Tuesday, December 3, 2019

Why You Have To Show Up So Early For Your Surgery

Few things are more aggravating for the operating room staff than patients who show up late for their surgeries. Many patients don't know, or don't care, that the OR schedule is planned to the minute. If one thing doesn't go as scheduled--the patient or doctor show up late, the OR equipment isn't ready, the patient has a difficult IV in preop--then the entire day in that room gets messed up. The other cases fall further and further behind schedule. Yet some patients still think they can just waltz into the hospital at 7:55 AM for their 8:00 case. Sorry it doesn't work that way. This is not like making an appointment for your mani-pedi.

We tell our patients to come to the hospital ninety minutes before their procedures. Why so early you ask? There are numerous ways that the schedule can get tripped up between the time the patient leaves the house to when they actually go into the operating room. First of all, if you've never been to the hospital where you're having surgery, you might easily get lost on the way. When you get here, you have to find parking which may not necessarily be close to the hospital building (all the good parking spaces are reserved for MD's and hospital volunteers by the way).

Even if somebody drops you off at the front door so you don't have to make the long trek from the parking lot, you still have to find your way to hospital registration so they can check you into the system. Remember that there may be dozens of people coming in to do the exact same thing you're doing. So this might take awhile.

After you register, you'll be led to preop holding. Here you'll have to change out of your clothes into the skimpy hospital gown. And most likely you'll want to make a quick trip to the restroom. Depending on your mobility, this could take longer than you think. Sometimes the staff may have to check in your valuables like your phone or wallet because those can't be taken into the OR.

Now the real work starts. The preop nurse will start asking you a whole bunch of questions about your personal history. Some of the questions may not seem relevant to why you're there in the first place but all patients get asked the same questions. So be patient and don't get snarky; they're just doing their jobs.

At some point the same nurse, or if you're lucky another nurse, will start your IV. Did you bring your veins today? Since you've been good and remained NPO since midnight, most likely you're a bit dehydrated and cold so your veins are going to be flat and potentially difficult to access. If your veins are small and flat, sometimes they have to wait for the anesthesiologist or an IV team to come start the vein after they've unsuccessfully poked you a few times.

Then you have to talk to your anesthesiologist. If the anesthesiologist is particularly diligent with history taking and physical exam and you're not an ideal ASA 1 patient, the interview could take a 5-10 minutes or more. Then the operating room nurse will come and talk to you too, asking all the same questions as everybody else up to this point. Finally the surgeon will meander in, smile his thousand watt grin, and declare you ready for surgery.

But wait! There's one more thing. You haven't signed your consent yet. The nurse will then go over your consent and explain the procedure in detail again, including all the possible complications. If you're a good patient and do what the staff ask you, you'll sign on the dotted line without question. If you're smart and independent thinking, you'll want to read through the entire 10 point legalese filled paper and ask why you're consenting for potential complications like MI, stroke, even death when you're just there for a simple procedure. You aren't really signing up for possible death from a routine colonoscopy, are you? So if you have more questions to ask your surgeon or anesthesiologist, this will further increase the amount of time spent in preop.

As you can see, coming into the hospital for a procedure is not as easy as walking into a Starbucks and expecting service instantly. There are multiple obligations that have to be performed before one gets into the operating room. I haven't even mentioned other possible sources of delays like getting blood tests or ECG's before the surgery. So please come to the hospital when the doctor's office tells you to show up, not the time of the actual procedure. You'll save yourself and the OR staff a lot of aggravation.

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