PREOPERATIVE AND POSTOPERATIVE ORGANIZATION

Effective OR directors must not limit their focus to issues within the OR itself; they also need to have control over both preoperative and postoperative activities. The title Director of Perioperative Services is often used to more clearly define the scope of management of this position. Bottlenecks in throughput that occur before or after the surgical procedure will neutralize efficiencies developed within the OR itself.

Attention should be given to the preoperative process (see Chapter 25 ). The admitting process should be streamlined and organized to meet the needs of the surgical patient.^{[62] [63] [64]} Preoperative testing clinics and protocols for assessment have helped reduce costs, as well as delays on the day of surgery. The preoperative facility (same-day surgery or inpatient holding room) should be organized so that patients are available without delay for their preparation for surgery. Inpatient management also must be organized to meet the very different needs of this group of patients. A protocol for transporting floor and ICU patients to the OR will allow better case starts and turnovers.

The PACU must also function well to allow efficient OR throughput. ^{[65] [66] [67]} Recently, issues such as hospital floor bed and ICU capacity have resulted in the PACU being filled to capacity and unable to accommodate new OR patients. Maximizing fast-track discharges and modifications in scheduling outpatients and inpatients will help alleviate PACU congestion. For further discussion on ways to improve PACU function, see Chapter 71 .