1. Shift Realignment Process Sign In/Out Times May 7, 2014

2. Team Members Group of Physicians, CRNAs, and Administrative Staff Drs. Gagliano, Makai, and Schneider CRNAs Stacey Fletcher, Vince Hughes, Megan Tomasco, and Dante Villecco Steve Ashman, Christy Mack, Amber Schooley, Heather Smith, and Francine Venit

3. Survey Results Data from the survey highlighted Sign In/Out Times weren’t accurately reflecting the work being performed Changes will effect Christiana and Wilmington Hospitals

4. Outcome Sign In & Out times will shift to 15 minutes earlier Will reflect actual time needed to sign in to be prepared to start day There will be some changes to the shift names to reflect the correct time you should be actually signing in at the site. Example of C shift Old shift “C” was 0730-1600, with case starting at 0800 New shift “C715” will be 0715-1545, with case starting at 0800

5. Changes go into effect on JUNE 8, 2014

6. Wilmington Hospital OR Shift Changes Changes are more in line with shifts needed by the Wilmington Site due to the Heavy Total Joint Population

7. End of Day Prior to departure, the Pre & Post Ops must be completed. The Clinical Coordinators may also need to be relieved from clinical duties in order to complete other tasks. AFTER THESE TASKS ARE COMPLETED, breaks should be given with priority going to the late shifts. The expectation is for the CRNA to be relieved approx. 15 min prior to the posted shift end time. This will allow time for report to be given in the OR and fanny pack return. In order for this to occur, afternoon assignments should be completed and posted on the Anesthesia Board by the coordinator’s desk at 1430. Shifts should be relieved in the correct order of departure. Dismissals must come from the Primary MD carrying the 1481 pager. If you are a late CRNA getting relieved early, please double check that all regular people have been relieved – please try not to rely on a “quick case” to finish up prior to signing out.

8. WOR Shifts WOR Shifts & Dismissal Order Shift Codes Scheduled As:Shift Times:Shift Description: W630 0630 - 1500ECTs - 1st Person WEJR W700 0630 - 1500Wilm Early Joint Regional W645 W700 0645 - 1515ECTs - 2nd Person WJR W700 0700 - 1530Wilm Joint Regional WEJG W700 0700 - 1530Wilm Early Joint General W700 0700 - 1530 W700+ 0700 - 1530OT Backup as needed for CRNA CALL OUT WJG W 0730 - 1600Wilm Joint General W W 0730 - 1600 WOT20730 - 1800Or time you leave - 1st Released WOT0730 - 1800Or time you leave - 2nd Released W+0730 - 1600OT Backup as needed for CRNA CALL OUT W120730 - 2000 @ 0630 Post Call - Help with ECTs & OR Set - Up. To be dismissed by Primary MD. 24*OCW0730 - 0730@ 0630 Post Call - Help with ECTs & OR Set - Up. To be dismissed by Primary MD. OCW 1445 - 0730@ 0630 Post Call - Help with ECTs & OR Set - Up. To be dismissed by Primary MD. Shift Codes W630, W, WOT2, WOT, W+, W700, W700+, W12, 24*OCW, OCW will be on Master Schedule W645, WEJR, WJR, WEJG, WJG will be listed on Face Sheet

9. New Shift Descriptions W630 – previously W700 – Will be scheduled as W630. This person is the first ECT person. The shift is 0630 – 1500. Set up OR for cases. Obtain ECT cart from PACU Clean room & ECT from Pharmacy. Report to PACU for patient prep & IV starts. W645 – new shift – Will be scheduled at W700 or W700+. This person is the second ECT person. The shift is 0645 – 1515. Set up OR for cases. Report to PACU to assist with patient prep & IV starts. WEJR – new shift code – Will be scheduled as W700 or W700+. The shift is 0630 – 1500. This person will be scheduled in an EARLY JOINT with REGIONAL ANESTHESIA POSTED AS THE FIRST CASE. You should be in P & H ready to assist with spinal insertion by 0645, in the OR by 0710. WJR – new shift code – Will be scheduled as W700 or W700+. The shift is 0700 - 1530. This person will be scheduled in the SECOND JOINT ROOM WITH REGIONAL ANESTHESIA POSTED AS THE FIRST CASE. WEJG – new shift code. Will be scheduled as W700 or W700+. The shift is 0700 – 1530. This person will be scheduled in an EARLY JOINT ROOM WITH GENERAL ANESTHESIA POSTED AS THE FIRST CASE. WJG – new shift code. Will be scheduled as W. The shift is 0730 – 1600. This person with be scheduled in the SECOND JOINT ROOM WITH GENERAL ANESTHESIA POSTED AS THE FIRST CASE. W700 – previously W730 – Will be scheduled as W700 This shift is 0700-1530. This early shift can be flexed to any of the Joint shifts or 2 nd ECT. You may be changed to a W if an early start is not needed. The W700+ will cover CRNA call outs.

10. OCW Expectations OCW – The shift is 1445 – 0730. Post call - If not involved in a case at 0630, you should report to PACU/P&H to assist with IVs for ECTs and first case starts. You should then check in with the primary to be dismissed by your scheduled time. 24*OCW - The shift is 0730 – 0730. Post call – If not involved in a case at 0630, you should report to PACU/P&H to assist with IVs for ECTs and first case starts. You should then check in with the primary to be dismissed by your scheduled time.

11. Shift Type Summary In summary, what you will see on the MASTER CRNA SCHEDULE: W630 W700 May be flexed to any of the new early shift codes: W645, WEJR, WJR, WEJG, WJG W700+ W W+ WOT2 WOT W12 24*OCW OCW

12. You will see the new shift codes on the FACE SHEET as these relate to your DAILY ASSIGNMENT. IF YOU ARE SCHEDULED AS A W700, YOU WILL BE FLEXED TO COVER ANY ONE OF THESE EARLY SHIFTS – THIS IS CONSISTANT WITH OUR CURRENT PRACTICE. IF SCHEDULED AS A W700 BUT THERE IS NO NEED FOR AN ADDITIONAL EARLY PERSON, YOU WILL BE CHANGED TO A W. This is to meet the clinical needs of the site We will do our best to avoid scheduling a late person in an earlier room, but this may be unavoidable due to Clinical needs. Please document your shift when signing in and account for any OT accrued. The Wilmington OR is still continuing to grow with increased case numbers and service lines We are continuing to adapt to these changes.

13. Christiana OR Hospital Changes The Christiana shift names have been changed to reflect the actual time the CRNA signs in and puts pen to paper.

14. COR Shifts COR Shifts & Dismissal Order Shift CodesShift Times:Shift Description: C7150715 – 1545 C6450645 – 1515 COT20715 – 1745Or time you leave COT30715 – 1745Or time you leave C645/OT30645 – 1800SAT/SUN ONLY – Or time you leave C645+0645 – 1515OT Backup as Needed for CRNA CALL OUT C715+0715 – 1545OT Backup as Needed for CRNA CALL OUT C100715 – 1745 C120645 – 1915 C715/E0715 – 2315 E1445 – 2315 OCC1445 – 71516 Hour Call COB1445 – 71516 Hour Call 24*OCC0715 – 071524 Hour Call 24*EOCC0645 – 0645SAT/SUN & Holidays ONLY - 24 Hour Call 24*COB0645 – 064524 Hour Call H06450645 – 1515OT for Cardiac Rooms ONLY HOT0715 – 1800LAST OT shift to be relieved C645/H30645 – 1515Or as needed to support cardiac rooms C715/H30715 – 1545Or as needed to support cardiac rooms

15. Signs Will be Posted: At each site Clinical Coordinators will receive these On Portal as a pop-up and news article

16. Things to Remember These changes go into effect on June 8, 2014 Please continue to be flexible and adaptable when it comes the new shift codes. Please be sure to check the Daily Schedule for your shift assignment. Teamwork and Adaptability will be necessary to facilitate dismissals. These shifts are a direct result of your comments to the staffing survey and reflect more accurately what we are doing already on a daily basis.

17. Thank you!