times and turnovers it becomes fun again, like a race against myself.

if you want fun, stay in academics. if you want to make some money, go into PP

 

[DoctwoB]

Not every surgeon is fast. But commonly there are operative times of:

7m cataract
7m appy
10m BTL
10m CTR
15m chole
20m cysto, litho, stent
20min TURP or TURBT
20m ERCP
20m C-section
20-25m hip nail or pin
20-30m hernias
20m knee or shoulder scope
25m septoplasty nasoplasty
25m AVF creation
25m TAH, BSO
25m BKA
30m thyroidectomy
60m mastectomy and ax LN
3h robot prostatectomy
Haven't done lap nephrectomy in a while but those are fast and not much EBL

A surgeon would be considered slow for most of those procedures for >2x time.

There's a phrase for a 20 minute TURP. Sham surgery. That's either a greedy surgeon who is staging a procedure that doesn't require staging, or operating on many patients who don't need surgery.

 

[jthedestroyr]

You have to give it back and shut that BS down.
"I don't complain about a 2 hour appy, so please hold your constructive criticism until the end of the day and we can recap all the lowlights."



--
Il Destriero

That requires an attending to back you.

 

[IlDestriero]

Aren't you there with your attending struggling with your 10 minute aline?


--
Il Destriero

 

[teeva]

don't you get bored?

Yes, all the time. But if you want fun, excitement, danger, or obstacles in life, there are hobbies for that.

Besides, there's always the dying septic perf bowel or hemorrhaging OB pt to take care of once in a while.

 

[Maverikk]

One aspect to consider is patient selection. I worked at a small 200 bed community hospital, they can do quick gall bladders and knees, yes the surgeon is fast, but also they know how to pick appropriate patients. Are you going to book an ASA2 but who has 5 past abdominal surgeries for a 30 min gall bladder, no way. There were one or two who were 'slow' but patient selection had a lot to do with this. I have a friend at an outpatient surg center who does same day TKAs, handles all the catheter and pain calls, gets reimbursed for it and is much more careful with the blocks now but I still don't know how they get the volume they do