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Decreasing the Hours That Anesthesiologists and Nurse Anesthetists Work Late

Kaufman, Jeffrey L. MD, FACS

doi: 10.1213/ANE.0000000000001360
Letters to the Editor: Letter to the Editor

Published ahead of print June 23, 2016

Baystate Vascular Services, Springfield, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts, Baystate Medical Center, Springfield, Massachusetts,

Published ahead of print June 23, 2016

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To the Editor:

Granting that operating room (OR) hours and staff management is a highly complex process, it is still a service that will involve overtime. Dr. Dexter’s analysis1 is provocative, because it advocates for benchmarks. However, several parameters are missing in this analysis. First is the interaction of the OR schedule with the surgeon’s office schedule. If there is tension between the need to move or even reschedule a case with my office patient list, OR management may think that their priority is higher. However, to the patient who has scheduled time off from work for the 15-minute visit with the doctor on a particular day, the greater hardship may be the shift of that office visit to allow the OR procedure for another patient to move. Second is the reality that many surgeons have developed multiple offices, so they have rigid periods of unavailability. Third is the reality that office sites are increasingly not on the same physical grounds as the OR units, so the surgeon may be unavailable to make a quick change in schedule. Fourth is the tendency of many surgeons to pack their office days and to expand office days, such that there is less flexibility in their ability to move their cases. The model advocated by the authors seems to assume that cases can transfer among surgeons in a group for maximum efficiency. That is patently untrue for many groups, and, in any case, it is even more frequent for the patient to object to dealing with a partner she/he has never seen before for the procedure. Tightly packed office schedules—and this is my personal experience—lead to days where it is necessary to pack more work into a longer and exhausting OR schedule that invariably causes anesthesia staff to go into overtime.

Jeffrey L. Kaufman, MD, FACSBaystate Vascular ServicesSpringfield, MassachusettsTufts University School of MedicineBoston, MassachusettsBaystate Medical CenterSpringfield,

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1. Dexter F, Wachtel RE, Epstein RH. Decreasing the hours that anesthesiologists and nurse anesthetists work late by making decisions to reduce the hours of over-utilized operating room time. Anesth Analg 2016;122:83142.
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