Just wondering if groups have an attending out of the OR to "facilitate and/or run the board..."
Our group (all MD) is getting pressure from the hospital to have an Anesthesiologist out and about to help move things along smoothly, keep an eye on PACU patients, etc. We're looking to see what the hospital will provide for us to offer these services. We're not an eat what you kill group, but having a person out of the OR will bring in less revenue to our group and we're not quite willing to suck that. What are the experiences of other groups out there?
drccw
What's the structure of your group? Residents or CRNAs? How many ORs are you having to cover?
I've only been working as an attending for about a year, but I can give you two perspectives.
My residency program was way busier than we are at my current institution. The attending running the board usually just had one room, occasionally if they were short staffed two rooms. The attending running the board also had a resident, usually a senior resident. It sucked being the resident in the room on some days, but the system worked. The attending running the board was able to coordinate shifting of cases, planning for addons, etc. We had a resident in the PACU and a separate attending, who also had a resident, would "cover" the PACU. The PACU resident carried the floor intubation pager, so the PACU attending was available to help with floor intubations if needed. It was rare to have the PACU resident call the attending for help.
Where I am now there are no residents, but there are CRNAs. We have 8 ORs, but don't have enough CRNA/attending staff to run more than 7. Any empty OR gets used for emergencies and helping to bounce surgeons (provided there is nursing staff to handle it). There are 3 attendings in the main OR. I have on the busier days covered 4 ORs, but usually only 3 ORs (occasionally 2). The OR chief is the default board runner, but if he is not there the task goes to the late person. Usually that person will get one of the lighter rooms, and usually only covers 2 rooms (occasionally 3). PACU responsibility is shared. The attending who's patient is in PACU usually covers that patient(s) in PACU, but the overall responsibility is that of the late person. We don't do as many blocks as we used to, but because the cases here run relatively long, it is usually not a big deal to bring a patient early for a block and get it done in the holding area. The holding area is big enough that we don't really need a special room.
I've noticed many times the hangups come when surgeons want to add on cases on complicated patients and don't give appropriate notice to allow for an assessment. Stressing the importance of proper attending to attending communication and setting a limit on how late add-ons can be added may help control some of your issues.
I've only been the board runner a handful of times now, and I don't envy your situation at all. But assuming you are doing supervision, and don't have an enormous number of ORs (big assumptions, I know), you should be able to make it work. The alternative is to get a subsidy from the hospital to pay this person's salary (after all they are the ones who want an extra person).
Good luck.
