Table of Contents

4) Letter to MAB informing them of our decision with regards to 1) and 2) above
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

First, before we get to the results proper, an apology about the wrong dates quoted in the first paragraph of the questionnaire that was sent out. I really can't for the life of me figure out how November became March but it happened. Sorry.

Secondly, thanks to all of you who have taken the time and trouble to reply to the questionnaire promptly. Everyone sent in their replies in time to be included to be presented to the MAB.

Note that the numbering that follows corresponds with the numbering in the questionnaire. Secondly, some of you did not actually mark in the appropriate box to indicate your vote. In these situations, if any comments were given, I have cast your vote according to the comments given. Hope I didn't make any mistakes.

Now on to the results.

At its meeting held on 10 November, 1999, the MAB agreed to our proposals in section 1 more or less in toto.

1) Difficulty in Getting Anaesthetist for Code Blue Situations

    1) a) Weekly Anaesthetic Roster

A few of you have also given suggestions on how the roster should be formatted. Basically, the list of anaesthetists covering the emergencies for the day will be listed in one column right next to the date with the relevant times printed next to each name, e.g.
 

A footnote incorporating the relevant sections from 1) b) below will be added to the weekly roster.

    1) b) Contacting an Anaesthetist for Non-Operative Emergencies

To reiterate,

1. One person shall be designated as the Contact. This will be,
1. During office hours (0800-1800 on Mon. to Fri. and 0800-1300 on Sat.), the Coordinator of the North Tower Operation Theatres, and
2. Outside of office hours, the Deputy Nursing Administrator (DNA) for OT.
2. All non-operative emergency cases shall be referred directly to the Contact who will be fully responsible to get an anaesthetist to attend the emergency. The order of preference will be,
1. Emergency or 1st on call anaesthetist
2. 2nd on call anaesthetist
3. Any available anaesthetist still in the hospital
4. Other anaesthetists outside the hospital
3. The Contact must be informed of the reason for the referral to judge the urgency of the case and to inform the anaesthetist. It is not sufficient to say that Dr. X wants an anaesthetist.
4. All anaesthetists must cooperate and come when called. If you are not in the hospital, please inform the Contact how long it will take you to reach the hospital so that she may arrange for another anaesthetist if necessary.

As agreed previously, if the responding anaesthetist is not covering emergencies, he or she has the option of handing the case back to the person covering emergencies if he so desires.

    1) c) Distribution of Weekly Anaesthetic Roster

The weekly anaesthetic roster will henceforth be distributed to all the wards, including ICU, CCU, HDU, Daycare, ER and Labour Ward. At the MAB, other areas like Endoscopy/Daycare Services, Diagnostic Services, Haemodialysis Unit and so on were suggested to be added into the list.

    1) d) Changes to Anaesthetic Roster

As agreed,

1. Any changes to the roster must be communicated to the Contact.
2. During office hours, the Coordinator will inform Medical Staff Services (Ms. Doreen Loh) at Ext. 6680 who will be responsible for informing all other critical areas including ICU, CCU, HDU, ER and Labour Ward (and other areas as noted in 1) c). After office hours, the DNA will be personally responsible to inform all critical areas.

    1) e) Care of ICU/CCU Patients Who Are Already Under the Care of an Anaesthetist

To recapitulate,

1. The anaesthetist concerned is responsible to ensure continuity of care to the patient.
1. If he knows that he will not be available, e.g. when going on leave, he should arrange for another anaesthetist to cover him during his absence.
2. If he is unexpectedly called, and is unable to attend to the patient, it is the responsibility of the anaesthetist to arrange for a colleague, generally the anaesthetist covering emergencies at the time, to attend to the patient.
2. The anaesthetist is personally responsible to find a replacement anaesthetist and should not pass off this responsibility to the primary physician.
3. While he may ask the Contact to find out who is available, he must, nonetheless, personally speak to the other anaesthetist to ensure that the other anaesthetist is fully aware of the clinical status of the patient.

If approved by the MAB, the above procedures in 1) a), b), c) and d) will be passed on to the appropriate nursing and administrative staff to ensure that they know the proper procedure to follow. (The above were accepted by the MAB at its meeting on 10 November 1999.)

2) Allocation of Operative Cases/Lists

    2) a) Additional Cases in Scheduled Lists

It is hereby agreed that all cases added by a named surgeon into his own list, whether they are elective or emergency cases, and whether or nor other surgeons have added cases into the list, shall be anaesthetised by the scheduled anaesthetist.

    2) b) Replacement Cover for Saturday 1st Call in the Afternoon

Henceforth, if on a Saturday, the 1st on call has an afternoon elective list, a third anaesthetist shall be asked to cover him until he finishes his elective list while the 2nd on call continues to cover the 2nd call.

Several members also stressed that those who have an elective list on Saturday afternoons, should not ask for and should not be given calls (1st or 2nd) on those days to avoid this problem in the first place.

3) Other Matters

    3) a) Elective List Overruns

While all agreed that the emergency list must go on, many mentioned that the staff staying back must be adequately compensated for their dedication and hard work. The suggestion is that all elective lists going overtime should be charged the full second team charge and that this be used to pay all those staying back their well earned second team charge on top of their overtime pay.

    3) b) Standard Instructions for Fasting of Patients for Elective Surgery

I will circulate a draft of the Instructions within a week or two.

Some have stressed that if one anaesthetist has "failed" a patient based on inadequate fasting time, we should all respect his decision and not override it and continue to do the case.

Remember that this only applies to elective cases. Also, these are not guidelines but are only instructions to the patients to reduce the chance of misunderstandings about the required fasting times and how to deal with solids, clear fluids and non-clear fluids. It is still up to each anaesthetist to decide on each individual case as he sees fit.

    3) c) Obstetric Epidural Chart

To facilitate the above, I will circulate another short questionnaire for you to state your technique so that everyone's technique is included in the chart.

There was a suggestion that instead of a form, we use a rubber stamp instead. I will include this option in the questionnaire for the epidural chart. This is actually a pretty interesting idea. My only concern is that the rubber stamp may be too big.

    3) d) Cleaning of Anaesthetic Drug Trolleys, Machine Work Surfaces and Drug Trays, and Checking of Soda-lime Absorber.

This decision will be communicated to the OT Nurse Manager.