Perioperative & Surgical Services

You own the grid. Services and surgeons hold recurring block time, and your job is to see that it gets used — chasing the block that is going to sit empty, working the release deadline so unused time goes back to the open pool while someone can still book into it, and fielding the call from a surgeon who wants a Tuesday that belongs to somebody else. Cases get posted with a duration the surgeon's office estimated, and you know which of those estimates run long and which run short. At the block review you bring utilization by service to the OR committee, and someone's time gets taken away, which is never a comfortable meeting.

Every case has a card — the surgeon's list of instruments, sutures, implants, prep and positioning — and every card drives a pick list that someone pulls into a case cart ahead of the case. The cards drift. A surgeon changed sutures a while back and nobody edited the card, so a pack gets opened and thrown away every single time. Items sit on the card as hold-and-open-only-if-needed and get opened anyway. Meanwhile the case that actually goes wrong is the one where the tray came up short at count, the implant size on the shelf was not the size the surgeon wanted, or the vendor's trunk stock never made it through the door because the rep's credentialing had lapsed.

The circulator documents the case as it runs — times, positioning, prep, counts, specimens, who was in the room — while the anesthesia record builds from the monitors alongside it. Afterwards someone has to make the record and the bill agree. Implants need their identifiers captured and logged. The operative report has to be there, and a note has to be in the chart before the patient moves to the next level of care if the full report is not yet filed. Charges come off room time, supplies, implants and anesthesia units, and the ones that get missed are the ones documented in a free-text field nobody bills from. Then an abstractor reads the same case again for the surgical registry, pulling elements that were in the chart the whole time.

Your day starts with whether first cases went on time, and the reasons they did not are always the same short list — the patient arrived late, the consent was not signed, the block had not been placed, the surgeon was still in clinic, the room was not ready. From there you run the board: who is running parallel rooms, which case is going long and what that does to everything behind it, which add-on can still be worked in. At the back end, recovery fills. Phase I nurses hold patients who are ready to move because there is no inpatient bed, and a held bay stops the next case from coming out, which stops the next case from starting. By afternoon you are deciding what moves and what gets cancelled, and telling a patient who has been NPO and waiting since early morning.