What would you do if...?
Imagine this, you are the Medical Director of a MultiSpecialty Surgery Center located in the United States. This morning was a normal morning for you, so as you always do, you make rounds on your patients, then off to your surgery center. You hang out there for two hours and then move towards your private practice to see your Post-Op Patients from prior day.
Before leaving the surgery center, you ask the surgery scheduler what the day was looking like. She replies, "got the new doc doing an abdominoplasty this am". "Ok, so he pays us for the OR time or does the patient pay us"? you ask. She replies with the surgeon pays us. Oh Good. So much easier they both concur. So you leave onto your private practice.The tummy tuck was scheduled for 10AM and starts around 1110 AM. You go about your day seeing your post-op patients and then decide on your route home, you'd swing by the ASC and see how things progressed with the credentialed surgeon.
Much to your surprise, when you arrive to the ASC, the scrub tech asks to speak with you. You think, OMG what's about to be voiced? Is it terrible, or is it a whining session of the staff? You ask the tech what was on her mind and she says the most unimaginable thing you'd ever expect that you could hear coming from a surgical technician at your surgery center. "This morning the surgeon, Dr. XYZ came to perform his tummy tuck on patient, XYZ. Everything was normal course of business and business as we see in our facility except for this major issue. The surgeon receives a call during the last portion of the surgery. Right before he started the suturing, he gets a call. The circulator answers the phone and holds the phone up to the surgeon's ear where the surgeon listens to his wife tell him that their pet dog needed to be taken to the vet hospital. Ok, so nothing new here. Calls come through the Operatory Space for an array of different reasons, though the vet is new for most of us. I digress...
The wife informs the husband he needs to take the dog to the vet, so what he then does is to inform the surgical tech she is to close the wound. Mind you, this surgical tech had never worked with this surgeon before, so he would not understand her ability or technique for providing this suturing. Not to fail to mention, the request is outside her scope of practice and training as a surgical tech. So, he informs her of this, she complained that she was not comfortable with this request. He then looks at the anesthesia provider and informs him that he will be back by the time the patient is coming out from being under the general anesthesia.The surgeon leaves, the tech begins to suture the wound. The anesthesia provider continues to monitor the patient and then prepares to bring her back to being alert and oriented to her place, day, and time.
The surgeon does return right at the very time that the patient is beginning to be verbal and communicative. She is visited by the surgeon and the surgeon speaks as if he was present the entire time of the case. He does not inform the patient that there was an emergency in which called him out of the OR and to his private residence to retrieve his family pet and then take it to the Vet. He fails to mention that the wife called him, when she proclaims not to be working and we are all trying to still figure out why she did not take the canine to the doctor, right?
Of course during this conversation with the tech, your mind is fluttering a million thoughts. Thoughts from OMG, I leave this place for one morning and look at the potential harm to a patient. Or thoughts of, the staff just let him leave? I thought we had a procedure for something almost like this or similar anyways? Anesthesia just said nothing? Did anyone think to call me when this happened instead of waiting til the end of the day to inform me? All sorts of descriptives were paused, I knew I had my work cut out for me. So with this type of scenario, what would you have done? Given what you have read is all you know and you can only base your decision on what information you have, what would you have done differently?
In my next article, we summarize your comments and tell you the best way we've learned to handle a repeat.