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Discussion

OR Scheduling Issues

I've been working in a for-profit hospital OR for about 6 months now (we are not a trauma facility), and I'm concerned about the way our elective and add-on cases are being scheduled. We always have elective cases scheduled after the end of our day (which is supposed to be 3pm), and we also get add-ons as well. Some of these cases seem to be urgent (appy's, I&Ds, etc), but we also have others such as carpal tunnels, laminectomies, and so on. We have late staff that stays til 7pm, but even still our call team often has to stay into the late hours and other staff (who are NOT on call) are forced to stay past their scheduled shift as well to finish these cases.

I come from a non-profit, level 1 trauma, teaching OR so scheduling non-urgent cases like this so late in the day and forcing staff to stay late for them is totally foreign to me.

My question is, is this type of scheduling typical? How does your OR structure your elective scheduling and add-on scheduling?

Thanks for your thoughts!

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    • Featured Replies

    "for profit" and "not for profit" designations are meaningless in terms of OR scheduling. "Not for profit" doesn't mean "we don't care about money". It means the profit has to be spent in ways other than a for profit agency spends theirs.

    If a surgeon brings high revenue cases to a hospital, it's worth it to the hospital to bend the scheduling rules for him/her. And they do. The folks that provide the services for the surgeon to do his thing are cogs in the big wheel. The good news is that we get money for doing that.

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    • Admin

    Add ones are structured into levels: 1 is actively or darn near dying or limb/sight. So, ruptured AAAs, traumas, fractures with neurovascular compromise,etc.

    2 is stuff that isn't life/limb/sight but could be if not done sooner rather than later. Our policy is that these cases must be in the OR within 8 hours of booking. The surgeon can always re-evaluate and upgrade to level 1.

    Level 3 is standard add on cases that could wait- surgeon convenience.

    The other part of this policy is that regardless of the order cases are booked, level 1 always goes first. A level 2 will go before a level 3. Due to anesthesia availability, we can only run a set number of rooms, so sometimes those level 3 cases end up being delayed so long the surgeon gives up and puts it on for the next day.

    We do not force staff to stay unless they are in a room that is already running with no one to relieve- and volunteers are asked for first- (and the room will close as soon as that case is done) or in the event of a mass casualty incident.

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    • Author

    My concern is that non-emergent cases are often scheduled and then started knowing that we don't have the staff to cover them or relieve those who started the case.

    There's a mantra used often by our schedulers and board runners -- "Never say no", as in they're never allowed to tell a surgeon no if they want to put a case on. Obviously I'm not advocating denying any patient a surgery that needs to be done, but in our OR that applies to elective cases for same day to next week to everything in between. Is that normal? It just seems to me than on this unit there's no staff advocacy. On my old unit add-on cases were a discussion between the nurse board runner, anesthesia board runner, and the surgeon. We scheduled cases according to our staffing and anesthesia staffing (unless of course it was emergent in which case we made exceptions).

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    I've worked at places like that. They would board elective cases into the night and we were just expected to stay. It was a constant fight. I tried really hard to institute things like being on call (we weren't on call since we are elective surgery) or signing up ahead to be the one that stays late if stuck. That way I could at least plan ahead. Management wouldn't support it. Nothing ever changed, so I left. They always find new people then burn them out. I guess that's ok to them.

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    We are the worker bees and the queen bee(s) make all the decisions w/o regard to staffing is my motto. That being said, our charge nurses and manager will even go to bat for us, but the chain of command is way higher than them when it comes to OR $$$$. Do you have a union/mandation policy? Try to change what you have the power to...Odds are you arent going to change the way they do add on cases, but perhaps adding another call team, mandation policy so you its a fair record of how often people are being forced to stay over, etc.

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