Survey: Anesthesiologists Think They Should Be in Charge

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Carbocation1

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"OR Director" sounds like a fancy title, but what does it actually mean? That anesthesiologists will have to do hospitalist work for no extra pay? Will surgeons merely become "actors" in this hierarchy?

http://www.anesthesiologynews.com/V...ment&d_id=3&i=March+2015&i_id=1156&a_id=29637

New York—Most anesthesiologists believe they should be in charge of key decisions in the operating room (OR) regarding resource and personnel allocation, despite a lack of training in these areas, according to a recent survey.

Researchers asked attendees at the 68th New York State Society of Anesthesiologists’ (NYSSA) PostGraduate Assembly (PGA) if they thought anesthesiologists should serve as “OR directors.” Respondents were also asked whether they thought anesthesiologists had the leadership skills, ability to gather data and knowledge of necessary interventions needed to take on the role. The survey results were posted on the last day of the PGA. More than 11% of the 3,069 attendees responded, and 94.2% said anesthesiologists should be OR directors.

“The OR can either be a major source of revenue for a hospital or a major drain on its operating budget,” said lead investigator Steven Boggs, MD. “In order to maximize revenues, there needs to be a coordinated effort to increase quality and efficiency, and we believe as a profession that anesthesiologists are best suited to take a leadership role in this effort.”

Dr. Boggs, OR director and chief of anesthesiology, James J. Peters VA Medical Center, New York City, acknowledged that the PGA survey enrolled a “self-selected population” that did not include the perspectives of nurses and surgeons on this issue. He and the co-authors of the study—Elizabeth A.M. Frost, MD, clinical professor of anesthesiology at Mount Sinai Hospital, New York City, and Jessica Feinleib, MD, PhD, assistant professor of anesthesiology at Yale School of Medicine, New Haven, Conn.—emphasized that they do not view the findings as a referendum on the American Society of Anesthesiologists’ Perioperative Surgical Home (PSH) model because the survey addressed a specific aspect of the potential leadership function for anesthesiologists in the OR: resource and staff management.

However, they noted that their findings were particularly striking because other studies suggest recent graduates of residency programs are not adequately trained in OR financial and personnel management.

“At our centers, we’ve really seen a dramatic improvement in all of the major OR productivity metrics since anesthesiology assumed the role of OR director,” said Dr. Boggs. “We’ve seen that anesthesiologists really offer the attention to detail and can handle the learning curve this shift entails. But there are fundamental questions for the profession as a whole, particularly in light of the [PSH] model. Are we preparing our young anesthesiologists to assume this leadership role?”

Another issue is whether or not the other specialists working in the OR—namely the surgeons and nurses—are ready and willing to defer leadership to their colleagues in anesthesiology. According to the study authors, surgeons in their respective centers have been “happy” to cede this management role and the additional work and responsibilities it entails to anesthesiologists—especially surgeons who handle complex surgical cases, such as orthopedic surgeons and neurosurgeons. They said anesthesiologists are logical managers of surgical cases in these settings given their extensive responsibilities in “preoperative optimization” and postoperative recovery of the patients involved.

On the other hand, anesthesiologists can still improve efficiency in the OR without being permanently assigned as an OR director, according to Frederick L. Greene, MD, FACS, clinical professor of surgery at University of North Carolina School of Medicine, Chapel Hill, and medical director of Cancer Data Registry, Levine Cancer Institute, Charlotte, N.C.

Dr. Greene said his institution implemented a system that established a “surgeon of the day” to manage the OR. In this system, a surgeon is effectively appointed OR director for a specific day and given responsibility for making OR staffing and scheduling decisions and managing efficiency.

The surgeon serving in this role is not assigned surgical cases for the day. The anesthesiologist in this system coordinates the provision of anesthesia and oversees patient care in the postanesthesia care unit.

—Brian Dunleavy
 
Carbocation1, this is what already happens in many places. It's by far the best way to run an OR. The floor-runner also covers the PACU and helps in difficult situations. It's usually an experienced anesthesiologist who knows everybody, most surgeons' quirks, most of his/her colleagues' strengths and weaknesses, which anesthesiologist works well with which surgeon etc.

This is also how most surgicenters are run. No rocket science here. One just has to be on top of things.

Surgeons are not actors in such a system; they are divas. Everything is done in order to help them, and move their cases along faster.
 
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Carbocation1, this is what already happens in many places. It's by far the best way to run an OR. The floor-runner also covers the PACU and helps in difficult situations. It's usually an experienced anesthesiologist who knows everybody, most surgeons' quirks, most of his/her colleagues' strengths and weaknesses, which anesthesiologist works well with which surgeon etc.

This is also how most surgicenters are run. No rocket science here. One just has to be on top of things.

Surgeons are not actors in such a system; they are divas. Everything is done in order to help them, and move their cases along faster.
Thanks for your response, FFP. It seems to me that Anesthesiologists already assume tremendous responsibilities, yet most people are unaware of this -- especially my medical school classmates. Every time I have a discussion with them I find myself defending the specialty against their ignorance.
 
We have an anesthesiologist OR manager and a nursing manager during the weekdays. They manage the ORs and staffing together.
Their training is on the job training, and they are selected for experience and correct personality traits for the job.
The medical directors of the ASCs are also Anesthesiologists.
 
We are just as ildestriero described. New grads are slowly brought into the system and learn on the job. Seasoned vets are allowed to manage the OR sooner. We use our call person for this position. All changes to the system go through the call/float person. The goal is efficiency.

However, I am liking this surgeon manager of the day idea some. I would love to see how that would go down in my hospital. We are not so busy that the manager can't have others duTies as IlDestriero described but if take some of those Knowitall surgeons and make them run things from time to time they might have more understanding. I would ove to see the big Ortho guy tell the big spine guy he can't flip flop to another room because the general surgeons need it. We do this all the time and they get pissed at times.
 
take some of those Knowitall surgeons and make them run things from time to time they might have more understanding.

Man, what a ****show that would be.

If they started at 7:00 AM, they'd probably have the OR over committed for the day by 7:30, and then blame anesthesia for turnover times.
 
One does not need medical knowledge really to do that job. If you make anesthesiologist do that job you will further make people believe we are glorified nurses which we are NOT. We are NOT part of the OR. We visit just like the surgeons for the sake of the patient. The OR STAFF has to cater to us just like the surgeons. Thats how I roll and thats how every anesthesiologist should roll. I did not study medicine to run the or for the hospitals.
 
One does not need medical knowledge really to do that job. If you make anesthesiologist do that job you will further make people believe we are glorified nurses which we are NOT. We are NOT part of the OR. We visit just like the surgeons for the sake of the patient. The OR STAFF has to cater to us just like the surgeons. Thats how I roll and thats how every anesthesiologist should roll. I did not study medicine to run the or for the hospitals.

That's all well and good but whoever you cede this power to will roll their agenda right over yours. It pays to be involved.
 
One does not need medical knowledge really to do that job. If you make anesthesiologist do that job you will further make people believe we are glorified nurses which we are NOT. We are NOT part of the OR. We visit just like the surgeons for the sake of the patient. The OR STAFF has to cater to us just like the surgeons. Thats how I roll and thats how every anesthesiologist should roll. I did not study medicine to run the or for the hospitals.
No, I disagree. Our setup is much like IlDestriero's and Noyac's. There's a periop nurse who manages nurses, scrubs, and which ORs are open. An anesthesiologist runs the board as his job for the day. Between handling consults, fielding add-on cases and finding rooms/staff for them same day (or the next day), helping other anesthesiologists or CRNAs with routine or problem issues, and making all of the staff/resident/rotator assignments for 2 days hence, it's a job that demands one person's full attention. It can be more exhausting and demanding than doing a day full of cases by yourself.

And it does benefit from medical knowledge, ie a person who has the ability to return a page and know enough about the procedure, the particular surgeon, the actual urgency of the case vs the line recited by the surgeon, the acuity of the patient, the likely duration of other cases underway and yet to start, and which of your available staff is best suited for the case. And then give the surgeon a reasonably accurate answer to "when can I do this case" before hanging up the phone.

I can't imagine the cats here getting herded efficiently enough to get the day's scheduled work done at a reasonable hour without an anesthesiologist steering things. No, there's not a lot of glory in being a doctor standing next to the periop nurse looking at the board working out logistics together, but we're a service specialty and the logistics need to be done well, or everyone gets screwed and everyone's unhappy.
 
ie a person who has the ability to return a page and know enough about the procedure, the particular surgeon, the actual urgency of the case vs the line recited by the surgeon, the acuity of the patient, which of your available staff is best suited for the case.

"There is a fracture. I need to fix it." ???
 
This trash gets presented at the PGA? What's next? The sky is blue and the sea green?
 
No, I disagree. Our setup is much like IlDestriero's and Noyac's. There's a periop nurse who manages nurses, scrubs, and which ORs are open. An anesthesiologist runs the board as his job for the day. Between handling consults, fielding add-on cases and finding rooms/staff for them same day (or the next day), helping other anesthesiologists or CRNAs with routine or problem issues, and making all of the staff/resident/rotator assignments for 2 days hence, it's a job that demands one person's full attention. It can be more exhausting and demanding than doing a day full of cases by yourself.

And it does benefit from medical knowledge, ie a person who has the ability to return a page and know enough about the procedure, the particular surgeon, the actual urgency of the case vs the line recited by the surgeon, the acuity of the patient, the likely duration of other cases underway and yet to start, and which of your available staff is best suited for the case. And then give the surgeon a reasonably accurate answer to "when can I do this case" before hanging up the phone.

I can't imagine the cats here getting herded efficiently enough to get the day's scheduled work done at a reasonable hour without an anesthesiologist steering things. No, there's not a lot of glory in being a doctor standing next to the periop nurse looking at the board working out logistics together, but we're a service specialty and the logistics need to be done well, or everyone gets screwed and everyone's unhappy.
You are describing a board runner. That is fine. THe previous posters were talking about being OR director who hires OR nurses orders equipment etc. This is NOT our job and shouldnt be. We are VISITORS in the OR just like the surgeons.
 
I wasn't talking about being an OR director, our ASC medical directors manage the clinical stuff and manage the scheduling with a nurse manager. Block time, etc. decisions are executive level and depend on need, availability and strategic goals.
I don't think taking over periop nursing and the supply chain is part of the perioperative home design.
Though we do manage our own anesthesia equipment, through the supply chain.
 
Honestly it would be great to have an anesthesiologist as an OR director. But an OR director should not be limited to an anesthesiologist, physician, surgeon. The main skill an OR director should have is recognizing everyones strengths and weaknesses, supply dynamics, hiring skill. I have had nurse, crna, and anesthesiologist, and surgeon OR directors and each had their own strengths. As far as hiring nurses and ordering equipment as someone who does that now you do not want to be apart of that game. In my current gig I deal with ordering of equipment drugs, and supply chain and it is often a bear of a duty. At a very large institution I trained at we had secretaries who would act as the anesthesia CON that would funnel higher level decisions with the AOD (anesthesia officer of the day) who still had OR clinical responsibilities this worked well. Back to the beach.....
 
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