Post-it note 9/19/21-OR timing

The post-it reads ‘timing is not a science. MD’s don’t follow a proscribed march to finishing cases. In short, shit happens. Please do not count your chickens before they hatch and rob me of a third CRNA and hobble the evening.’


That elusive, misunderstood, much maligned view of how long cases are going to take to finish.

I could fill books with what I know about timing.

It is specific to both case, and surgeon

One surgeon may be 33 minutes on a lap appy.

Another may be 90.

It is all dependent on what the abdomen looks like when the scope is first inserted.

It is all dependent on skill level of the surgeon; the meticulousness of the surgeon, the poor, or not, protoplasm of the patient.

It can be dependent on the availability of the anesthesiologist; are they in another unit intubating, or on OB inserting an epidural.

It can be dependent on the OR team and their cohesiveness as a working group; do they have everything they need, including reloads of the stapler?

It can be dependent on the likelihood of the lap appy becoming an open laparotomy; CTs are only as good as who reads them, and sometimes there are surprises.

It can be dependent one who in pre-op is prepping the patient; we all know that one nurse who takes FOREVER!

There are many, many factors that need to be considered and tabulated regarding timing.

Times the number of surgeons, times the kind of cases, times the X factor.

It all goes into the OR charge nurse’s tabulation of time.

Mostly I get it right.

But I’ve been doing this for years.

This is a skill that is hard to teach.

This is a skill that is hard to learn.

However, the charge nurse and the head CRNA need to be in constant communication about needs of the department.

They should not send their third CRNA home at 1600 because no cases have been added.

And the phone rings at 1605 for an emergent case.

And the OR has been hobbled.

There are three teams available.

With 2 CRNAs.

And the emergency will have to wait.

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