SUMMARY

Operating rooms are complex environments, but vital to the success of hospitals. Pressure to efficiently run ORs, with emphasis on quality and cost, has required a re-evaluation of OR management structure. Redesigning

TABLE 86-21 -- Operating room agencies and regulators

Joint Commission for Accreditation of Healthcare Organizations (JCAHO)

Accreditation Association for Ambulatory Healthcare (AAAH)

Drug Enforcement Administration (DEA)

Food and Drug Administration (FDA)

Centers for Disease Control and Prevention (CDC)

Department of Health and Human Services (DHHS)

Centers for Medicare and Medicaid Services (CMS)

Occupational Safety and Health Administration (OSHA)

American National Standards Institute (ANSI)

National Fire Protection Association (NFPA)

National Committee for Quality Assurance (NCQA)

National Academy of Sciences/Institute of Medicine

Safe Medical Devices Act

Health Insurance Portability and Accountability Act (HIPAA)

OR governance has been essential in addressing the changes required to make ORs run more effectively. Such redesign has resulted in an increasing trend to place overall responsibility in the hands of a single person, often referred to as the OR director.

Much of an OR director's efforts are focused on ensuring smooth, efficient throughput of patients in the perioperative area. Accurate scheduling, on-time OR starts, efficient turnover, and proper surgical case management are critical to the success of running the surgical schedule. OR directors must develop strategies to manage the variability that occurs in the surgical schedule as a result of add-ons, emergency cases, and cancellations. They must also construct systems that seek to control surgical and anesthesia costs.

A comprehensive OR information system that can capture and organize OR data is essential for the OR director. Detailed data are required for instituting a successful business plan for the OR and bringing about changes in how the OR functions. The OR director must understand OR economics and use sound strategies for cost control and revenue enhancement.

The role of the OR director has evolved into a broad and encompassing perspective of a manager of the perioperative process. Although the challenges in making an OR function optimally are great, the benefits of an efficient and successful OR are critical to the hospital, to anesthesiologists, and to surgeons who work in this environment.