Valley Logistics

There are just a handful of residents at the Valley, which means that we can get fairly complicated cases since there aren't a lot of senior residents vying for the "hard" rooms. In fact, on my second day at Valley, I was assigned to endoscopic abdominal aortic aneurysm repairs, cases that go smoothly most of the time, but if something goes wrong, it can be an instantaneous disaster. The cases we get are pretty diverse, and I got my mix of general surgery cases, urology, orthopedics, neurosurgery, and out-of-OR procedures like endoscopy. But I noticed that compared to the VA and Stanford, there were far fewer scheduled cases and far more add-ons from the emergency department or the inpatient wards. This may simply be a reflection of the patient population which uses Valley more as an emergency department, urgent care, and episodic care center rather than a long-term continuity of care facility. It may also reflect the fact that follow-up can be unreliable, and so if a patient has a disease that requires surgery, admitting them and doing the surgery may be better for the patient than discharging them with an appointment.