constraints, risk, and ego in OR start delays… simple example

First off, there must be a 100 different reasons for late OR starts.  Everything from surgeons, anesthesiologist, nurses, equipment, meetings, policies, traffic, school age children and equipment…to a mix of any of the above.  The trick is in understanding the goals of the participants (ffs vs salary, etc) and to design the system so that enough people (maybe not everyone) like it to support it whole heartily.  A good system does not play favorites, but does reward those who use it efficiently.

LEGEND:   Anesthesia -> green          Surgeon-> lavender           Nursing-> red

The scenario for these three graphs is that of a single anesthesiologist checking the patient in pre-op holding(starting IV), setting up the anesthesia machine and drugs, and doing the induction.  The first two tasks can be done in reverse order: setting up the anesthesia machine and drugs first, then seeing the patient in pre-op holding.

In this first graph, the anesthesiologist has priority over the surgeon and nurse to interview the patient in pre-op holding: anesthesia(line 5, green bar), then the OR nurse(line 4, red), then the surgeon (line 6, lavender).  With this priority, the surgeon can cut at 9:40 (last line on graph); and the anesthesiologist has an extra 15 minute buffer to deal with any problems that might arise getting the patient asleep (12th line down).

Now, suppose the surgeon (lavender, 6th line down) demands to see the patient first and doesn’t let the anesthesiologist (green, 5th line down) see the patient immediately.  The savvy anesthesiologist will use that time to set up the room (green, 13th line down), then return to see the patient in pre-op after the OR nurse (red, 4th line down) has seen the patient. In this situation, the surgeon can still cut at 9:40 (last line), but there is no buffer time for the anesthesiologist if there’s a problem getting the patient to sleep.  A corollary to not having a buffer is that the anesthetic risk increases because of the perceived need to hurry.

In this last case, the anesthesiologist chooses not to be savvy, and interviews the patient after both surgeon and nurse.  The anesthesiologist then sets up the room and puts the patient to sleep.  The surgeon’s cut-time is delayed 10 minutes until 9:50 (last line).  There is no buffer for the anesthesiologist in case of problems, and risk to the patient increases because of the perceived need to rush.

About Brian D Gregory MD, MBA

Board Certified Anesthesiologist for 30 years. TOC design and implement for 30 years. MBA from U of Georgia '90: Finance, Data Management, Risk Management. Practiced in multiple US states and Saudi Arabia at KFSH&RC and KFMC Taught residents in two locations. Worked with CRNAs for 20 years.
This entry was posted in anesthesiologist, CEO, healthcare reform, scheduling, surgeon, Uncategorized and tagged , , , , . Bookmark the permalink.

1 Response to constraints, risk, and ego in OR start delays… simple example

  1. Stephen Lorenz says:

    Excellent article, and very good explanation of one component of the problem.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s