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Afternoon,
Slight correction PACU Hold tracking spreadsheet link is https://app.smartsheet.com/b/form/6fa7650838ba4d0db75a182870789592
Thanks, Gen
From: Marshall Tenenbein, Dr. mtenenbein2@hsc.mb.ca Sent: Wednesday, September 3, 2025 2:03 PM To: hsc-clinicians-anesthesia@lists.umanitoba.ca Subject: HSC Anesthesia Update September 2025
HSC Anesthesia Update – September 2025 I hope everyone had a great summer, whether it was spending time with loved ones, travelling, spending time at the lake, or just enjoying one of our city’s fantastic summers. Now that the OR is back in full swing, I thought it would be a good time to send out an update email. For those new to the department, I try to limit the amount of times I send out department wide emails. As a result, sometimes they can be quite lengthy, but at least have the advantage of all the information being in 1 place.
OR Capacity: Starting yesterday, Sept 2nd, we officially returned to full slates. HSC OR is scheduled for 17 slates. On some days this means 16 slates and a full DCD room, on other days it means 16 scheduled slates and 1 slate split between DCD in the morning and ACSS (Gold) in the afternoon. We will usually have 15 slates in the main OR and 2 slates in ND OR.
OR Nursing: Over the summer, OR nursing numbers have been quite good. We were able to run the DCD room on the majority of days. However now with the “summer slowdown” ending, I predict it will be harder to consistently staff the DCD room but time will tell. At the very least, I believe a trauma hospital needs to have the capacity to “pull” staff from other theatres in order to deal with life threatening surgical emergencies. We also prioritize honouring the Gold time, sometimes resulting in closure of the 4 hours of DCD time but opening up that room in the afternoon for Gold. We will continue to schedule the IHA in the DCD room which has a slate guarantee. For a full list of guaranteed slates, please refer to the smartsheet: https://app.smartsheet.com/b/form/b804b59ce0594f66909c956e046ac0d7. The weekend slate guarantee is a different smartsheet: https://app.smartsheet.com/b/form/2feb68c4a5a44d3d85c4fecf9a46a56d
Emergency List: This year’s summer slowdown was the smallest ever. We went down to 13 rooms, typically this was 10-11 in the past. As a result, we did a large amount of emergency work during the day: ortho trauma/Gold/Spine/Random cases in DCD time. Overall, the emergency list remained quite manageable over most of the summer with some short periods of ballooning. Getting to E3’s quicker helped the hospital’s bed base numbers which helped us by resulting in a smaller “PACU Hold” problem PACU: As above, PACU holds have been reasonable over the summer, however we all know this problem worsens with increased elective slates and decreased hospital capacity. We are working on finding a balance between maximizing the amount of care we can provide while at the same time not biting off more than we can chew. HSC is in the difficult position of having a large waitlist of life prolonging/improving complex operations while also having to deal with emergent operations which can’t be performed anywhere else. Reducing OR access for either of these surgical categories is extremely difficult. In order to mitigate the PACU hold problem, in the afternoons, a significant part pre-op holding will be used for treating patients who have achieved criteria for PACU discharge but can’t be discharged from PACU due to flow issues. As a result, the remaining part of pre-op holding will be prioritized for in-patients and for patients receiving pre-op epidurals, regional blocks etc. On occasion, day surgery, short stay and SDA patients may stay in MS3 until being brought down direct to the OR. This means we can go up to MS3 to assess patients. I appreciate this is less than ideal, but it is a small inconvenience to help with PACU problem. We will be keeping the direct to MS3 pathway for Phase I recovery, so assessing your next patient before coming back down is a reasonable pathway. Please use the smartsheet so that we can track PACU holds: https://app.smartsheet.com/b/form/b804b59ce0594f66909c956e046ac0d7
Personnel: HSC has an extremely strong group of Anesthesiologists, numbering around 55. Total FTE is around 32 which is extremely close to our required FTE. In terms of overnight, in-house calls, a 1.0 HSC FTE should expect to do around 12 each of maternity and OR call per year. Liz Konrad has returned from her parental leave. She can be reached at 204-479-1560. We thank Drexler for his exceptional service in her absence. We hope to see Drex again as we are in the process of increasing our RT FTE in the very near future. Cell Saver: No major new developments at this time. Perfusionists remain on call to HSC 24/7, but are not in house on days M-F as they were in the past. For elective cases, we have been providing them with advanced notice of cell saver cases for which they have been providing excellent service. In emergency situations, they should continue to be called in via St B paging. We are working on initiating a training program for RTs and ACAs to learn cell salvage. This has been happening informally during cell saver cases with the perfusionists, but more robust training is required. There are also issues related to the ACA contract of supervision contract with the CPSM that need to be addressed. Equipment: We have a fair amount of video laryngoscopes on the floor. Unfortunately, many are approaching end of life and will need to be replaced. We will be using them until they are no longer safe and functional. Ultrasound machines can be scarce first thing in the morning, but our supply appears appropriate during other parts of the day. I think the main issue is residents coming early and claiming the ultrasound machines for their OR “just in case” the Artline is difficult. I’m not sure if they are being told to do this during boot camp or receiving feedback from attendings about being prepared for all possibilities. Personally, I believe this is a reasonable practice after hours when cases can be urgent, patients unstable, limited help is around and only 1 or 2 rooms are running. However, elective cases are quite different and can be a good time obtain the necessary competency of non ultrasound guided artline insertions. There are many occasions when the ortho Anesthesiologist needs an ultrasound to do a quick brachial plexus block but an ultrasound isn’t available because it is waiting in theatre 6 for a central line insertion eventhough the patient is still in an induction room for an epidural insertion. I think by delaying to claim an ultrasound until the time when it is actually needed will go a long way. The goal live date for the long awaited TEG 6s is September 22nd. The vendor, Haemonetics will be providing on-site training at HSC next week from Sept 9-Sept 12. Please make every effort to attend a drop in session during the day in room JJ-294, around the corner form our Team Room. The B Braun large volume pump saga is continuing. We are being told critical care will be switching over to Fresenius Kabi pumps for vasopressors and inotropes but still use B Braun for everything else. Personally I don’t like the idea of having 2 varieties of large volume pumps in the OR. Having just 1 vendor in the OR makes sense but we will have some issues with tubing compatibility for when Anesthesiologists want to use pumps for volume management in large cases such as neuro. Patients will be coming up to the OR with B Braun tubing, and will have to be sent to the ward with B Braun tubing, so I think any FK tubing we use will have to be Teed in to the B Braun tubing. Unfortunately, the decision to go with B Braun without conducting a clinical trial involving the OR is resulting in huge waste of money and increase in disposable plastics. In discussions with Priya in PACU, they are a bit in the dark with plans going forward, but anticipating a blended large volume pump arrangement in PACU.
The syringe pump RFP is a bit different. We were all invited to a hands on demonstration for 4 vendors. Of the 4, those who attended quickly eliminated 2, leaving Medfusion (our current product) and Baxter. Unfortunately, Baxter later withdrew their submission leaving us with Medfusion. The only other possible option is the BD Alaris syringe pump, which we had previously eliminated. Personally, I think we should proceed with Medfusion considering the pump has served us well for over a decade. We mostly have the 3500 model in the region, with some 4000’s around. Considering we all will have to be trained on the FK large volume pumps, I think it’s best not to have to learn a new syringe pump which was judged as inferior.
PAC As many are aware, PAC nursing screens all charts and the vast majority are deemed to either requring a formal PAC assessment vs not requiring a formal assessment. A small substet of charts are in a grey zone and require screening by an Anesthesiologist to determine whether a full assessment is needed. With HSC having around 55 Anesthesiologists, PAC nursing has seen a wide range of variability in practice/opinions. As a result, we are trialing a new system for these “grey” zone charts where a smaller group of Anesthesiologists make the decision. This group will be those who work in step down. We are attempting to schedule an Anesthesiologist who does step down in PAC at least once per week. For ND cases, PAC sheets are clearly marked and highlighted, so please take this in to considering when approving patients for ND OR.
Department Emails: HSC Anesthesia now has a department “mailman list”. For department wide communication, you can write to hsc-clinicians-anesthesia@lists.umanitoba.camailto:hsc-clinicians-anesthesia@lists.umanitoba.ca. A moderator will then release your email for distribution.
APS: We have a strong group of APS physicians numbering in the low 20’s. APS continues to be divided Tues-Thurs, and Fri-Monday stretches. The typical APS physician is on APS 4 times per year, or 2 total weeks which I think is a sweat spot. APS continues to take the brunt of offsites which can be extremely challenging at times. There are days with limited to zero offsites but other days which are extremely busy. The goal is to limit offsites to less than 4 hour per day. We aren’t yet in a position to have a daily offsite person (many days don’t merit one), so for the time being the APS physician will continue to serve as the IHA2, serving as a great resource to the hospital. With Alex’s strong leadership, new order sets have been developed. Additionally, he has succeeded in convincing the ED to allow PCA initiation for admitted patients in the emergency department who are awaiting a ward bed. This will be extremely beneficial for our rib fracture patients. This will be rolled out in the near future. At this point, the ED is still not able to accommodate epidurals, but this is definitely a step in the right direction.
Holiday Party: Let me know if anyone has ideas on what we want to do this year. I think it’s time to return to an event more inclusive for everyone who works with us. It doesn’t need to be a formal sit down dinner, but perhaps an evening event with an open bar, tons of circulating appetizers, and mingling, ?cards… This event would be in addition to our 3rd annual just faculty dinner, date TBD.
Department Leadership: I have now surpassed 4 years as HSC Site lead. I am still enjoying this position immensely and in the absence of a coup or something unforeseen I would like to continue on until the end of 2026, totaling 5.5 years. I’m a firm believer 5 years is the approximate natural shelf life of a position like this. If this timeline matches your personal and professional goals/situation, and you are interested in site leadership, please feel free to reach out to myself, Heather, or Prakashen. It’s always nice to have a period of co-site leads for a couple months to ease the transition.
Professionalism: Thank-you for all you do in making HSC Anesthesia such a fantastic place to work.
On a personal Note: I am deeply concerned with the rise in all forms of hate, but particularly in the huge spike in anti-Semitism locally, nationally, and globally. When I was growing up, friends and family referred to me by my Hebrew/Yiddish name, Moish. Around my university years, this was replaced by Marshall, partly due to me wanting to hide some of my identity. With hate on the rise, I think it is important to embrace our identities instead of hiding them out of fear or intimidation. So going forward, if you are comfortable, feel free to refer to me by that name. The name Marshall remains appropriate as well so don’t worry about offending me either way. Disclaimer : This email (including any attachments or enclosed documents) is intended for the addressee(s) only and may contain privileged, proprietary or confidential information. Any unauthorized use, disclosure, distribution, copying or dissemination is strictly prohibited. If you receive this email in error, please notify the sender immediately, return the original (if applicable) and delete the email. Avis : Le présent courriel (y compris toute pièce jointe) est destiné à la personne ou aux personnes à qui il est adressé, et peut contenir des renseignements confidentiels, privés ou protégés par un privilège juridique. Toute utilisation, divulgation, distribution, copie ou diffusion non autorisée est strictement défendue. Si vous avez reçu le présent courriel par erreur, veuillez en informer immédiatement l’expéditeur, retourner l’original (le cas échéant) et supprimer ce courriel. Disclaimer : This email (including any attachments or enclosed documents) is intended for the addressee(s) only and may contain privileged, proprietary or confidential information. Any unauthorized use, disclosure, distribution, copying or dissemination is strictly prohibited. If you receive this email in error, please notify the sender immediately, return the original (if applicable) and delete the email. Avis : Le présent courriel (y compris toute pièce jointe) est destiné à la personne ou aux personnes à qui il est adressé, et peut contenir des renseignements confidentiels, privés ou protégés par un privilège juridique. Toute utilisation, divulgation, distribution, copie ou diffusion non autorisée est strictement défendue. Si vous avez reçu le présent courriel par erreur, veuillez en informer immédiatement l’expéditeur, retourner l’original (le cas échéant) et supprimer ce courriel.