The post-it reads ‘At the same point yesterday, surgeon needed something, scrub needed something, CNRA needed something, OR phone in pocket is ringing, wall phone is ringing. Who to answer first?’
Prioritization is a poorly conceived and executed skill sometimes in the OR.
Which of the 5 somethings got answered first?
Always the first consideration, when presented with such a puzzle, is which need is a legitimate need that puts the patient first.
The CRNA may have only needed a bag of fluids.
Or for me to call the anesthesiologist.
The surgeon may have only needed a refill on the suture.
Or something to do with their next case.
The scrub tech may have only needed more laps
Or for me to turn the radio on.
The wall phone ringing may have only been the pathologist with a read on the frozen that was sent.
Or another surgeon with another case.
The phone in the pocket may have only been PACU with a need.
Or the supervisor with a schedule request.
All of the five could have been something that needed immediate attention.
The patient tanking requiring the anesthesiologist.
The bleeding requiring a stick stitch to throw a stitch across.
The laps needed to sop up more blood that was suddenly there.
The pathologist to tell the surgeon that the sample that was sent frozen showed XY or Z.
The supervisor to tell me that there is a courier at the desk.
All of these scenarios could have been true and have been true in the past.
The best thing to do is to walk to where the monitor is visible, to see if there is anything alarming.
To ask the surgeon what he needed.
To look at the scrub techs sign language to see if it is more sponges that are needed.
The pocket phone can be glanced at to ascertain who is calling.
All of this can be done in less than 5 seconds.
And the priority can fall into place.
The pathologist can speak to the surgeon while you are calling the anesthesiologist and getting the extra suture and lap sponges.
Things can be done at the same time.
The surgeon needs to tell you about his next case.
The CRNA needs a bag of fluids.
The scrub tech would like the radio on.
The wall phone is a wrong number.
The pocket phone is the supervisor looking for their schedules.
It is knowing how to prioritize sometimes conflicting needs of the room that makes a circulator efficient at their job.
This is something I try to teach people when I am doing education.
Do not let the cacophony ear blind you to the immediate needs of the patient.
Because they are why we are all in the room.