Operational Guidelines
Specific to Anesthesiology
- • Do not schedule mole team residents cases during the day.
- • Do not assign attendings with very complicated cases a second room to cover unless absolutely necessary.
- • Do not assign attendings to cover two very junior residents unless absolutely necessary.
- • When doubling up an attending, schedule in adjacent rooms whenever possible.
- • For difficult problems, consult with the Clinical Coordinator of Anesthesia Services, and in his absence, the Medical Director of the Operating Room. If both are unavailable, consult with the attending physician on call.
- • If the surgical team is 15 minutes late, the Medical Director of the OR will be notified. The procedure may be delayed or canceled by the anesthesiologist and OR Nursing Supervisor, and another patient will be called.
- • The decision as to whether the operation will be performed under local anesthesia or with the services of an anesthesiologist should be made by the attending physician the day preceding surgery before the operating room schedule is submitted.
- • Operative and anesthesia permits, and necessary lab work must be in order and in the patient’s chart prior to coming to the operating room. All patients having local anesthesia are to have a brief history and physical.
- • When cases in the operating room require more time than anticipated or are completed earlier than anticipated, room assignments for subsequent cases may be changed to expedite the schedule; but only when a change of surgeon or anesthesiologist is felt not to jeopardize the patient’s care or violate an agreement between patient and physician.
- • All patients having operative procedures or exams in operating room will have functioning intravenous catheters, unless deemed unnecessary by the attending physician. Patients who go to the recovery room will have functioning intravenous catheters unless not previously placed in the operating room.
Clinical Coordinator: The clinical coordinator (CC) is the coordinator, arbitrator, and administrator of the operating room and can be reached by paging STH pager #3900. The CC makes out assignments, accepts emergency cases, and coordinates the efforts of the resident and faculty teams. The CC’s at both Shands and the VAMC are to be relieved of duties by the on-call attending physician personnel at 4:30 pm.
Efficient Use of the Operating Room: The ideal turnover time between OR cases is < 30 minutes. The anesthesiologist and the circulator are responsible for calling for preop medication and for sending for the next patient on the OR schedule: If the patient is not in the preop holding area, transportation time should be taken into consideration. All OR personnel should make every effort to move the cases as quickly and efficiently as possible.
Attending Coverage in the Operating Room: When not able to fulfill his operating room responsibilities, the attending anesthesiologist must arrange for and provide a substitute, unless the clinical coordinator determines there will be adequate attending coverage in the operating room.
Attending Coverage for Call: On-call residents will contact their attending physician for all cases, elective or emergency. Every patient receiving anesthesia at Shands must have a faculty member responsible for the anesthetic and present at induction and emergence from anesthesia and all other critical times. The patient cannot be billed for anesthesia services if an attending physician has not provided this coverage.
