Which Patient Gets into the OR First? Perioperative Leadership by Anesthesia is Critical

Anesthesia providers are being called upon to play a pivotal leadership roles in managing cases through the OR. It is in the best interest of the anesthesia providers or group to actively participate in the problem solving session with the hospital. The more ingrained you are the less likely that administration will go looking for a lower cost alternative to your anesthesia service.  Read further to learn how Wellstar Kennestone Hospital, a 600-bed hospital in Marietta, GA, working with its anesthesia chief and Press Ganey, developed an innovative approach to this problem.

When several patients needing urgent or emergent surgery arrive at a hospital simultaneously, who decides which case gets into the OR first? For true emergencies, the decision is generally straightforward, with the patient rushed into the first available room.

But in many other situations, the decision is not as clear: Should the patient with an open fracture go first; should it be the patient with an ectopic pregnancy, or perhaps the patient with an intestinal obstruction? Does the most senior surgeon get the first available OR slot? Should the decision be made on the basis of first-come, first-served? Or maybe the most assertive surgeon gets his or her case in first?

Often the decision falls to the anesthesiologist of the day in the OR. But no matter who makes the decision, the competition between surgeons over this matter, and the daily arguments with anesthesiologists, cause frustrations to both surgeons and anesthesiologists. And at times, patients end up waiting for surgery longer than is clinically optimal.

Ideally, the decision should be based on an objective measure that reflects the clinical needs of the patient and gives surgeons, anesthesiologists, and OR staff a predictable and fair system for prioritizing their cases.