OR staffing

[Neogenesis]

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Would like everyone's opinion on appropriate/ adequate staffing numbers to run a 3 OR suite (small community hospital). Additional duties include manning pre-op clinic (1 provider needed). Possibly adding 4th OR (mostly GI scopes planned currently). Home call with 45 min response time.

Trying to get a sense of what is minimum staff needed to run on daily basis, what would be ideal staffing to run. Please account for things like admin duty/board runner and leaves. Basically trying to figure exactly how many people should be employed to make sure that there's no crunches/need to cancel services.

Any ideas or experiences are welcome.

 

[aneftp]

1. very hard to give you a definitive answer on staffing needs until you find out OR and GI room utilization percentages.

Have the OR (whoever is running the show) print out how often and how many hours a day is each OR room being utilized.

Because you mention the word "minimal staffing".

If you aren't busy at all in some small community hospitals. You minimum staffing needs could really be just 2 CRNAs and 1 MD.

If you are really busy you may need 1 MD and 5 CRNAS (float CRNA to give breaks/crossover etc).

 

[Neogenesis]

Good point. Little more clarification. Main 3 ORs vary but run 6-10 hr/d (usually at least 1 or 2 @ 9h/d). Adding GI room is in talks now. Additionally home call gets called in probably less than 50% of the time.

 

[aneftp]

Small hospital:

You do not need to tie up one anesthesia provider for pre op. I've rarely seen a small hospital have a dedicated prep person. It's a waste of resources.

You (the MD) can review the charts while in the OR. If a patient needs to come in, you can evaluate them yourselves in about 10 minutes.

Right now, it seems you need 3 AAs/CRNAs with 1 MD. Depends on the model. Do you want medical direction or no medical direction. Depends on hospital by laws as well.

 

[Idiopathic]

how does home call work in this environment, if you are running 1 MD with medical supervision? does that mean that as the MD you are on call 100% of the time or when the CRNA comes in to do a case you just magically end up on the chart?

 

[BobBarker]

Magic. Different standards at night.

 

[Idiopathic]

fair enough. so then 1MD and 3CRNA can share 3:1 call with someone always on vacation

 

[Idiopathic]

although i guess the MD can never technically be on vacation without locums coverage?

 

[Neogenesis]

So if 3:1, what about post call, vacation, etc? Are you saying 3 rooms = 3 people at any given time. How does that work then with requirements for "readily available" as the MD if you're also running a case in a room?

 

[norwood]

So if 3:1, what about post call, vacation, etc? Are you saying 3 rooms = 3 people at any given time. How does that work then with requirements for "readily available" as the MD if you're also running a case in a room?

Can't supervise and be hands-on at the same time.

Does this hospital also do OB? Emergency airways for ER/ICU? Coverage for MRI or other "playing away from home" assignments? That can significantly affect things.

 

[Neogenesis]

OB essentially a non issue. ER/floor intubations/codes need to be covered as well (minimal/rare though). Occasional off site sedations, blocks etc.

 

[IlDestriero]

So if 3:1, what about post call, vacation, etc? Are you saying 3 rooms = 3 people at any given time. How does that work then with requirements for "readily available" as the MD if you're also running a case in a room?

I think a lot of micro groups work that way. You source a few locums guys to come in for your planned vacations. If you're lucky you can get a regular thing going. They would have to pay me a lot, well >600, to essentially be on call for emergencies 24/7/365 when not on vacation.
You need one MD and 4 CRNAs to make this work and a locums arrangement. The locums can help with CRNAs going out for surgery, etc. as well. The problem with being so short staffed is you have no back up if someone is really out sick. Coming in with the sniffles and a back ache is a given. If you could convince the hospital to pay for a CRNA to cover lunches and staff your pre op clinic, you'd be golden with a built in back up, but that's a big luxury. If you're getting out at 2, you probably don't need a lunch at all. When I was in my small community hospital, lunch was usually a yogurt or sandwich between cases. Power through and go home early was the norm.

 

[IlDestriero]

OB essentially a non issue. ER/floor intubations/codes need to be covered as well (minimal/rare though). Occasional off site sedations, blocks etc.

Codes are not a problem, but sedations, etc would have to be scheduled or added on at the end of the day. Properly setting up and managing your block times (surgeon/proceduralist times, not anesthetic blocks) will be a bear, but will pay off huge dividends and avoid a lot of conflicts.

 

[24858]

4 mds. One always on vacay

 

[24858]

I would refuse to put my license at risk by having a crna taking call solo. Plus it would an embarrassment to me.

 

[IlDestriero]

I would refuse to put my license at risk by having a crna taking call solo. Plus it would an embarrassment to me.

You're license wouldn't be at risk, but maybe your malpractice insurance would.