Five rooms cranking, an open fracture downstairs and an emergency bleed on the way. It's a surgical perfect storm, and a common occurrence for me. My job as the resource specialty coordinator at Mary Washington Hospital in Fredericksburg, Va., is to organize the mass chaos I experience in the hospital's 10 ORs during my 12-hour shift. I oversee the schedule and communicate with surgeons, PACU and anesthesia to ensure an even flow of elective and inpatient cases through our department. Here's what my day looks like.

Every minute counts
I arrive each day at 6:30 a.m. and immediately check the day's staffing schedule for callouts. I'll then meet with my three specialty coordinators (ortho, neuro/vascular, ENT/plastics/GYN) to map out the day's surgical schedule and address unresolved issues from the previous night's cases. If a member of the surgical staff has called out, I'll ask one of the surgical coordinators to fill in. By 7:15 a.m., I want complete surgical teams assigned to cases so we're ready to roll into rooms in 15 minutes.

After talking with the specialty coordinators, I'll head to the front desk to meet with my secretary (and, in my opinion, the brains of the OR), Alethia Washington. She's been with the hospital longer than any of us and is the one person I count on the most. Hanging next to her at the front desk is a 5-foot by 12-foot dry-erase board displaying the day's entire surgical schedule. The board lists the procedure, surgeon, staff assignments and OR number.

The key to managing my day is constantly frontloading the schedule. If a case is cancelled in the morning, I try to move an afternoon procedure into the open slot. The same goes for cases that end a few minutes early. I'll check the board repeatedly, looking for a sliver of time to move surgeries up in the schedule. A few minutes here, 15 minutes there - constantly shifting start times into small windows like that is a big part of what I do.

My goal is to slowly ratchet back the number of rooms in use throughout the day. This lets me keep my options open for emergency add-on procedures. In the morning, nine of our 10 rooms are in use (we allocate one room for cysto procedures). We run a full schedule until 3 p.m.; that's when I taper down to six rooms. By 7 p.m., my goal is to downshift again, this time to two active rooms with one surgical team on call for emergency cases.

Dealing with add-ons
Many think inpatient surgery done in the hospital's main OR takes precedence over outpatient cases. That's not our philosophy. We have the same concept of wellness and put the same emphasis on throughput, regardless of procedure. Our goal is to not have to cancel elective procedures.

When an unscheduled case presents, we assign it a letter (alphabetically - on a record day we made it all the way to T) and write it on the dry erase board. I then page the surgeon who'll perform the case to determine his availability. I'll find out times the doc is available, look for corresponding openings in the schedule and coordinate my staff accordingly.

That might seem like basic advice, but we just started following that protocol. I used to check on the status of the patient, anesthesia, surgical teams and place the case in an open slot in the schedule before contacting the surgeon. That caused more headaches than it solved. I'd go through all the effort to shift staff and room assignments, only to find out the surgeon wasn't available.

As much as we try to keep elective cases on schedule, moving the procedures is sometimes an unfortunate reality in a busy hospital; emergencies happen, and they'll always take precedence. But by being proactive to fill and move scheduled cases into holes that appear in the schedule early in the day, you'll have more flexibility to fill in elective procedures on the back end. We have an average of 30 elective cases pass through our ORs each day, and our cancellation rate is less than one percent.

When a case is bumped, it's the responsibility of the surgeon doing the bumping to contact his surgeon colleague. But in reality, I'm often the one making the call. I'll also go out to the waiting room and talk to the patient scheduled for the elective procedure. Nine times out of 10 they're fine with the delay - especially when I tell them that the case we're labeling a priority is a life-and-limb procedure.

Every now and then I deal with patients who aren't thrilled about waiting a few extra minutes for their case to start. That's understandable. I try to convey that time in the OR is never set in stone - never, that is, until the procedure is complete. Assure annoyed patients that their case will be slid into the next available opening in the schedule. If I've been doing my job throughout the day, the delay shouldn't be too long.

Lend an ear - and a hand
An important point: Other than overseeing the comings and goings of patients, I have no additional responsibilities. The surgical schedule is so complex and requires such an incredible attention to detail that my entire focus has to be on the big board.

I also have an intense work ethic and I believe that's a must for anyone filling this role. I'm constantly on the move, rotating to each OR to check the status of cases. I deal with 150 different attitudes a day and consider my thick skin an essential qualification. Coordinating cases in a busy hospital is full of high stress and little thanks. If I'm not noticed during a shift, that means things went according to plan.

Since I don't sit in an office (or anywhere else, for that matter), I tell the surgical staff that I have an open-ear policy. I consider myself a resource, and will always listen to problems that arise throughout the day. I'll also jump in to give someone a quick break during a long case. My focus has to be on the big picture, but that doesn't mean I lose sight of the little things that can help my staff.