1. The current emphasis on cost containment and efficiency requires anesthesiologists to take an active role in eliminating dysfunctional aspects of OR practice (e.g., first-case morning start times).
   1. Anesthesiologists with insight, overview, and a unique perspective are best qualified to provide leadership in an OR.
   2. An important aspect of OR organization is materials management.
2. Scheduling Cases
   1. Anesthesiologists need to participate in scheduling of cases because the number of anesthesia professionals depends on the daily caseload, including “offsite” diagnostic areas.
   2. The majority of ORs use block scheduling (preassigned guaranteed OR time with an agreed cutoff time), open scheduling (first come, first serve), or a combination.
   3. Computerization will likely benefit every OR.
3. Preoperative Clinic. Use of an anesthesia preoperative evaluation clinic usually results in more efficient running of the OR and avoidance of unanticipated cancellations and delays.
4. Anesthesiology Personnel Issues. In light of the current and future shortage of anesthesia professionals, managing and maintaining a stable supply promises to dominate the OR landscape for years.
5. Cost and Quality Issues
   1. Health care accounts for approximately 14% of the US gross domestic product, and anesthesia (directly and indirectly) represents 3% to 5% of total health care costs.
   2. Anesthesia drug expenses represent a small portion of the total perioperative costs, but the great number of doses administered contributes substantially to the aggregate total cost to the institution.
      1. Reducing fresh gas flow from 5 to 2 L/min whenever possible would save approximately $100 million annually in the United States.
      2. More expensive techniques and drugs may reduce indirect costs (e.g., propofol is infusion more expensive but may decrease PACU time and reduce the patient's nausea and vomiting).
      3. For long surgical procedures, newer and more expensive drugs may offer limited benefits over older and less expensive longer acting alternatives.
      4. It is estimated that the 10 highest expenditure drugs account for more than 80% of the anesthetic drug costs at some institutions.

Scope of Practice

1. Administrative Components of All Anesthesiology Practices
2. Practice Essentials
3. Evolving Practice Arrangements
4. Health Insurance Portability and Accountability Act
5. Expansion Into Perioperative Medicine, Hospital Care, and Hyperbaric Medicine
6. Operating Room Management