by Elizabeth Hofheinz, M.P.H., M.Ed., September 18, 2019
What bugs surgeons in the OR? We decided to ask one high-volume spine surgeon. He had a lot to say.
First of all, “variability” is not a word that is often welcomed in any OR. “There is significant variability in the quality of the xray techs who participate in our surgeries. Worse, it is often totally unpredictable which xray techs participate in surgery on a given day,” says this surgeon. “So often I don’t know who my xray tech is for a given case until the moment I walk in the OR. And that person may be changed out in the middle of a procedure. Having a dedicated xray tech enables someone to more deeply understand some of subtle tips about how to image the spine such as rotating the C-arm and radiation safety such as collimation. Unfortunately, within most hospitals including my hospital, the xray technicians work for the Department of Radiology. Thus, their leadership is not part of the operating room team and they are not familiar with operating room procedures.”
“For example, the xray technicians shifts change at 8am which usually corresponds to the middle of surgery since my surgeries start at 7am. The truth is that xray techs do little fluoroscopy training as part of their schooling. The xray technicians are also not exclusively dedicated to the operating room. Thus, they xray technicians might do a chest xray on a hospital floor and then come work in my spine case. I believe that this compromises reliability and reproducibility.”
“Overall, it would be much better as far as image quality and radiation safety if we had dedicated xray techs who are accountable to OR leadership. To remedy this problem, the operative service lines at hospitals should include service specialties that affect operating room efficiency and safety, such as intraoperating imaging, sterile processing, and environmental services.”
We often hear that physicians didn’t go to medical school to do paperwork. But, says this surgeon, the same can be said for some nurses. “We have circulator nurses in the operating room to police sterility, acquire instruments and equipment needed on the operative field, and to interface with anesthesia. If, for example, in the event of a dural tear, they should be preparing to open instruments to repair the dural tear, such as sutures, instruments, sealants, and perhaps even a drain. Unfortunately, the responsibilities of many circulator nurses conflict significantly with their requirements for documentation. The amount of documentation required of nurses now in OR is outrageous. The circulator nurses are chained to a computer doing charting for the vast majority of a case…they are not doing nursing! There are pages and pages of information to chart and log in. Unfortunately, it is now to the point where the charting is interfering with their ability to anticipate what the surgeon might need.”
“As it is now, they are so focused on the charting requirements that they are not able to anticipate the next step of a procedure. While things are often ‘templatable’ for us, they are not for nurses. They have to document who positioned the patient, who placed the SCD [sequential compression device], what is the lot number of the screws that were used, etc. While important to know, shouldn’t we put ‘live’ patient care ahead of those things?”
Lastly, he says, leave Pavarotti or the Black Eyed Peas out of the OR. “I think that playing music in the OR is a distraction from what could in some situations be a life-or-death experience. Your lag time is longer to do anything because you are focused on the song. I equate it to driving in really bad weather…the first thing you do is turn down the radio so that you can divert your senses in order to see better and focus. There is no music in court during trials…or in any other professional setting…why should it be in the OR?”
