Thursday, January 06, 2005

Parallel Processing

Another recurring problem at the hospital is the total inefficiency of most of the recurring processes we perform. I'm thinking here specifically of the operating room.

I've counseled my patient, often they have signed consent, and they and I both know what we're planning to do in surgery. Nevertheless, the procedure will not be set into motion unless I am physically present at the bedside. Once I'm there (for no real reason), then the anesthesiologist will see the patient and the room will be prepared (yes, it should be done in advance but realistically it takes twice as long if you're not hovering around in a vaguely disapproving way). Then they bring in the patient and anesthesia will get going. It takes usually about 30 minutes to get the patient on the bed and then intubated, and then we have to position the patient for surgery. So I have to arrive and then stand around doing nothing for basically 40 minutes every morning waiting for everyone else to do these things.

I can't depend on the residents to get it done, because they're totally unreliable and might not even show up. When they do show, they don't usually have the weight to push the nurses and anesthesiologists to get the case going.

Parallel processing would allow the room to be prepared and the patient to be prepped by anesthesia in advance of the start time.

During the course of the operation, I'm usually faced with the same problem - I'll ask for a scope and the circulating nurse, if she hasn't left the room for some reason (WHY? Where else do they go while we're operating on the patient?) - will unpack one. If when I come to the room I ask if the scope is in the room and opened, I'm being unreasonably demanding- "Relax...all in good time" is the attitude I get.

This reminds me that while you might think the OR is a place where people just get the job done, in reality, it is just like many other workplaces. If I don't ask "nicely" for a clamp, the scrub tech gets huffy and will complain that I hurt his or her feelings. And the administration will always take their side. Never mind that the patient is bleeding and I'd really like the instruments handed to me a little more quickly...if I suggest that the tech is slow they're INSULTED. I have to overlook the fact that a nontrivial percentage of the time they don't even know all of the names of the instruments, so when I call for something, there's a delay while that's translated into something comprehensible to them.


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