Q: Extracorporeal Shock Wave Lithotripsy (ESWL)

Is there a safe limit to the number of Extracorporeal Shock Wave Lithotripsy (ESWL) procedures that can be done in a day? Some facilities have an ESWL machine brought in for procedures, and the operator/driver of the machine can only work so many hours and be driving for so many hours without being considered unsafe. Are there any small facilities that have run into this dilemma. The surgeons always want to schedule as many as they can, then they take longer than expected, and it can lead to a very long day for the operator/driver.

A: We are a small facility and do up to five per day. We have not run into any issues.

A: No issues here with “over service” hours

A: I have never had that problem and we did ESWLs one day per week and all the urologists scheduled on that day so we did more than five.

Q: Discharging with a Taxi

Is it acceptable to allow a patient that has received general anesthesia to be discharged with a Uber or taxi as their means of transportation to home?

A: Not without a responsible adult, according to The Joint Commission. It has been a challenge for the last several years for us as docs want to be able to do it. Get your underwriters to comment on it and a copy of The Joint Commission regulations to show the folks who think it is OK.

A: Only if they have a responsible adult with them, in addition to the taxi driver.

A: No.

A: We only allow if they have a responsible party accompanying them in the taxi.

A: I think that could get you in trouble.

A: Although it is not ideal, we have discharged patients home in a taxi but require a surgeon order in writing.

A: I assume you mean alone in a taxi. If so, then no that would not be acceptable in my opinion. Post general anesthesia discharge would require someone to take responsibility for being with the patient for the first 24 hours after same-day surgery. Of course, the patient and the designated care provider can go home in a taxi, but the patient should not be discharged alone. In the past, we usually insured that prior to surgery. If they showed up alone, we would make sure that someone was picking them up and going to stay with them. On several occasions we cancelled surgery for this reason and if we could not cancel surgery then we admitted them overnight.

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