For a surgeon’s view, see “The ‘Perioperativists‘ Are Coming!” by Frederick L. Greene, MD.
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.