END OF THE DAY RELIEF: WHEN EXPECTATIONS MEET REALITY

1. END OF THE DAY RELIEF:WHEN EXPECTATIONS MEET REALITY SCOTT HOFFMAN, M.D. DEPARTMENT OF ANESTHESIOLOGY VANDERBILT UNIVERSITY SCHOOL OF MEDICNE NASHVILLE, TENNESSEE

2. PREMISE: • EVERYONE WANTS TO GO HOME.....EVENTUALLY!!!

3. SO……. • WE NEED A PLAN!!!

4. SUCH A PLAN WILL…. • ALLOW FOR SOME DEGREE OF PREDICTABILITY FOR FACULTY • BE A TOOL TO ASSIST THE AIC IN PLANNING STAFFING FOR THE NEXT DAY • PROVIDE STAFFING INFORMATION/PLANNING FOR THE EVENING/NIGHT CALL TEAM

5. CHARACTERISTICS OF OUR PLAN • FAIRNESS • CONSISTENCY • FLEXIBILTIY

6. SUCH A PLAN WILL…. • MEET END-OF-DAY STAFFING NEEDS • TAKE INTO ACCOUNT SUPERVISION RATIOS • HAVE BUY-IN BY THOSE AFFECTED • CAN BE EASILY MODIFIED AS NEEDS DICTATE

7. OUR PLAN AT VANDERBILT • DOES NOT INCLUDE OUR CARDIAC ANESTHESIOLOGY DIVISION • DOES NOT INCLUDE OUR OB ANESTHESIOLOGY DIVISION • MIGHT INCLUDE AN ON-CAMPUS AMBULATORY SURGERY CENTER

8. END-OF-DAY RELIEF • BASED ON PRE- AND POST-CALL STATUS

9. OUR PRIORITY LIST

10. OUR PLAN IS A GOOD ONE…BUT NOT PERFECT • OOR LOCATIONS • LATE CALL SWITCHES • FACULTY WHO “ARRANGE” THEIR OWN RELIEF • A SHORT CALL TEAM

11. OUR PLAN IS A GOOD ONE….BUT NOT PERFECT • COMPLEX CASES (e.g. BIG VASCULAR CASES) • FACULTY WHO WANT TO FINISH THEIR CASES

12. TEMPORARY RELIEF DURING THE CLINICAL WORK DAY • WHAT ABOUT RELIEF FOR FACULTY WHO MUST ATTEND MEETINGS DURING THE CLINICAL WORK DAY?

13. WAIT….. • NOT ONLY ATTENDING FACULTY WANT TO GO HOME!!!

14. THE C-1 POSITION • MANAGES COVERAGE FOR IN-ROOM STAFF ABSENCES • COORDINATES AFTERNOON RELIEF FOR IN-ROOM PROVIDERS

15. RESIDENT RELIEF • EDUCATION VS. WORK HOUR REQUIREMENTS

16. TRACKING WORK HOURS • WE TRACK OUR RESIDENTS’ AND SRNAs’ WORK HOURS

17. 24/7 • VANDERBILT UNIVERSITY HOSPITAL’S MAIN OPERATING ROOM IS A 24/7 OPERATION

18. THE END • EVERYONE HAS GONE HOME! • SEE YOU TOMORROW!

19. LIAM IS WAITING AT HOME!