People to Know: Jeremy Bengson, MD – Medical Director of Inverness Orthopedics and Spine Surgery Center
Location and parking: Inverness is located at 175 Inverness Drive West. You have two free parking options—uncovered spots are located outside of the main entrance and a parking garage is located to the left of the main entrance.
Walk through the main entrance, turn right once you enter the lobby, and proceed down the hallway toward the elevator bank. Take the elevators or stairs up to the surgery center on the fourth floor.
Before you start:
Schedule a time to visit Inverness in advance of your rotation start date (ideally on an off/post-call day, in order to see normal daily operations). Meet with Dr. Bengson, Lisa Dettmer, or Benny Dhanoa to get a thorough walkthrough of the surgery center, ensure badge/Pyxis access, and meet key members of the surgical and nursing staff.
Review the Orientation Welcome Packet written by Dr. Bengson (heavily referenced here) prior to your first day
Review the “UCHealth Inverness Exclusion Criteria” document to understand patient candidacy for surgery at Inverness
Review the “UCHealth Inverness Surgeon Preference Guide”
Contact the attendings you will be working with the night before your first day (INV_C2 will be your point person; INV_OR will be a second attending likely also overseeing rooms) and make a plan of action for first case blocks. It is possible to have upwards of six first case blocks, which is amazing and wonderful and obviously can get crazy, so plan and communicate effectively J
Important contacts within the Department of Anesthesiology:
- Chris Lace, MD, Vice Chair of Clinical Strategy, Community Engagement, and Quality, Medical Executive Committee (MEC) Member
- Jeremy Bengson, MD, Medical Director of Anesthesia Services, MEC Member
- Lisa Dettmer, CRNA, APP Co-Lead
- Benny Dhanoa, CAA, APP Co-Lead
- Mike Rosario, Anesthesia Tech
See the Orientation Welcome Packet referenced above for additional surgical, perioperative, and pharmaceutical staff.
Codes and logins:
- Door Access (e.g. locker room, conference rooms, ORs, etc): UCH resident badge
- Epic Environment / Context: IP INVERNESS ANESTHESIA
Schedule
First case starts are generally at 7:00 am Monday through Friday (with every last Monday of the month reserved for administrative meetings = 8:00 am start). Cases are generally not scheduled past 5 pm.
Arrive to Inverness at 6:00 am to change into scrubs and begin consenting patients. Always check with the preop RN if it is an appropriate time for you to chat with the patient while they complete other tasks. You will typically be finished around 3:00 pm, depending on the schedule.
Layout:
Surgery center on the fourth floor: take the elevators or stairs from the lobby up to the surgery center on the fourth floor
Turn right out of the elevator bank/stairwell on the fourth floor and proceed toward the two conference rooms on the left side of the hallway, enter whichever is unoccupied, and badge through to make your way into the surgery center. If both conference rooms are locked/occupied, you may enter the surgery center through the patient entrance left of the check-in desk when you exit the elevator bank.
Locker room: located toward the “back” of the surgery center, if you are entering from the check-in desk or conference rooms; proceed past preop/PACU/OR entrances and toward the back hallway of administrative offices, turn right, and badge into the appropriate locker room
After proceeding into the locker room, you will see an assortment of green scrubs (these don’t require badge access). Please return these at the end of the day (i.e. do not bring them home / exchange them at AMC)
Change into green scrubs and place your belongings into one of the generic “Anesthesia” lockers. Then, make your way out to pre-op.
Preop and PACU: Preop and PACU bays are separated; patients will roll back with their brick/monitors and return to PACU with the brick/monitors
ORs: Inverness has 6 ORs
Typically, two attending anesthesiologists will be assigned to Inverness and either split coverage of rooms with APPs or one attending will sit their own cases while the other oversees 3-4 ORs
Break room: located along the back hallway, past preop; does not require a badge or code for entry
Has a water station, sink, microwave, multiple fridges, tables and chairs that you are welcome to use
Daily workflow:
Per the Orientation Welcome Packet, your “primary goal is to learn how to work effectively in a fast-paced, high-performance orthopedic practice, with an emphasis on efficiency, communication, and perioperative management and teamwork.” You will be generally paired with the AIC attending on any given day and be working directly with a team of orthopedic surgeons and sports medicine experts to provide high quality care to a number of patients (including professional and college athletes as a result of UCHealth partnerships). You will bolster your regional anesthesia techniques, become more confident in your abilities to supervise multiple rooms, and see the results of your management plans and peripheral nerve blocks through patient recovery. With that said, daily resident tasks are as follows:
Arrive at 6:00 am and change into green scrubs
Grab the anesthesia charge phone from one of the Cisco phone charging banks (familiarize yourself with the location of these on the day of your tour) and let the INV_C2 attending know once you have it in your possession
Make your way to preop, introduce yourself to nursing staff, review any changes to the schedule and note patients in need of consent/blocks
It is expected that all preops and consents are completed prior to 6:45 am, so that patients can be blocked as appropriate and make it into the OR for their 7:00 am starts. Be sure to update the Encounter Date of the note as preop notes are generally started / signed ~2 weeks prior
The lead APP will create and add you to a daily group text chat—it’s awesome and will make you wish we did this everywhere else…
Be present for induction in all rooms that you are supervising; let the charge attending know when you are heading to induce (or if you are busy with a task that will preclude you from getting to the OR in a timely manner, i.e. IV placement, preop consent, etc.)
Perform all blocks with the assigned attending(s) present
Ensure that APPs/in-room providers get ample time for breaks/lunch; they are encouraged to get their own breaks whenever possible, but it is ultimately an AIC/pre-tending responsibility to ensure this is completed
Before heading out for the day, review the schedule for the next day with your attending and call ALL patients with possible first case blocks. Calling the day before allows you to 1) gather all relevant medical and anesthetic history as you would in preop and to address any “red flags,” 2) to answer any questions the patient may have about their block without making them feel rushed, and 3) to streamline the following day team’s workflow.
Pharmacy:
There are two main Pyxis machines (OR sterile corridor, preop/PACU) and a Pyxis machine in each OR. Returns can be made at either of the main Pyxis machines, but waste of controlled substances must be performed at an OR Pyxis with a witness. If you need premeds to perform a block, do your best to grab them in advance from the in-room provider (alternatively, pull them yourself from the preop Pyxis). Inverness does not have narcotic bags or a centralized pharmacy on the 4th floor.
Blocks:
Inverness has a surgeon preferences document that must be referenced prior to considering and offering blocks to different patients. If you did not receive or have lost access to this document, reach out to a colleague or Dr. Bengson prior to starting your rotation. It will save you a lot of time and headache. QR codes for the Surgeon Preference Guide are posted by all of the anesthesia computer workstations around the ORs and in preop with the most up-to-date version of the “live” document.
The block cart at Inverness is located in the preop nurses’ station by the charge desk, across from preop bay 7. The code to access the cart is 1267 Enter. Confirm the block with your attending and touch base with the pre-op nurse in advance to let them know about your plans and timing. The APPs who preop these patients ahead of time are great at entering ultrasound orders into Epic. DO NOT enter another ultrasound order without checking to see if the patient already has one and cannot be pulled up on any given US worklist. Discuss block dosages with your attending prior to drawing up meds from the block cart.
Once consents are signed/dated and the patient has an appropriate site mark from a PA, attending surgeon or fellow*, you may proceed with the block. Fentanyl sedation can be given prior to the circulator seeing the patient, but any additional sedation including midazolam requires that the circulator see the patient and confirm the necessary paperwork is complete. Perform the timeout with the patient’s bedside RN, save all images from the ultrasound, and chart the block procedure note and premeds as you do on APS.
WARNING
Unlike at other UCHealth facilities, at Inverness, a surgical consent must be obtained by an attending, fellow, or PA. Surgical residents may NOT obtain consent from or mark the patient.
Anesthesia tech:
Mike Rosario is the anesthesia tech for Inverness. He makes it into the OR to help with induction before you can get there almost 100% of the time. He is amazing. He is part of the daily group chat, his cell phone number is included below, and his number is also affixed to every anesthesia machine. Call him for any technical or supply issues in the ORs or preop/PACU.
Key phone numbers:
Anesthesiologist In Charge (Anesthesiologist On Call, INV_C2 on QGenda) x6-9900
2nd Attending Phone (2nd Anesthesiologist, INV_OR on QGenda) x6-9896
Anesthesia OR Numbers
- OR 1 x6-9891
- OR 2 x6-9892
- OR 3 x6-9893
- OR 6 x6-9890
- OR 7 x6-9888
- OR 8 x6-9889
Nursing OR Numbers
- OR 1 x6-9857
- OR 2 x6-9858
- OR 3 x6-9859
- OR 6 x6-9862
- OR 7 x6-9860
- OR 8 x6-9861
- OR Charge x6-9884
- Preop/PACU Charge x6-9899
- Preop x6-9845
- PACU x6-9844
- Control Desk x6-9849
- Anesthesia Tech (Mike Rosario) x6-9881, 815-342-6639 (cell)
- PAT RNs (Mary Griffith, Karen Egan, Jill Pandolfo) x6-9869
- OR Schedulers (Margaret Joy, Taylor Breyer) x6-9868
- Radiology Techs (Tracey Clay, Brian Bodkin) x6-9886