A contribution from Dr.Caridi-Schieble (anesthesiologist): This is the first time as an anesthesiologist that I was actually excited to hear that we were on PACU hold. A dreaded event in the states, here in Haiti we were just shocked we had already done that many cases so early in the day! Of course in the greater picture it means we're able to help more people here, but what I was most amazed by was the level of efficiency in the OR that we had achieved with so little resources.
Monday was a slow start, but we still managed to do 5 cases. The next day, we scheduled 7 cases, aiming high but with a warning to the students that everyone was going to have to tighten up if we were going to do this. Of course the students took this as a challenge with the fervor and confidence we've come to expect of them. Over dinner that night we talked as a team about how we were going to get this done. We identified all the little lapses that slowed us down, assigned roles, and everyone championed some small part of the day to make sure everything stayed on track. Everyone from tech to attending had a contribution, and everyone committed to the goal. We got our turnover time to as little as 10 minutes and all the cases got done. The next day we were running ahead of schedule and the PACU hold ensued. Wednesday, we even got PACU sorted out and 7 cases done without a hitch. Then my mind was completely blown today: 9 cases. Wow.
There is a lesson here I think for the US where we groan and agonize over inefficiency and OR culture and workflow and then throw our hands up during endless committee meetings when we never seem to be able to change things. How is it we were able to so quickly adapt and improve our flow in a setting where we have so little resources?
I think the secret lies in the dinner the night before. Surgeon, anesthesia team, scrub nurses, students, translators, everyone all talking about the cases the day before. All feeling comfortable enough to voice their concerns, and everyone be visible enough to be accountable for their part. Criticism is accepted. As a group we have worked and planned for months, shared a living space, and know each other as people as well. So when we need to pull it together, we stand ready to talk to each other and make miracles happen, even to overflow a Haitian PACU.
MS4 Lindsey and MS3 John discussing next day OR schedule with surgeons Dr. Haack and Pettitt and anesthesiologist Dr. Caridi
Dr. Haack, Saiying, MS4 Beth repairing an inguinal hernia