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Administration/Are there guidelines for high-volume days?

QUESTION:

I work in an ambulatory facility which occasionally has special surgical days. On those days, three to five times the regular daily number of surgeries are done in order to decrease the waiting list of patients (pediatrics, general surgery, and ENT). Does SAMBA have any guidelines or suggestions for this high-volume day?

-- From Celina Beatriz Contreras, MD, Merida, Venezuela

REPLY:

This sounds like a real challenge! The "special surgical day" is not, as far as I know, something done in North American hospitals. Nor have I seen anything in the literature to describe how best to organize for such a day. The practice here is generally to try to even out the flow of cases and make things as predictable as possible. The obvious issues, such as increasing proportionately the number of anesthesia providers, OR nurses, and recovery personnel I am sure you've already thought of. You will need extra supplies, drugs and disposables. You will need to have all your care processes very streamlined, and here I imagine that preparation and planning with all the staff will be key. You will also need a good breakfast and probably a lot of coffee!

I would suggest sitting down with your administrator, and at least one representative from nursing and from your surgical group, to discuss the plan. Although the goal of reducing waiting lists is laudable, your primary objective should be to ensure patient safety. Because of the large case load, you will be especially vulnerable to "production pressure", but you should emphasize to the other staff that you cannot decrease vigilance or standards.

I think that for your high volume day, you would be wise to select only your healthiest patients, and to avoid especially complex cases. It might be a good idea to have all your prospective patients seen preoperatively by a primary care person or anesthesiologist to make sure they are all in good shape, and having the right kinds of operations that are likely to go smoothly.

Good luck!

-- From Gary Kantor, MD, Cleveland, Ohio

REPLY:

I think patient safety must be the first priority.  Don't push your team's limits but always have a good safety margin.  Don't let your surgical colleagues put you under pressure.  In case of severe complications, no one will be able to help you and, be sure, you will be criticized and/or punished.

-- From Wellingto Ferreira, M.D., VitÓria, ES, Brazil

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