Operating Room Management II

The scheduler also has to deal with add-on, urgent, and emergent cases. Emergent cases are relatively simple; they must go to the operating room as soon as possible, and the scheduler just needs to find an anesthesia and nursing team. But how do you distribute urgent and add-on cases? At 5pm, it might not be reasonable to start a 5 hour case, but a 45 minute laparoscopic cholecystectomy should go. What anesthesia team does the cases? In theory, it should be on the on-call anesthetists, but they may still be in on-going cases. Do you assign someone who should be leaving soon to 5pm surgeries? At some point, there should only be a handful of surgeries going, and then just one or two rooms running as the hospital can't pay all the staff overtime. And as staffing ratios get slimmer through the night, the scheduler still needs to have the resources to respond to an emergent trauma case if necessary. I don't know how all of this works, but it's pretty fascinating.

If an emergency comes in and all the operating rooms are already assigned, then someone will be "bumped." That is, a surgeon's protected elective surgery time might be superseded by the emergency. How do you account for this? Does the surgeon get credits? Do his cases get greater priority in the future? As I go from hospital to hospital, I see various systems and committees dedicated to solving this problem.

Ultimately, money is important in operating room management. Operating rooms are incredibly expensive, and so you want them running at full efficiency if possible. Downtime means that a surgeon, surgical resident, anesthesiologist, anesthesia resident, circulating nurse, scrub nurse, technicians, and housekeeping are all idle. So part of managing the operating rooms is that puzzle of packing a suitcase: you want to get as much to fit in there as possible with minimum wasted space.