Tuesday, October 9, 2007

Operating on no sleep

We in anaesthesia do not work after being on call. This has always been a topic of derision among our surgical colleagues.

I was having supper with the former OR director at my former hospital a few months ago. The OR director is the poor sucker who is responsible for the smooth running of the operating room. This poor individual tried to do his best for over a year frustrated by the OR administration who wouldn't take his advice and his own Department who wouldn't back him up so he quit and went back to just being an ordinary anaesthesiologist and we went without an OR director for over a year until we found someone stupid or optimistic enought to do the job.

Anyway my former hospital does a lot of transplants. For various reasons most of these occur at night. There are reasons for this. You have some poor soul in ICU who is beyond hope. At morning rounds the decision is made to abandon life support and think about organ donation. By the time all the necessary tests have been done to establish brain death and all the relative have had their last visit, most of the day has passed and we are in to evening which is when the "harvest" starts. This means that the liver, heart and lung transplants don't start until close to or after midnight.

This of course means that if we can potentially have 1 heart transplant, 2 lungs and a liver all going on at the same time. That means that 4 sub-specialist anaes are working all night. These services are not staffed so that the anaes. is off post-call, however most individuals have no interest in working the next day. Therefore however is the OR coordinator is supposed to find 4 anaes to fill in the next day. Although there are a number of part-timers who can be called on, this can be a problem. After such nights there is usually a massive shuffling of lists which is annoying to those POAs in the department.

Surgeons however, like the alcoholic who believes he is witty and sexually attractive when drunk, still believe they can operate competently on no sleep.

My colleague was faced with this problem one morning of trying to find anaes. to work. He looked at the list and saw that one of the cardiac surgeons scheduled to work that day was also one of the individuals who worked all night. He spoke with the individual, a paediatric cardiac surgeon, who assured him that he intended to do his elective list, even though he had worked all night. So my colleague shuffled rooms and cajoled people and the surgeon was able to do his list.

The surgeon's elective case which was a paediatric patient and a re-do died on the table. My colleague still wonders whether he should have just cancelled the list.


T. said...

This should be required reading for EVERYBODY - patients, surgeons, legislators...EVERYBODY.

Dragonfly said...

Interesting post. That certainly is an issue. It is good to see more awareness of fatigue as a safety issue, I am somewhat hopeful (though realistic) that by the time this is an issue for me, some things will be different. But am resigned that they won't be...