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Anesthesia and Operating Room Efficiency

Joe Cantlupe, for HealthLeaders Media, December 13, 2012
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Success key No. 3:  Alignment

To improve the flow of patient utilization in the OR, St. Luke's Hospital created a perioperative governing council, says Herring, the anesthesia medical director. The key word in the council, he says, is "governing." This group is empowered to dictate OR improvements, so it has clout. That wasn't always the case. Previously, the hospital had an advisory council that made recommendations, but their suggestions for improvement weren't always addressed—and that, Herring says, wasn't good enough.

The perioperative governing council is composed of hospital administration officials, surgeons, and anesthesiologists. Physician involvement and leadership are essential, Herring says. As a result, physician membership originally was assigned and approved by the St. Luke's C-suite and now the committee itself decides its membership. The governing council's decisions are forwarded to responsible hospital personnel and medical staff committees as appropriate.

The council is responsible for scheduling surgery start times, anesthesia schedule management, and block times prior to surgery, with an effort to ease caseloads, Herring says. The 16-member council includes five members from anesthesia, seven members from surgery, and four members from administration as a way to give balance in efforts to improve efficiency, according to Herring. The council also works with a surgery executive committee, which includes the director of surgery, the anesthesia director, the COO, and director of surgical services to focus on start times and set the agenda for the council.

The hospital changed from an advisory to a governing council with physicians to give the group enough power to go forward, he adds. The system was used to complete a block scheduling arrangement in which anesthesiologists, who work for their own groups, sign contracts about their availability with the hospital, Herring says. He characterizes the contracting process as the result of a collaborative effort that defines scheduling and block times.

Although there was initial resistance to the coordinated effort, "we gained a lot of political support as the doctors came to understand what we were trying to do," Herring says. "It began to make sense, to have a focus."

Coordinating care and improving patient flow are often the responsibility of the medical director of the OR. At New Milford, that role is assigned to Zane, chief of the department
of anesthesiology.

As head of the OR, Zane coordinates staff as well as anesthesiologists. He belongs to a physician network, the Western Connecticut Medical Group, which provides anesthesiologists to New Milford Hospital and two other healthcare facilities. Many of the anesthesiologists interchange their role based on the needs of the particular hospital, "matching the supply with the demand," Zane says. "It's very flexible and very good for staffing," he explains. "When it is busy in one place, we can shift staff to another place, if one staff is slow."

Along the way, they built a multidisciplinary team, with anesthesiologists having a key role. As anesthesiology chief and medical director of the operating room, he coordinates staff. "It's an OR team, and that's an important factor," Zane says. "We're a team."

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