Published on 07/02/2015 by admin
Filed under Anesthesiology
Last modified 07/02/2015
This article have been viewed 1858 times
James D. Kindscher, MD
The operating room (OR) is a complex and dynamic part of a health care system. Although many centers expect the OR to produce strong profit margins, it is also well recognized that this unit is very expensive to run. The OR relies on coordinated activities among medical specialties, nursing, and support staff to function at an optimal level. The subject of OR management is broad and can be found in more detail in the literature. This chapter will describe aspects of OR management that are important to the anesthesiologist.
Most hospitals have an OR committee that is active in directing the function of this unit. This committee usually consists of leaders in the different sections of surgery, anesthesiology, and hospital management. The scope and authority of the OR committee depend upon local facility and medical practice governance structures. Often this committee will review performance standards, develop policies, offer budgetary guidance, and allocate OR time to surgeons or divisions.
The OR committee is not designed to meet the day-to-day needs of the OR, nor is it able to personally intervene when a challenge occurs in this unit. Therefore, many hospitals have created the position of medical director of the OR. This person is charged with leading improvements in the OR and ensuring compliance with the directives of the OR committee and hospital leadership. The medical director must balance the needs of physicians, nurses, hospital, and patients to maximize OR performance. Anesthesiologists frequently serve in the role of medical director because they are present in the OR on a daily basis, understand the different aspects of OR throughput, and can balance the needs of the different groups working in this area. The medical director position may require significant time and energy from the physician and should be supported by both the physician’s group and the hospital. The expectations for this position must be clearly defined. Responsibilities may include policy development, conflict resolution, regulatory compliance, participation on committees related to OR function, and daily supervision of the unit.
Surgeons, anesthesiologists, nurses, and hospital leadership all have different views on what OR efficiency means. Surgeons want convenient and readily available OR access, anesthesiologists want smooth-running schedules, nurses desire predictable shifts, and hospitals seek maximal profit margins for this costly unit. The medical director can help bridge these different interests to help the OR achieve its best function. Some of the key areas of focus for OR efficiency are scheduling, first-case starts, turnovers, and daily schedule management. Agreement on the definitions of these terms is essential.
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