Survival Skills

Brodus Franklin and Jaime Gasco

Note to the reader: Some of the material contained in this chapter is a matter of the authors’ opinion, and should not be considered absolute fact.

11.1 Managing a Service

How should you manage your service?

1. Keep an organized list.

2. Know your patients and care for their progress.

3. Talk to families daily.

4. Communicate with other teams effectively.

5. Turnover and disposition should be planned the moment a patient is admitted.

What is the concept of operational readiness condition (OPERCON) when running a neurosurgery service?

That means you have, in your mind, a sense of the overall status of your service that enables you to anticipate the critical decisions that you will need to make. The more critical actions or decisions to be made, the lower the OPERCON status (similar to the DEFCON—defense condition—status).

What is your “mental OPERCON” influenced by?

A combination of factors:

1. The status on the floor

2. The status in the ICU

3. The pressure from attending/upper levels (Figure 11.1)

Status of Service	Exercise Term	Description
OPERCON 5	At ease	No immediate action required. Things are moving well. Standard watch of the service and clerical work May perform activities related to academics when free
OPERCON 4	Prerounds Preop checks Postop checks	Ensure the safety of the patients, implementing changes that may need immediate correction. Keep things secure.
OPERCON 3	Rounding Nonemergent consults	Increase in readiness. Promptly leading your service and seeing consults. Communicating with attending regarding their patients and with chief of service
OPERCON 2	Multitasking required Multiple consults Emergent consults Procedures required	Rapid response to emergency consultations. Need to adapt to multiple consultations and/or procedures in a short span of time. Decision and action take priority over anything else. Prioritization and judgment are required.
OPERCON 1	Coding/emergency surgery	Highest level of performance/speed and critical decision making. *You are in charge and others rely on you and your leadership.* Display a combination of effectiveness, knowledge, and control of the situation.

Fig. 11.1 The OPERCON levels represent a guideline of grades of “awareness” to consider when managing a service. Each clinician should have a method to be alert proportionally to the level of difficulty presented by the service each day.

How should patients be presented?

Be systematic, always the same way.

Follow a coherent order.

Only gold members can continue reading. Log In or Register to continue