Scheduling surgery is like a game of chess

In early 2021, I was appointed Deputy Chief of Anesthesiology. Because it is a grass-roots hospital, the talent echelon construction is not perfect, and the department does not have the position of “inpatient general”, and the daily work is handled by the director of the department. The overwhelmed head of the department handed me over to arrange surgery, shifts and some daily chores. Since then, my life has undergone a qualitative change.

Before, reading, raising children, walking, traveling. Now, from home to the department, from the department back to home, there are constant calls every day. In fact, I became a veritable “inpatient chief”, playing a big game with the operating department every day!

“Get out of the car (ju)!” A neurosurgery “internal carotid artery ablation” released a big move.

“Cannon!” An emergency “transfemoral cerebral arteriography + thrombectomy” in the neurology department was a surprise soldier.

“The Boy Scouts launch a full-scale attack!” 8 children under the age of 5 in the ear, nose and throat “tonsillectomy + adenoidectomy” required general anesthesia.

“The old group is coming!” Three orthopedic 6 units over the age of 85 “femoral neck fractures” need “total hip replacement” or “PFNA intramedullary nail fixation”

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Woke up from a dream, looked at my phone, 4 o’clock in the morning… Two words lingered in my mind for a long time, so I opened the memo on my phone and wrote down – “play chess” two Character. The mind became clearer and clearer.

The opponent’s ten main armies are the first, second, third, bone one, bone two, bone three, gynecology, obstetrics, otolaryngology, stomatology, and elective surgery as the main force. The main battlefield attacked our army (anesthesiology and surgery department), and the other three cavalry battalions neurology, pain, and ophthalmology have long been outflanked by emergency and expert surgery. As a sharp knife, it is directly inserted into the heart of our army, while emergency tracheal intubation in various departments and painless delivery in obstetrics are hard to prevent as long-range attacks. Among our twelve generals, there are still two expeditionary troops “painless endoscopy” and “fever clinics” stationed outside all year round, and except for those who work at night, after night, and on public holidays, the number of people available every day is actually very small. How to play this game of chess?

Every day, opening the “surgery notice” for elective surgery is like seeing the top ten operating departments in action. The so-called know yourself and the enemy, and you will not be imperiled in a hundred battles. Therefore, first look at the number of operations, the size of the operation, the estimated operation time, and then look at the age of the patient and the complexity of the operation. There is a teacher in the operating department who is responsible for arranging surgery like me. The two of us will cooperate according to the type of surgical incision, the age of the patient, the severity and complexity of the surgery, the needs of special equipment for surgery, and the differences in the operating room and the needs of anesthesiologists and operating room nurses. Considering all aspects, first arrange a certain number of operating rooms.

The same department should try to arrange the same operating room;

Surgeries that require the same special equipment should be arranged in the same operating room, such as surgeries using C-arms;

Pediatric and elderly patients are prioritized;

Incision type I surgery should be arranged first;

Next, I will comprehensively consider the anesthesiologist’s familiarity and proficiency in different surgeries and anesthesia methods, as well as the workload of the previous day, consider the fatigue level of the anesthesiologist, and combine with the surgeon’s level , operation speed and even habits, etc., arrange different anesthesiologists to be responsible for different operating rooms, one person one operating room, one-on-one battle. In addition, arrange one or two people to be responsible for emergency and expert surgery. If emergency or expert surgery is like a small raid team that suddenly appears on the army position, it is similar to interspersed and sharp knife squads. , Experts perform several operations at the same time, and they have to temporarily assign rest personnel to work overtime, and the same is true for the nursing team in the operating room. At this point, the surgical arrangement is over. After setting up the battle, the operating room is the battle ground, and the decisive battle begins.

In fact, the enemy of this game of chess is not the operating department, but the disease of the patients in the operating department. The anesthesiology department, the operating room and the operating departments work together and coordinate with each other, placing their pieces in the best position and defeating the disease together, which is the biggest victory! It’s a good move!

Author: Wang Wenjiang, graduated from Xinxiang Medical College with an undergraduate degree in anesthesia. He is currently the deputy director of the Department of Anesthesiology of Yichuan County People’s Hospital, a member of the Anesthesia Professional Committee of Luoyang Medical Association, and a tumor of Luoyang Medical Association Anti-Cancer Association. Member of the Standing Committee of Anesthesia and Analgesia Professional Committee.

[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~