A Sample O.R. Surgeon’s Preference List

Why You Need This

As you start your practice, most likely you will be in a new O.R. environment. So, how do you have the O.R. staff, and even the anesthesiologists/anesthetists — to whom your practice is new — immediately and accurately provide the supplies, equipment and “ “set-up” you require?

Each surgeon has different preferences and it is laborious and time-consuming to have to verbally state your preferences, every time you enter the O.R., for:

• Positioning of the patient on the O.R. table
• Room arrangements, i.e., location of the anesthesia specialist, Mayo stand, back table, cautery unit, tower,et al.
• Placement/positioning of the endotracheal tube or laryngeal mask airway.
• Usual local anesthetic for each type of case.
• Sutures routinely used.
• Nasal packing materials
• Drains, by size, configuration
• Antibiotic, steroid and other medications routinely used

There are many variables in the equation of safe, efficient and economical O.R. care. By being very specific as to your desires, those ends will be met.

Your Focus Must Be on the Patient, Not Logistics

Most importantly, not having to recite one’s choices, as the patient is being prepared for surgery and the induction of anesthesia, frees you to concentrate on the patient’s welfare and safety in the OR. Working through your checklist, just as you see the airline captain and first officer do prior to take-off. Speaking of “captain”, as “Captain of the Ship”, the surgeon must be focused on all that is happening in the OR and not be distracted by having to recite his/her routine preferences before each operation. Your eyes and ears need to be what everyone else is doing and making sure they are doing it right. Your written directives will aid that process.

All the surgeon’s requirements should be known by the anesthesia specialist and OR staff before you and your patient enter the operating room. When the staff is well-educated, there is excellence of preparation and harmony of the participants. This translates to patient safety, efficiency and economy of time and dollars which is a joy to observe. Like a concert orchestra; everyone knows what to do; they are all reading the same music notes.

Such a “Protocol Book” will save you time and reduce the repetitive nuisance of:

“ Doctor, what kind of suture do you use for ____________?”

Use our Protocol Book as a sample. Invest the time in creating your own. Then, have the O.R. administrator print out the YOUR text and YOUR photos, place into a three-ring binder and insist that it is in the room for each case you do and that it be reviewed as the room is being prepared for your patient to enter.

Put this into place and be assured, the preparation time will be the best investment of your time and energy. Just like the word-processing machine replaced the time-wasting and tediousness of typing the “usual text” of a report or letter individually.

Finally, you are encouraged to have the same anesthesia specialist, same surgical assistant and same circulating RN for all your cases. Why not? Familiarity breeds excellence. And, the excellence of “the team” translates to safety and better outcomes.

Robert Kotler, MD, FACS