The Personal Health Navigator is available to all Canadian patients. Questions about your doctor, hospital or how to navigate the health care system can be sent to AskLisa@Sunnybrook.ca
The Question: My father has been on a “wait and see” list for 36 hours, with an IV drip. Once they know surgery isn’t going to happen, why wouldn’t they feed him normal food?
The Answer: The “wait and see” surgical list is ubiquitous to Canadian hospitals. That’s because a hospital, with finite resources, must operate at or near occupancy to be efficient in the public health care system. This is in stark contrast to the United States, which has the ability to treat a paying patient more quickly in a private system where hospitals, in some cases, are only half full and are looking for business.
Since your father came through emergency department, he did not have a booked operation. He was deemed clinically stable, put on an intravenous fluid to keep him hydrated, then placed in a queue for the operating room. This is probably the most frustrating part for patients. He will wait for some time – hours, sometimes several days – to move up the queue, knowing that a more ill or injured person who is admitted will be bumped to the top of the list. Conversely, a booked surgery may be cancelled, and your father may quickly be seen.
Still, your point is a good one: you simply want to know why he wasn’t fed and when a surgeon makes “the call” to say your father can now eat, then try the next day to get into the operating room.
“On the acute units, we depend on the call from the surgical team for further information about the planned surgery,” said Smitha Casper-DeSouza, patient care manager at Sunnybrook Hospital. “As soon as we know, we inform the patients/families.”
Patients on the “wait and see list” include those with fractures, diverticulitis, gallbladder issues or bowel obstructions.
“Sometimes a patient might be fourth on the list and might be waiting for two days,” said Ms. Casper-DeSouza. “You are on a priority list but other urgent/emergency situations may arise. The most important thing is you are medically stable and are being monitored.”
Your father is restricted from eating or drinking, to decrease the risk of vomiting during surgery so he is ready at a moment’s notice to go into the operating room.
Cynthia Holm, director of operations, OR and related services at Sunnybrook, said the physician decides how a patient will be booked. The patient could be booked into that surgeon’s elective schedule or it could be given a higher priority.
“All patients on an emergency list are further actively reviewed by the surgical team as to patient priority and patient flow,” she wrote in e-mail.
Still, it can be hectic in a hospital and they may not get back to you as soon as you would like. When that happens, ask the nurse looking after your father or the team leader for an update.
Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Her blog is reprinted on healthydebate.ca with the kind permission of Sunnybrook Health Sciences Centre. Send questions to AskLisa@sunnybrook.ca.
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Five days, assuming the patient is healthy, has been eating a good balanced diet up until those five days.
People have to stop eating for five days after stomach or bowel surgery, it may not be optimal, or perfect, but it works, the majority of the time. Will there be outliers? Of course, but how can one predict, there is no test other than a good history and physical.
Thanks for those comments, Alain. That is helpful for patients to know.
Assuming the patient is not nutritionally deficient an IV drip at 125cc/hr with a glucose solution will satisfy all metabolic needs for five days. Studies were done in the 60’s and that knowledge is now considered expected of all surgeons.
It is actually a question on the Board exams.
Assuming the patient is not nutritionally deficient, an IV drip with glucose will satisfy all metabolic needs for five days.
This is from the Royal College Principles of Surgery exam
Nicholas,
Thank you for your very thoughtful comments, especially your insight as a gynecologist providing care. It’s been my experience as well that patients are surprised to learn of these everyday realities.
This is a very difficult process to experience for patients and care providers. As a gynaecologist, we provide care for patients requiring semi-urgent surgeries, common one being a dilatation and curettage (D and C) for miscarriages. As these are deemed not “life-threatening” or emergency surgeries, women do frequently have to wait for protracted periods of time getting “bumped” by more urgent cases. Both the patient and the doctor have to put many things “on hold” while waiting to do the procedure after hours. It would seem simple to bump an elective case during the day but bear in mind those cases have waited many months to get there and have arranged support, time off, they have farmed out family obligations etc. This is VERY disruptive to this group of patients, their work and their families. It is very difficult to provide truly patient centred care in our present system as it is designed.
Every surgical specialty has similar issues- hip or other fractures for orthopedics, semi-urgent gall bladder problems or appendicitis for general surgeons, etc. etc.
In my experience patients are very shocked to learn of these kinds or everyday realities of our system. Unfortunately it is only when people have to navigate the system for these or other reasons do Canadians find that we do have serious problems with access to care.
Thank you for your comment, Barb. Infections are an important patient safety issue.
From the patient safety perspective, something that is worthy of consideration is the increased risk of infection to the patient resulting from inadequate nutrition for an extended period of time prior to surgery.
If the patient should sustain an infection, not only will he/she suffer and possibly die, but there might be an extended stay in the hospital causing further postponement of surgery for other patients. The human and financial cost of infection is not something that should be ignored.