Wednesday, July 31, 2013

Ways To Improve The Operating Room Environment

A recent post in Becker's ASC Review discussed strategies for improving communications and work environment in the operating room. Using ideas as outlined by a colorectal surgeon, it lists five methods that he felt should be implemented. The plans include using a preop huddle to make sure everybody in the OR is on the same page and taking the team approach during surgery because, you know, the anesthesiologist might be too intimidated by the superior surgeon to speak up.

Blah blah blah. What do you expect in an article that uses a surgeon as its source? They should have asked an anesthesiologist who will give the true low down on how to improve the atmosphere in the OR. This advice is directed to all the surgeons out there. You may think you're perfect, but there is always room for improvement.

1. Show up on time. Stop feeding us B.S. about how you weren't paged when the patient was ready to leave preop. If the schedule says 7:00 AM start, be here at 6:55 AM. Not 7:01, 7:05, or 7:15. We're not your mother who has to remind you that you'll be late for school if you don't get up soon. If you're not sure if the case will start on time, CALL. We'll tell you if we're running late. Don't make us chase you around on your cell phone, pager, and office numbers, none of which you will answer. And please man up about your tardiness. Don't feed us baloney that your secretary didn't tell you what time your case is supposed to start. It's your schedule and you're responsible for checking it before going to bed each night. I do. Why can't you?

2. During an operation, don't ask me to answer your pager or cell phone. That's not my job. I'm too busy making sure your patient doesn't die on the OR table. Frankly, it's nobody else's job in the room either. The nurse is as busy as me keeping the case going smoothly. If you have a resident, use him to answer your calls. Or your PA or  NP. My medical degree was not obtained with a rotation in answering phone calls.

3. Be quick about it. We know the difference between being meticulous and dawdling. We understand the former but won't put up with the latter. Even though I get paid more for longer cases I don't want to face the angry surgeon who is waiting to follow you in the room. He'll yell at the OR staff but will rarely confront the surgeon who is the major offender for why his case is starting an hour late.

4. Don't drag me into a faux emergency operation. It's not an emergency if the only reason the patient needs to go into the operating room stat is so you will make your dinner date that evening.

5. Stop acting juvenile. While this encompasses the previously listed suggestions such as showing up on time and not lying to get your case into the room, it also includes things like not throwing a temper tantrum if you can't get exactly what you want. Don't complain that your procedure card falsely listed a 3-0 Vicryl suture when you always use a 4-0 Vicryl suture when the OR has been using the same card for you for the last ten years. Stop throwing a hissy fit because your headlight isn't shining as brightly as you think it should be. Deal with it. Grow up!

6. Don't tell me how to do my anesthesia. If there is one thing that really, REALLY annoys me, it is a surgeon who emperiously tells me what kind of anesthesia to give. I have my own plans and I'll be happy to discuss them with you but you better remember I have the last word on this subject. As a corollary, don't tell your office patient beforehand what kind of anesthesia she will receive during an operation. You may think that the morbidly obese patient with severe obstructive sleep apnea and pulmonary hypertension only needs a MAC sedation for a case but I may completely disagree for the patient's own safety. I don't want to have to fight with the patient in preop to get her to agree with my plan for her anesthesia. If a patient asks, just tell her she will meet with the anesthesiologist before surgery to talk about it. That's all you need to say.

7. Don't cancel cases without telling anybody about it. Few things are more frustrating than preparing for a case and the patient never shows up because it had already been cancelled by you and you never told the surgery scheduler. It is a waste of my time and a wasted opportunity to use precious operating hours for legitimate cases. One simple phone call. That's all we ask.

8. Stop harassing me if I need to take a little break between cases. Don't page me incessantly if I need to take ten minutes to take a crap in the bathroom. If I need to get a cup of water, don't have the OR call my cell phone every thirty seconds to ask where I went. I cannot and refuse to be leashed to my anesthesia machine all day like a dog on the sidewalk. You get a nice break between cases while the rest of us are hustling to get your next case ready. It's only humane if we are shown a little consideration too.

These are some of my rules for improving the relationship between the anesthesiologist and surgeon. If you follow this guideline, we will get along just fine.


  1. So True! How annoying is the surgeon who arrives late, (and I can attest to that, waiting in pre-op for surgical resident to see the patient) before I can take them to theatre, working really hard during the list to keep it moving on time and being told towards the end, after The surgeon has run over by 1.5 hrs, how he would have finished on time if the turnover between cases had been faster! So unfair but happens all the time!

  2. Although I agree with showing up on time, not throwing hissy fits, taking responsibility for a case that runs long, etc., in my experience at an academic hospital, the surgeons and anesthesilogists actually have one of the strongest working relationships. This article sounds a touch petty, and puts down an entire group of specialists for what sounds like some bad specific experiences. The pre-op huddle, by the way, DOES clarify for circulators, scrubs, surgical and anesthesia residents how this surgeon positions, what tools he/she might use... Nothing to do with intimidation. If you work with multiple surgeons a day doing similar cases, all have their own idiosyncrasies and the "huddle" seems reasonable to me.