Sunday, August 26, 2012

The Preop Huddle. Management's Stupidest Idea Yet.

It's the bane of the operating room. The first case of the morning rarely starts exactly on time. Though the schedule may say 7:00 AM, frequently the patient doesn't get into the room until 7:15 or later. This sets up a cascade of delays as the second case in the room gets delayed, which further puts back the start time of the third case, etc... Of course by then the incriminating surgeon who didn't show up at 7:00 is long gone. He couldn't give a rat's behind about how he has caused much anxiety and headache for the operating room staff as we hustle to catch up with the clock and have to deal with irate patients wondering why they aren't going in on time.

In their infinite wisdom, the O.R. managers have decided to correct this situation by instituting what they call the preop huddle. They have decided that before the first case of the day, at 6:45 AM, all parties will congregate at the patient's bedside to assure a prompt start to the day. Who originated this brilliant idea for holding a meeting first thing in the morning? It was the surgeons. Because so many of them were being delayed later in the day, they complained to their chief, who naturally thought the fault lies with anesthesia and nursing. It couldn't possibly be one of their own colleagues who was causing all this mischief. So the surgical staff developed this huddle to make sure there would be no more "anesthesia delays".

This is so wrong on so many levels. First of all, 6:45 AM is probably the worst time to be holding a meeting of the minds. It is at that precise moment when everybody is getting the patient ready for surgery. I'm busy interviewing the patient, starting an IV, writing my electronic preop note, getting my narcotics, checking my anesthesia machine, and on and on. The last thing I have time for is stopping everything so I can stand next to the patient for a roll call.

The same situation goes for nursing. The preop nurses are trying to make sense of the chaos in preop holding as multiple patients have to be admitted at the same time. The room is noisy and hectic as dozens of surgeons, anesthesiologists, residents, medical students, and family members are wandering in and out of the room . The nurses are trying to get their patients ready for surgery in this environment and don't appreciate having to drop everything to hold a meeting. Plus the nurses work on a clock. They are always there in the morning because their shifts start way before 7:00 AM. They are not the culprits for OR delays.

The real source of the scheduling issues, if you haven't figured it out by now, are the surgeons. They saunter in at their leisure, expect everything to be ready for them, then wonder why the patient isn't in the room already. Nobody will be screaming for another surgeon if they are five minutes late showing up. What makes the OR managers think the huddle system will change this habit? If the surgeons can't be bothered to show up on time for a 7:00 AM case, what's going to make them appear magically for a 6:45 AM huddle? This new system is both befuddling and incredibly irritating.


  1. I left anesthesia because of this.

  2. Late surgeons can't be the only problem in your OR, and actually if they are regularly that late, then do something about it. Our biggest problems are poorly organized scrub techs and or nurses who can't read or don't read procedure cards, and who hold up bringing the pt into theroom until the case is completely set up. We also have a problem with anesthesia not seeing the patients in a timely manner before hand. We're trying to improve turn around time in OUr OR, and we started by last year measuring surgeon arrival time and wheels in time. This year we will measure wheels in, anesthesia start time, surgeon cut time, surgeon close time, wheels out.

  3. There are so many more important reasons to have a preop huddle than to take roll call. The process for getting a patient in to the operating room suite is very complex, with many opportunities for ineffective communication and errors. Preop huddles are the perfect thing to get everyone on the same page. It increases patient safety, builds team relationships and gets everyone in the habit of communicating with each other. Kudos to your OR managers for working to implement this important quality improvement effort for patients and staff.