How early is too early?

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makemoney2024

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What time do you have to be at work in the morning? I am at a place where start time is surgical cut time. And they have a lot of 7 AM cuts. And they have some arbitrary numbers they’re looking for as far as when we see our patients on the anesthesia side. And I’m struggling. I am not permanent so I’m thinking of looking for another job even though this one pays well because they are hounding me about getting there early enough. They want me there at 6 AM.
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makemoney2024 said:
What time do you have to be at work in the morning? I am at a place where start time is surgical cut time. And they have a lot of 7 AM cuts. And they have some arbitrary numbers they’re looking for as far as when we see our patients on the anesthesia side. And I’m struggling. I am not permanent so I’m thinking of looking for another job even though this one pays well because they are hounding me about getting there early enough. They want me there at 6 AM.
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We have to have charts “signed by 7” for a 7-4 workday. Usually means walking in at 645. This is for 730 “start time”. Generally means they are rolling to room by 715-720.
 
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We have a few 6:30 starts on the general side and 6:15 starts for hearts. Everything else is 7 or later.
 
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Ours are 7:30 wheels in/room time. I usually arrive at 7 for block/coffee/business time. Hearts are supposed to be 6:15 but usually 6:30ish. We staff a surgery center that sometimes has 6am starts but I refuse to go there.
 
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My shop only cares about what time patients roll into the room. Even then the nurses will fudge it a bit to avoid the extra work of charting a delay.

This means I show up at 7:15 for a 7:30 start. For heart cases I’ll show up a little earlier.
 
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thinkorswim said:
My shop only cares about what time patients roll into the room. Even then the nurses will fudge it a bit to avoid the extra work of charting a delay.

This means I show up at 7:15 for a 7:30 start. For heart cases I’ll show up a little earlier.
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We are encouraged to fudge by the OR leadership so the monthly performance charts look good. “96% on time starts!!” 😂

Same for antibiotic timing.
 
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only one of my surgeons occasionally has a 630 start - Im there by 600. Usually 7 arrival for 730 start,
 
makemoney2024 said:
What time do you have to be at work in the morning? I am at a place where start time is surgical cut time. And they have a lot of 7 AM cuts. And they have some arbitrary numbers they’re looking for as far as when we see our patients on the anesthesia side. And I’m struggling. I am not permanent so I’m thinking of looking for another job even though this one pays well because they are hounding me about getting there early enough. They want me there at 6 AM.
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If they have strict cut times for the surgeons they better have strict last stitch times as well. What if it’s an unanticipated difficult airway, what if lines are challenging, DLT just isn’t going and you need to pivot to a blocker. Are you supposed to get in room 45 minutes early, just in case things are difficult? That’s absurd. The metric should be in room time.

We have 7, 730 and occasionally 8am starts (in room time). I usually pull into garage 30 mins before room time, regardless of what I’m doing.
 
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Any start time before 7am is pure bull****.

As for the actual question, I generally roll in 0630-0645ish for consistency (ICU handoff starts at 0645). OR starts are typically 0715 or 0730. I'll stroll in, leisurely set up, consent, line/block my patient, then bull**** with colleagues until the nurses have done handoff.
 
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7.58am this am
Ready 8.11am. Walked out of hospital 2.31pm.

You boys are getting your **** pushed in
 
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Beeftenderloin said:
If they have strict cut times for the surgeons they better have strict last stitch times as well. What if it’s an unanticipated difficult airway, what if lines are challenging, DLT just isn’t going and you need to pivot to a blocker. Are you supposed to get in room 45 minutes early, just in case things are difficult? That’s absurd. The metric should be in room time.

We have 7, 730 and occasionally 8am starts (in room time). I usually pull into garage 30 mins before room time, regardless of what I’m doing.
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That’s what I say. And the other docs say. But no one is interested in actually pushing back to change it because the fossil of a leader of the department has been in charge since the 90s. No joke. He’s churned thru so many anesthesiologists because he thinks his way is the best way and anyone who tries to improve the situation eventually gets tired and leaves. And admin doesn’t want to do anything about it. He hoards all the big cases and even comes in on his post call days and days off to do the hearts cuz “no one else can do them”.
Oh and he loves a bronchial blocker. And doesn’t believe in billing for running epidurals. It’s an inbred shop in a small town and people think all this nonsense is normal.
I literally got asked by my recruiter today if I was “late” again and I just lost it. I am over it. F the money. I am too old for this.
 
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psychbender said:
Any start time before 7am is pure bull****.

As for the actual question, I generally roll in 0630-0645ish for consistency (ICU handoff starts at 0645). OR starts are typically 0715 or 0730. I'll stroll in, leisurely set up, consent, line/block my patient, then bull**** with colleagues until the nurses have done handoff.
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They literally go pick up the CSections at 0615. On my first week there I got in at 0615. So of course I was late cuz I had three 0700 starts and they all need to be in the room before 0645. And nurses page me to see patients if I haven’t seen them before 0630. And I cannot do a block unless the damn preop note is in the computer.
I am so over this!!!
 
Our "start times" are also considered to be incision time (7:30 most days. 8:00 Wednesdays). I usually see my patient right before 7 and they'll roll back between 7:10-7:20. I get there at 6:20-6:30 when I have a heart, because they'll bring the patient back at 7, and all other days I get there closer to 6:45-6:55. We are also "supposed" to have seen our patients and marked them as ready in Epic prior to 7. I always just change the time to before 7 when I put in the note or whatever. That's the only metric they look at.
 
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makemoney2024 said:
That’s what I say. And the other docs say. But no one is interested in actually pushing back to change it because the fossil of a leader of the department has been in charge since the 90s. No joke. He’s churned thru so many anesthesiologists because he thinks his way is the best way and anyone who tries to improve the situation eventually gets tired and leaves. And admin doesn’t want to do anything about it. He hoards all the big cases and even comes in on his post call days and days off to do the hearts cuz “no one else can do them”.
Oh and he loves a bronchial blocker. And doesn’t believe in billing for running epidurals. It’s an inbred shop in a small town and people think all this nonsense is normal.
I literally got asked by my recruiter today if I was “late” again and I just lost it. I am over it. F the money. I am too old for this.
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makemoney2024 said:
They literally go pick up the CSections at 0615. On my first week there I got in at 0615. So of course I was late cuz I had three 0700 starts and they all need to be in the room before 0645. And nurses page me to see patients if I haven’t seen them before 0630. And I cannot do a block unless the damn preop note is in the computer.
I am so over this!!!
Click to expand...


Start times are the least of the problems.
 
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makemoney2024 said:
That’s what I say. And the other docs say. But no one is interested in actually pushing back to change it because the fossil of a leader of the department has been in charge since the 90s. No joke. He’s churned thru so many anesthesiologists because he thinks his way is the best way and anyone who tries to improve the situation eventually gets tired and leaves. And admin doesn’t want to do anything about it. He hoards all the big cases and even comes in on his post call days and days off to do the hearts cuz “no one else can do them”.
Oh and he loves a bronchial blocker. And doesn’t believe in billing for running epidurals. It’s an inbred shop in a small town and people think all this nonsense is normal.
I literally got asked by my recruiter today if I was “late” again and I just lost it. I am over it. F the money. I am too old for this.
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This place seems like a disaster. The start/cut times are just the tip of the **** iceberg. If the pay isn’t astronomical and you aren’t geographically locked in for some reason, I’d start looking for new work ASAP.
 
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nimbus said:
Hearts are supposed to be 6:15 but usually 6:30ish.
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**** that

makemoney2024 said:
They literally go pick up the CSections at 0615.
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And that


I was asked in a meeting the other day if we'd consider starting a particular line at 0715 instead of 0730, because the scheduled cases were sometimes running until 8.

I didn't quite guffaw, but I did laugh.


You guys starting cases at 6 are going to die young(er than you have to). You realize that, right?
 
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pgg said:
**** that


And that


I was asked in a meeting the other day if we'd consider starting a particular line at 0715 instead of 0730, because the scheduled cases were sometimes running until 8.

I didn't quite guffaw, but I did laugh.


You guys starting cases at 6 are going to die young(er than you have to). You realize that, right?
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Interesting bit about dying younger, why? Where did you read that?

What about all the influencer dudes getting g up at 2am?


For the guys who start hearts at 6am, do you do 3 or 4 a day in regular hours then?
 
Beeftenderloin said:
This place seems like a disaster. The start/cut times are just the tip of the **** iceberg. If the pay isn’t astronomical and you aren’t geographically locked in for some reason, I’d start looking for new work ASAP.
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I am a locums. And sick of this ****.
 
Beeftenderloin said:
This place seems like a disaster. The start/cut times are just the tip of the **** iceberg. If the pay isn’t astronomical and you aren’t geographically locked in for some reason, I’d start looking for new work ASAP.
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I ran to a code the other day and there was no airway equipment in the crash cart. Literally sat there all thumbs because I didn’t bring the anesthesia bag that has all this stuff. I have never seen a crash cart without airway equipment but apparently this is a thing. And then I bring it up to the department head and we argue about how this is a patient safety issue and he tells me I am starting trouble. Because every hospital is different and this is how we do things here. You should have brought the anesthesia bag. NVM the fact that I didn’t know where it was stored. LOL.
 
pgg said:
**** that


And that


I was asked in a meeting the other day if we'd consider starting a particular line at 0715 instead of 0730, because the scheduled cases were sometimes running until 8.

I didn't quite guffaw, but I did laugh.


You guys starting cases at 6 are going to die young(er than you have to). You realize that, right?
Click to expand...
I don’t want to die young and the past couple of days with nurses literally paging me and texting me to do my job has pushed me to my limits. I am so over this. The money is good but I would rather make less and not deal with this BS.
I don’t give a damn about the nurses notes but the culture here is to hassle and page and text the docs to do their notes if the nurses do not deem you are moving fast enough. Like are they my boss? It’s such BS. Inbred, toxic, stupid. I was about ready to tell some of them off a couple of days ago.
Off to the next assignment where the Cardiology nurses do the same damn thing. I will put a stop to it next week. Getting too old for this BS.
 
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PpfSuxTube said:
Interesting bit about dying younger, why? Where did you read that?

What about all the influencer dudes getting g up at 2am?
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Quality, sufficient sleep is clearly and closely linked with longevity. I don't think that's at all controversial.

Maybe guys getting up at 4:30 or 5:00 AM every day to humor the insane chuckle****s who want to start at 6 are going to bed at 9 PM every night, but that seems unlikely.

We shouldn't pretend that these unnatural schedules in the name of "efficiency" are intelligent or wise.
 
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makemoney2024 said:
I don’t want to die young and the past couple of days with nurses literally paging me and texting me to do my job has pushed me to my limits. I am so over this. The money is good but I would rather make less and not deal with this BS.
I don’t give a damn about the nurses notes but the culture here is to hassle and page and text the docs to do their notes if the nurses do not deem you are moving fast enough. Like are they my boss? It’s such BS. Inbred, toxic, stupid. I was about ready to tell some of them off a couple of days ago.
Off to the next assignment where the Cardiology nurses do the same damn thing. I will put a stop to it next week. Getting too old for this BS.
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Just don't burn your bridges til you get your next gig signed
 
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makemoney2024 said:
I ran to a code the other day and there was no airway equipment in the crash cart. Literally sat there all thumbs because I didn’t bring the anesthesia bag that has all this stuff. I have never seen a crash cart without airway equipment but apparently this is a thing. And then I bring it up to the department head and we argue about how this is a patient safety issue and he tells me I am starting trouble. Because every hospital is different and this is how we do things here. You should have brought the anesthesia bag. NVM the fact that I didn’t know where it was stored. LOL.
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I’ve never seen a crash cart that didn’t at least have a BVM, OPAs, standard laryngoscope, tubes and stylets. Arguing against low cost redundancies in the name of patient safety, in favor of “this is how we do it because this is how we’ve always done it” ESPECIALLY in a facility using locums that may be less familiar with ‘their way of doing things’, is completely insane.
 
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Beeftenderloin said:
I’ve never seen a crash cart that didn’t at least have a BVM, OPAs, standard laryngoscope, tubes and stylets. Arguing against low cost redundancies in the name of patient safety, in favor of “this is how we do it because this is how we’ve always done it” ESPECIALLY in a facility using locums that may be less familiar with ‘their way of doing things’, is completely insane.
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Yeah they stopped stocking the crash carts with airway stuff because they kept having to throw away expired ETTs. But anywho, after my complaint the Chief CRNA actually did ameliorate it some to where now it comes in the ICU bag. Still not in the crash carts but at least the ICU bag will have it. At least someone tried to fix it thankfully.
 
makemoney2024 said:
Yeah they stopped stocking the crash carts with airway stuff because they kept having to throw away expired ETTs. But anywho, after my complaint the Chief CRNA actually did ameliorate it some to where now it comes in the ICU bag. Still not in the crash carts but at least the ICU bag will have it. At least someone tried to fix it thankfully.
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The more I learn, the worse this gets. A standard cuffed ETT costs less than $2. Life saving interventions isn’t the place to cut corners.
 
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Beeftenderloin said:
The more I learn, the worse this gets. A standard cuffed ETT costs less than $2. Life saving interventions isn’t the place to cut corners.
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Well there is some evidence that intubation during in hospital cardiac arrest has worse outcomes. But yeah it's a bit ridiculous
 
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According to our current neuroscience, You guys who are constantly interrupting your natural sleep are majorly risking early dementia and a host of other diseases
 
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thinkorswim said:
My shop only cares about what time patients roll into the room. Even then the nurses will fudge it a bit to avoid the extra work of charting a delay.

This means I show up at 7:15 for a 7:30 start. For heart cases I’ll show up a little earlier.
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This. Occasionally we have 7am starts. But the nurses seem to hate that and it’s really 715.

The worst are surgeons who request 7am start and show up at 715.
 
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turnupthegas said:
This. Occasionally we have 7am starts. But the nurses seem to hate that and it’s really 715.

The worst are surgeons who request 7am start and show up at 715.
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This stuff drives me crazy. I hate when someone complains that their case isn't "on time" and yet they consistently forget to mark the patient or put in their h&p and it's delayed because they have to come do these things that they are supposed to do every case.
 
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GassYous said:
This stuff drives me crazy. I hate when someone complains that their case isn't "on time" and yet they consistently forget to mark the patient or put in their h&p and it's delayed because they have to come do these things that they are supposed to do every case.
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I **** you not, we once had a surgeon walk in and talk with his 7:30 start patient at 7:28, then immediately turn around and yell to the OR nurse “where’s anesthesia? I don’t see them, it’s their fault for the delay.”

The anesthesiologist had already seen the patient, had their coffee, and was just around the corner talking with a colleague… The OR nurse reminded the surgeon that he still needed to update his H&P.
 
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thinkorswim said:
I **** you not, we once had a surgeon walk in and talk with his 7:30 start patient at 7:28, then immediately turn around and yell to the OR nurse “where’s anesthesia? I don’t see them, it’s their fault for the delay.”

The anesthesiologist had already seen the patient, had their coffee, and was just around the corner talking with a colleague… The OR nurse reminded the surgeon that he still needed to update his H&P.
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Not enough places have a neutral party running the board. Not enough surgeons get their first start taken away
 
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pgg said:
I'd like to see that randomized prospective trial get past the IRB.
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I mean what percentage of people who code in the hospital survive? We shouldn’t be so quick to intubate until we get ROSC. To me it’s common sense. If you are ventilating properly during a code that’s all you need. An advanced airway is recommended. Not a must.
 
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People don’t survive cardiac arrest because we do a terrible job predicting it, responding in a fast organized way, and correctly identifying the cause to inform treatment. Any signal in a data set of heterogeneous unwitnessed arrests that intubation worsens outcomes isn’t real in my opinion.
 
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In practice for over 30 years. This BS is baked into the job and is a major hurdle you have to accept or you go crazy. My personal pet peeve are OB nurses waiting until you finally get the 0300 C/D into room and then calling you to put in an epidural. “Can’t you wake up your backup?” The list is endless.
 
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Gasmd98 said:
In practice for over 30 years. This BS is baked into the job and is a major hurdle you have to accept or you go crazy. My personal pet peeve are OB nurses waiting until you finally get the 0300 C/D into room and then calling you to put in an epidural. “Can’t you wake up your backup?” The list is endless.
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Did we work at the same place?
 
T-burglar said:
People don’t survive cardiac arrest because we do a terrible job predicting it, responding in a fast organized way, and correctly identifying the cause to inform treatment. Any signal in a data set of heterogeneous unwitnessed arrests that intubation worsens outcomes isn’t real in my opinion.
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It’s not an opinion. This is actually been shown in studies. This is a board full of anesthesiologists correct?? You mean to tell me that we can’t oxygenate and ventilate without an ETT!? ACLS is about high quality chest compressions, circulation, fixing the issue and minimizing stoppage of all that to tube a patient. Bag masking a patient properly and resuscitating properly without running into intubation takes priority. And if all that is done properly then this minimizes taking vegetables and brain dead patients to the ICU to sit for an extra three days while people figure out if this patient is gonna “live” or die.
It’s that simple.
 
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Gasmd98 said:
In practice for over 30 years. This BS is baked into the job and is a major hurdle you have to accept or you go crazy. My personal pet peeve are OB nurses waiting until you finally get the 0300 C/D into room and then calling you to put in an epidural. “Can’t you wake up your backup?” The list is endless.
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The epidural can wait. Just like waiting till 15 minutes before shift change to call for one. Or saying the patient isn’t ready, isn’t ready, even though they are a multiple who’s had one before and then calling 30 minutes late as you are about to start dreaming that now she’s ready. Give me a break.
 
Gasmd98 said:
In practice for over 30 years. This BS is baked into the job and is a major hurdle you have to accept or you go crazy. My personal pet peeve are OB nurses waiting until you finally get the 0300 C/D into room and then calling you to put in an epidural. “Can’t you wake up your backup?” The list is endless.
Click to expand...
I always tell the nurses "epidurals placed between 7am and midnight work better..."
 
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makemoney2024 said:
It’s not an opinion. This is actually been shown in studies. This is a board full of anesthesiologists correct?? You mean to tell me that we can’t oxygenate and ventilate without an ETT!? ACLS is about high quality chest compressions, circulation, fixing the issue and minimizing stoppage of all that to tube a patient. Bag masking a patient properly and resuscitating properly without running into intubation takes priority. And if all that is done properly then this minimizes taking vegetables and brain dead patients to the ICU to sit for an extra three days while people figure out if this patient is gonna “live” or die.
It’s that simple.
Click to expand...


I think the key part is “unwitnessed cardiac arrest”. When I was an intern, we’d get them 2-3 times/week at 6:45am. Many of them were cold and stiff. Some have been dead for 3min while others have been dead for 3 hours. It is a very heterogeneous population. We all agree that “fixing the issue” is of paramount importance. @T-burgler is pointing out that the responders to many floor codes have no clue what the issue is. I don’t think you two are far apart on that.

And how is the quality of mask ventilation at most floor codes?
 
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nimbus said:
I think the key part is “unwitnessed cardiac arrest”. When I was an intern, we’d get them 2-3 times/week at 6:45am. Many of them were cold and stiff. Some have been dead for 3min while others have been dead for 3 hours. It is a very heterogeneous population. We all agree that “fixing the issue” is of paramount importance. @T-burgler is pointing out that the responders to many floor codes have no clue what the issue is. I don’t think you two are far apart on that.

And how is the quality of mask ventilation at most floor codes?
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Unwitnessed out of hospital I agree with you. And as far as the mask ventilation we can always assist. I just don’t jump into anything anymore till ROSC post Covid.
 
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