Operating Room Management I

After six months in the operating rooms, I have only a glimmer of knowledge about how operating room management works, and I can already tell it's incredibly complex. An anesthesia attending acts as the "scheduler," in charge of determining the order of cases, assigning the cases to anesthesiology teams, dealing with add-on cases, and probably playing a lot of roles I don't know about. For the most part, surgeons have protected block time when they do elective cases; each attending knows when he operates. But how do you determine the order of cases? Some cases have to be last if they involve an infection; others which may involve two surgical teams ought to go first when you know everyone will be free. But do you schedule a long case before short ones? When do you schedule a case with indeterminate length (such as a cancer surgery where it's unclear how extensive the resection will be)? If you schedule it early, then subsequent patients may be waiting inappropriately. If you schedule it later, then it can potentially go on past when you should be staffing elective cases. And a scheduler has to look at the big picture; not everyone can schedule cases requiring intraoperative X-ray at the same time, and not everyone can schedule a 2-hour case first thing in the morning because if all the patients arrive in the PACU (recovery room) at the same time, the nurses there will be overwhelmed. This may be the sort of problem that decision-making software and analyses can aid.