UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL ANESTHESIOLOGY RESIDENCY PROGRAM CA-3 ANESTHESIOLOGIST-IN-CHARGE (AIC) ROTATION OVERVIEW CA-3 residents will spend tw cntiguus weeks in the rle f anesthesilgist-in-charge in the University perating rm. They will nt be assigned t ther resident functins unless applicable t the management f the daily schedule. They will initially be riented t the daily tasks f the directr including managing placement f cases in the perating rm schedule, adjusting staffing during the day, crdinatin f scheduling with the surgens and nursing supervisr, and determinatin f staffing assignments fr the next day s schedule. They will carry the directr beeper during the day, addressing scheduling issues, persnnel issues, and case management as apprpriate. The designated AIC attending anesthesilgist will be available fr cnsultatin n all matters thrughut the day. GOAL The gal f this rtatin is t prvide the resident with a better understanding f the intricacies f Operating Rm management, hw the larger systems with which we interact (bth within and external t the institutin) impact the Operating Rm, and hw the Operating Rm impacts thse larger systems. COMPETENCIES Given the nature f this rtatin, mst f the bjectives incrprate several f the cmpetencies simultaneusly. They are placed in the categries belw based upn primary prcess. I. PROFESSIONALISM At the cnclusin f the rtatin, the resident will: Understand the imprtance f prfessinalism in the rle f perating rm management II. INTERPERSONAL AND COMMUNICATION SKILLS At the cnclusin f the rtatin, the resident will: Demnstrate prficiency in delegatin f tasks thrugh effective cmmunicatin with faculty, clleagues, CRNAs, nursing staff, and supprt staff Demnstrate prficiency in crdinating anesthesia care with nursing staff needs Demnstrate prficiency in the crdinatin anesthesia care with surgical specialties and ther services Acquire the basic skill set necessary fr team building, negtiatin and cnflict reslutin. III. SYSTEMS-BASED PRACTICE At the cnclusin f the rtatin, the resident shuld understand:
The difference between the scheduled elective surgery list and the Add-On /emergent/ urgent cases. Understand the basics tenets f prper resurce management The perating rm rganizatin as it applies t hspital administratin, surgical specialities, supprt staff, anesthesia and anesthetic supprt staff. Becme familiar with the rganizatinal structure f the Operating Rm and hw that interfaces with the larger system structure Learn hw manage staffing in a multicampus anesthesilgy practice mdel Learn hw effective OR management has a psitive impact n resident educatin Becme familiar with the Jint Cmmissin Patient safety gals as well the regulatry requirements with which an OR and Anesthesilgy department has t be cmpliant t maintain accreditatin Understand the basic cncepts f Anesthesia Billing Learn Basic LEAN cncepts fr managing the Operating Rm Operating rm efficiency as it relates t turnver times, rm utilizatin IV. PRACTICE-BASED LEARNING At the cnclusin f this rtatin, the resident will have: Learned abut the leadership pprtunities available t the anesthesilgist within Periperative Services Learned t cllabrate with the OR nursing leadership and cmmunicate with surgens regarding patient flw in the OR Learned abut the perating rm rganizatin as it applies t hspital administratin, surgical specialities, supprt staff, anesthesia and anesthetic supprt staff. CURRICULUM Didactics will begin with daily infrmal sessins as the day prgresses. Planned sessins thrughut the general curriculum will include: ABCD f Anesthesilgy Practice: AIC Rtatin Lecture Series Anesthesilgy and OR Management 101 Accreditatin and Regulatry Cmpliance BOB: Basics f Anesthesia Billing Cnflict Reslutin, Negtiatin and Team Building Drive Thrughput: Patient Experience and OR Efficiency LEAN Training Leadership Skills Systems Based Imprvement Prject
Each resident is required t submit a prpsal fr a Systems Based Imprvement Prject in ne f the fllwing areas: Patient Experience Imprving Quality f Care Increase OR Thrugh-put Cntribute t Financial Sustainability Each resident will have an AIC Attending wh will serve as their mentr fr her/his prject. The resident with the prpsal that is judged t have the ptential fr maximum impact will be given the pprtunity, supprt and funding t attend the American Sciety f Anesthesilgy Annual Practice Management Cnference Resident Track. Participatin in Cmmittees As a part f the AIC Rtatin, residents will be invited t attend and cntribute t the existing multidisciplinary Cmmittees wrking n imprving patient flw in Periperative Services, including the Operating Rm Executive Cmmittee. Expectatins frm Residents n AIC Rtatin The resident will schedule a time t meet with Dr. Kaur, the rtatin directr and Operating Rm Medical Directr/Clinical Vice Chair f the Department f Anesthesilgy, prir t the start f the rtatin. Review gals and bjectives f the AIC Rtatin at the abve meeting Obtain the reading package/curriculum frm Lisa Nichlsn, the residency cdinatr. Review the Slutins t Systems Based Prblems frm and cncept with the Rtatin Directr Identify a systems based prblem that impacts either patient flw/safety r efficiency in the OR Fill ut the Slutins t System Based Prblems frm at the end f the rtatin and review with the Rtatin Directr. Hand in the abve frm t the Residency Crdinatr s that it may be added t the Resident s Prtfli. Meet with the Rtatin directr at the end f the tw weeks : Wrap up meeting/lessns learned Curriculum/ Reading Package Bibligraphy: (Actual hard cpy package given t the resident prir t the start f the rtatin) 1. St. Jacques P, Patel N, Higgins M: Imprving Anesthesilgist Perfrmance Thrugh Prfiling and Incentives Jurn Clin Anes, March 2004, 16:523-528.
2. Abuleish A, Dexter F, Epstein R, Lubarsky D, Whitten C, Prugh D: Labr Csts Incurred by Anesthesilgy Grups Because f Operating Rms Nt Being Allcated and Cases Nt Being Scheduled t Maximize Operating Rm Efficiency Anesth Anal 2003;96:1109-13. 3. Jen A: A Hspital Administratr s View f the Operating Rm Jurn Clin Anes, 1995, 7:585-588. 4. Davies J: Team Cmmunicatin in the Operating Rm Acta Anesthes Scand 2005; 49:898-901. 5. Weinbrum A, Ekstein P, Ezri T: Efficiency f the Operating Rm Suite Amer Jurn f Surg 185 (2003): 244-250. 6. Lingard L, Reznick R, Espin S, Regehr G, DeVit I: Team Cmmunicatins in the Operating Rm: Talk Patterns, Sites f Tensin and Implicatins fr Nvices Academic Med, March 2002, 77.3:232-237. 7. O Neill L, Dexter F: Tactical Increases in Operating Rm Blck Time Based n Financial Data and Market Grwth Estimates frm Data Envelpment Analysis Ecnmics, Educatin & Plicy, February 2007, 104.2:355-368. 8. Abuleish A, Prugh D, Whitten C, Zrnw M, Lckhart A, Cnlay L, Abate J: Cmparing Clinical Prductivity f Anesthesilgy Grups Anesthesilgy 2002;97:608-15. 9. Dexter F, Macari A, Traub R: Which Algrithm fr Scheduling Add-n Elective Cases Maximizes Operating Rm Utilizatin? Anesthesilgy 1999;91:1491-500. 10. Dexter F, Macari A, Qian F, Traub R: Frecasting Surgical Grups Ttal Hurs f Elective Cases fr Allcatin f Blck Time Anesthesilgy 1999;91:1501-8. 11. Dexxter F, Macari A, Traub R, Lubarsky D: Operating Rm Utilizatin Alne is Nt an Accurate Metric fr the Allcatin f Operating Rm Blck Time t Individual Surgens with Lw Caselads Anesthesilgy 2003;98:1243-9. 12. Are Yur Hspital Operating Rms Efficient? A Scring System with Eight Perfrmance Indicatrs Anesthesilgy 2006;105:237-40 13. Seim A, Andersn B, Sandberg W: Statistical Prcess Cntrl as a Tl fr Mnitring Nn-perative Time Anesthesilgy 2006;105:370-80. 14. Dexter F: Design f Appintment Systems fr Pre-anesthesia Evaluatin Clinics t Minimize Patient Waiting Times: A Review f Cmputer Simulatin and Patient Survey Studies Anesth Analg 1999;89:925-31. 15. Strum D, Sampsn A, May J, Vargas L: Surgen and Type f Anesthesia Predict Variability in Surgical Prcedure Times Anesthesilgy 2000;92:1454-66.
Systems Based Practice/ Finding a Slutin The resident will learn hw Systems prblems can impact every aspect f patient care. He/she will identify ne such prblem during their tw week rtatin and prpse a slutin. (They will fill ut the attached frm) AIC ROTATION SYSTEMS-BASED PRACTICE EXPERIENCE PORTFOLIO ENTRY 1. What d yu knw nw that yu did nt knw befre? 2. Did yu bserve, frm a management perspective, any inefficiencies r prblems within the system? 3. Chse ne pint f inefficiency r prblem and suggest a wrkable slutin. 4. Any Impediments t implementatin f yur slutin that yu can thin f?