I had another one of those phone calls.
Ring, ring.
Me- This is Kate. How can I help you?
MD- This is Dr. Z. I have a patient who needs urgent surgery. There is a lot of blood and they are still bleeding. How fast can we start?
Me, after getting details-It is 2310. I am heading in now and the scrub tech is my next call. I will shoot for patient on the table at midnight.
MD- Well, I hope they still stay stable. Do what you can. **click**
Come to find out the surgeon knew about the case a good thirty-sixty minutes before they called me. They were watching to make sure the patient remained stable.
They were doing this by not ordering the type and cross. This is where the patient’s blood type is tested for type and crossmatched to ascertain the most compatible blood to give them in case of a transfusion need.
These tests take 30 minutes at a minimum.
And the order should not be buried in the pre-op orders. The ER can absolutely and would absolutely start the clock on this. This is essential for making sure the patient has blood available if necessary. Especially if they are bleeding.
They were doing this by not ordering the oral medication that they decided the patient MUST have prior to surgery. Again, something the ER can absolutely do. Anesthesia does not like giving anything orally due to the pesky NPO, especially minutes before induction.
By responding, when this oversight on the type and crossmatch was noted just prior to surgery, and the lack of oral medication was also noted just prior to surgery and the surgeon was questioned about the need for these both to be done before the patient heads back to surgery, oh, just the oral medication then.
On a patient we know is bleeding?
This is what you want to do?
Okay.
Handing the patient 2 oral tablets and a scant amount of water (seriously, like 1/8 of a cup) to wash them down with.
That took a minute to have the orders, that were just released, acknowledged, and released by pharmacy. Added 5 minutes to our pre-op time.
By continuing to pace around and say that they were WAITING and what was taking SO LONG?
Deep breath.
Count to TEN.
At no point did I snap back that these could have, should have been ordered just a mite earlier so that the meds would be given, and the type and cross that you no longer want could be initiated.
But it was close.
Managing surgeon expectations is a big part of the call process. But they can help themselves out by not acting like an impatient fool and, you know, ordering things in a timely manner.
Patient is fine and did not require blood.
On to the next case.
Dispatches from the Evening Shift 