Case Scheduling

[shodobe]

We have been having a real problem with scheduling of cases especially after hours. The surgeons think they should be able to schedule what they want when they want it. Anesthesia is caught between a rock and a hard place, do they let the surgeons get away with it or do they try to preserve a sense of control. Staff, on the other hand, doesn't want to work themselves to death and have people, who are not on call, stay over to finish up rooms.

My question is: how do all of you schedule your after hour cases? I think this is restricted to hospitals that don't run 24/7 and usually close the department at 11pm and nothing on the weekends.

1. Who is ultimately responsible for making decisions on scheduling

2. What kind of cases are allowed to be added on

3. How is your on-call staff utilized

4. Are staff constantly asked to stay over to finish rooms

5. Are there certain days of the week that are designated late days.

I just wanted to get a feel of what other ORs do that try to alleviate this constant problem. Thanks, Mike

[chartleypj]

>I just wanted to get a feel of what other ORs do that try to alleviate this constant problem. Thanks, Mike>

Mike,

This was the deal at the facility I worked at for 28 years; I resigned a month ago, so unless things have changed, this is what we did.

The Anesthesiologist and surgeon are ultimately responsible for making decisions relative to scheduling add-ons in the evening and on weekends. Of course, the RN in charge contributes to the decision-making process; however, both anesthesia and the surgeon decide whether or not something is an emergency/urgent.

Therein lies the problem; all the surgeon needs to do is declare the pt an emergency, and unless there is an anesthesia issue, the case is added.

All cases deemed an emergency are added; all cases needing to be done for the convenience of the surgeon are added (even at 10 PM ). All cases in which the goal is to get the patient done and out of the hospital asap are added.

OR call is 11-7 Mon-Fri; this staff does emergencies and has been known to be called in to actually do one of those cases an MD deems necessary because he his leaving for vacation in the morning.

On the weekend, 7-3 Saturday, the OR call team is responsible to clean, stock, prepare for Monday and do emergencies; many surgeons book 'emergency' cases Friday afternoon if they cannot get them on the schedule on Friday, or they wish to get them out of the hospital by Monday.

typical cases include ORIF hips. closed reductions, appi's, lap chole's and VATS.

The Saturday day staff covers call 3P-7A for emergencies only

The Sunday call staff covers 7a-7-a and they, too, do cases deemed an emergency by the surgeon.

During the week, staff was consistently asked to stay after 17:30 to finish up and/or they are unable to leave because just 1 team is available after 17:30, and cases are often begun late in the afternoon without consideration as to the working staff.

Our late cases include running 3 rooms every weekday 15:30-17:30 with the plan to go down to 1 room after 17:30

The facililty has done little to satisfy the needs of surgeons and staff, I sense they just don't know how to fix it.

I hope this helps,

Paula