A Locum’s ScrapBook: 2 Amigos & a Bag

I looked this definition up for a reason.  I had just finished up a case with a fellow Locum’s, at a new institution I had arrived to a few days prior.  Two days ago, I worked in tandem with this perfusionist as well as the chief of the program in order to get trained up and ready to cover this account.  We decided initially to tag team the first case, and have the chief back us up and help us get up to speed.

Well that approach was dismissed early, as the degree of difficulty of the case, as well as the tension of having two new perfusionists in the room, was adding to the surgeon’s stress level (which is a totally natural reaction for any heart program).

So a choice had to be made, one of us was going to pump, and the tag team wrestling approach was going to be abandoned in favor of the single sperm sink-or-swim mentality.  Motility 101.  I chose that path, and the case went far better than anticipated in regards to potential degree of difficulty (an aortic valve with arch implications).

Fast forwarding to the following case two days later:  The program chief was committed to another case at another hospital, so the two of us, our own “cohort” so to speak, would be pumping solo for the first time, with me backing up as the second perfusionist.  The equipment at hand?  A Bag, A roller head pump, and an unfamiliar EMR system.

Closed systems:  (bags) are familiar to me because I trained on them as a student and as far as roller head pumps- I have about 7 years of clinical experience using them as well.  My associate (the second Amigo) was just as familiar with the concepts, so the challenges at hand were to work with a pump that was one generation newer than similar pumps that I was used to from that particular manufacturer, generating staff and physician confidence, and making sure I had mapped out locations for all of our disposables, fluids, meds, and equipment.

All of this represents a predictable process that Locum’s perfusionists encounter:  Intro to new clinical geography (how to get there and where to find it kind of stuff), intro to new staff; intro to new surgeons; intro to new paradigms, intro to new CQI and administrative processes, and negotiating the hardest road of all, personalities.

Personalities:  Today, personalities weren’t an issue whatsoever.  We were solo, so there wasn’t anyone to compare us to or to defer to.  We were the bottom line, hence the title of this post.  Plus… We both respected each other, and there wasn’t a hint or a sniffle of ego entering into the arena 🙂

Equipment?  It’s always different at any place, some pieces more updated than others, some shinier, some with a little bit of wear and tear, but all in all?  You always face a learning curve thing, and it’s usually just brushing up on one or two items if you have been doing this for awhile.

New Doctors & Staff?  Well the staff here couldn’t be any more friendly and accommodating.  The surgeon had a feisty personality, and overall was clearly an advocate for his patients.

Communication:  This was a first for me.  The surgeon wants us to read him the ABG results when we get them.  To me, that’s like inviting a fox into the hen house, as I take a lot of pride in having perfect blood gasses, plus it establishes a pathway to communicating with the surgeon and conveying a sense of confidence to that surgeon, that we know and OWN what we are doing.  Do it long enough, and eventually the surgeon will be so comfortable with you- he will not ask, and totally forget your are there.

The perfect pump run?  He forgets you are there 🙂

The Elephant in the Room:  Today, the EMR system (or the lack of familiarity of the clinicians assigned to employ it) had some issues.  Reboots, phone calls, lost data, and hard crashes.  All of which are easily dealt with but a distraction nevertheless.  The way I look at it, you can’t blame the system you are using if you aren’t familiar with it.  In this case, yeah we knew our perfusion equipment, but the data entry thing was less familiar, and as all things unfamiliar, can take awhile to assimilate.  Losing the ability to electronically chart can create unnecessary stress and undue disorientation from the task at hand, but still has it’s place in terms of clinical prioritization.  My position statement is pretty simple:  patient care and attention to clinical detail comes first- data management and documentation can easily be placed on a back burner and entered retrospectively in the event of software or a computer failure.  Clinical acumen should never be paralyzed or diminished due to undue reliance or pressure to document if the process to document becomes more burdensome than the attention to clinical detail necessary to safely conduct cardiopulmonary bypass.

It’s called troubleshooting:  This isn’t a post designed to diminish or discard the obvious benefits of EMR charting.  It isn’t a review or comparison of any software system versus another.  It is about our reliance on computers , software programs, and our ability to navigate through it.  Every time you use an new charting program, it becomes easier and less of a hurdle.  It’s a practice over time thing.  Just like anything else in our field, you acclimate and eventually that elephant transitions to mouse 🙂

My backup plan for any place I go to I always bring a flashlight.  That is true physically and metaphorically.  What is my flashlight if data systems become locked out, inaccessible, or become unduly distracting to patient care?   A  backup perfusion hard copy record- just in case.  Can’t stop charting just because of mechanical, electrical, computer, or human error.

Putting it all together:  Today was a fun day. The two of us had never worked together, came to the table with similar skill and mind sets, both share the same passion, and we had a lot in common.  Basically the same thing as putting two airplane pilots together in the same cockpit of a plane neither one has ever flown before.  As long as you apply the same principals that got you there, and trust your co-pilot, your passengers are gonna be OK.

Thanks DC!  🙂