When several patients needing urgent or emergent surgery require use of an OR at the same, who decides which case goes to the OR first? For true emergencies, the decision is generally straightforward, with the Patient rushed into the first available room. In many instances, however, the decision is not as clear. Should the patient with an open fracture go first? Should it be the patient with an ectopic pregnancy or perhaps the patient with an intestinal obstruction? Does the most senior surgeon get the first available OR slot? Should the decision be made on the basis of first-come, first-served? Or maybe the most assertive surgeon gets his or her case in first? Often the decision falls to the anesthesiologist of the day in the OR. Bu no matter who makes the decision, the competition between surgeons and arguments with anesthesiologists causes frustration. At times patients end up waiting for surgery longer than is clinically. Ideally, the decision should be base on an objective measure that reflects the clinical needs of the patient and gives surgeons, anesthesiologists and OR staff a predictable and fair system for prioritizing cases. Using a classification system for urgent surgery (such as the main article) also is the first step toward improving the flow of patients through the organization. Because the OR is the hub of inpatient flow, streamlining flow through the OR will also improve flow through the organization.

The complete article can be found in the July 2010 issue of OR Manager or at http://www.ORmanager.com