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While some cases end up taking longer than one thinks, certainly anything that you know going in will be markedly more than 30-45 minutes should NOT be performed in the ED setting.  That is what surgi-suites, same day surgical units and offices are for.  It is neither an appropriate use of an emergency department or its staff AND it may be unsafe for the patient, particularly if the case requires sedation for prolonged periods.  General anesthesia is a much better way to go.  I'm surprised your hospital does not restrict his activities.  I'm assuming that these cases are ones coming initially through the ED that require consultation and not his elective private patients - I've seen that in some community EDs and it drives me crazy!

Jackie Corboy
Childrens Memorial Hospital
Northwest Community Hospital

________________________________________
From: Pediatric Emergency Medicine Discussion List [[log in to unmask]] On Behalf Of Thomas Krzmarzick [[log in to unmask]]
Sent: Thursday, April 01, 2010 7:53 AM
To: [log in to unmask]
Subject: Length of plastic surgery procedures in the ED

Recently, one of our plastic surgeons is repairing complex wounds in small
children in the ED rather than take them to the operating room.  Several of
these cases have lasted 4 hours (one case was 6 hours).  He has been
resistant to having these patients sedated for their procedure.  I don't take
patients to the OR so I don't know everything that goes into the decision
making process.  My gut tells me that a case that takes longer than 90
minutes or so needs to be done elsewhere (OR).  Besides the care issues,
tying up my PCA/nurse for hours (or ED MD if he would let us sedate these
patients) is detrimental to our patient flow.

I am trying to get a feel for what is done in other peds EDs.

Do you have a limit on the length of the case that can be done in the ED?

How do you handle these type of cases in your institution?

Thanks.

Thomas Krzmarzick M.D.
Medical Director
Dayton Childrens

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