Do your anesthesia providers help transfer patients from the holding area to the OR suite? Absolutely, say most of the readers responding to a question on our online discussion board. But they were quick to add that rarely does the anesthesia provider act alone in this role. Rather, most respondents said it was the norm for the anesthesiologist or CRNA to work with the circulating nurse to escort patients from pre-op to surgery and from the OR to PACU. "Our anesthesia care providers are excellent," gushes one reader. They "assist in transport from pre-op to OR with the RN. They help position in the OR and transfer from OR to PACU."

At another facility, the circulating nurses and nurse anesthetists handle patient transport, while the in-house anesthesiologist helps by taking care of patients in pre-op and bringing family members to the recovery area when it's time for discharge. "Great team!" boasts that facility's administrator.

Depending on how you handle room turnovers and where you administer anesthesia, it might be more efficient to have either the circulator or the anesthesia provider transport patients, not both. One surgical services director says her circulating nurse transports the patient to the OR alone, and the anesthesiologist arrives after the patient has been transferred to the OR bed. After the case, the anesthesiologist and PACU nurse together transport the patient to recovery, while the circulator stays behind to help the surgical tech turn over the room.

No matter which approach you take, the important thing is to make sure everyone is doing her part to keep the schedule running smoothly and safely. As one anesthesia provider puts it, "Teamwork, I believe, is the answer, rather than specific rules."

Do You Let Patients Go Home to an Empty House?
The beauty of outpatient surgery is that patients can return to their homes just hours after induction and recover in the privacy and comfort of their own surroundings. Unfortunately, some patients have little choice but to return to an empty house or apartment, with no one to look after them in case a complication arises. Is it the surgical facility's responsibility to make sure patients have someone stay with them, at least for the first night? Should you cancel a case if you know the patient will be alone overnight?

It's a sticky (and thankfully rare) situation, says a reader, but there are precautionary measures you can take. "We make sure they have everything they need, emergency numbers, and we do extra phone calls to follow up with the patient."

Another respondent adds that the facility is obligated to educate the patient about potential hazards, but that it's difficult to enforce a home caregiver policy. That hasn't stopped one facility from taking a firm stance: "All of our anesthesia cases (any case that is not straight local only) are required to have someone stay with them overnight," writes a surgical services director. "We have cancelled cases when the patient has not arranged for this."

Reeling in Docs Who Run Over Their Blocks
Nothing disrupts the schedule and racks up the overtime like surgeons who run over their block times. Try these strategies:

• 3-strike rule. First-time offenders get a verbal warning. The second infraction triggers a letter from the board listing fees for future tardy starts. Surgeons receive an invoice after the third time they run over their block. Fees are calculated at 15-minute intervals until the surgeon arrives.
• Post delays for all to see. This is the shame game. Add a "case delays" column to that whiteboard you use to list each case of the day. In red marker, write what caused the delay: "surgeon late," "equip," "staffing" and so on. You can also break down the data by the reasons for late starts and the names of the offenders. A similar idea: Post the names of late surgeons in the surgeon's lounge. "The art of monitoring often renders results that are more timely," says a reader. "Remember that peer pressure has the greatest influence. We really improve when the numbers are in front of us."
• Get your surgeons on "Lombardi Time." Hall of Fame football coach Vince Lombardi insisted that his players show up for meetings, prepared, at least 10 to 15 minutes early. This became known as "Lombardi Time." Tell your surgeons that they aren't on time unless they arrive at least 15 minutes before the scheduled start time.