First-case morning start times base changed from a suggestion to a mandate. Delays ot any son are now often tracked electronic-ally in real time and carefully scrutinized to eliminate waste and inefficiency. Together, anesthesiologists, surgeons, OR nurses and techni¬cians. And increasingly, professional administrators/managers need to determine who is best qualified to he a leader in the day-today management of ihr OR.1 Clearly, different groups hase different perspectives. However, anesthesiologists are in the best position to see the "big picture." both overall and on any given day. Surgeons are commonly elsewhere before and after their individual cases (and sometimes for the beginning and the end of their moncler clothing casesl; nurses and administrators may lack the meibcal knowledge to make appropriate, timely decisions, loften "on the lly." I: is the anesthesiologist with the insight, overs lew, and unique perspective who is best qualified to pro¬vide leadership in an OR community. Thr subsequent recogni¬tion and appreciation from the either groups lespecully hospi¬tal admimsir.itiunl will clearly rstabfcth the anesthesiologistsas concerned physicians genuinely micrrstcd in ihr welfare of the OR and the institution. Organization The symbiotic relationship lietween anesthesia professionals and surgeons remains unchanged. Both groups recognize this fact and also the common goal of having ihe OR function in a safe, expeditious manner. The age-old question. "Who is in charge of the operating room?" still confronts nxany hospi tah/imtilolkim- moncler jackets Because some anesthesiology groups ate sub¬sidized hy the hospital, the OR organization in such cases has changed accordingly. Many hospital administrators want to have input rciurding who is m charge of thr OR with an eye to increasing efficiency and throughput while reducing cost. Their wishes have an even added significance when more of their dollars are involved through the anesthesiology group subsidy. Sometimes there can be no real answer to. "Who's in charge? Because tif thr complexity of the interpersonal rela¬tionships in the OR. Sntne institutions have a professional manager moncler toften a former OR registered nurse.i whose sole job is to organize and rim the OR. Ihrs individual may lie vested with enough authoeitv to be recognized by all as the person in charge. Other institutions ostensibly have a "medical ditectur of the OR." I lowever. The implications to the surgeons that an anesthesiologist is in charge, or vice versa, hase caused many institutions to abandon tlir moncler jacket sale title or rrtam the position but assign no authority to it. moncler jacket In such instances, institutions usually rrsolvr disputrs through some authority with a physician's perspective. If there is no mrdical director with authority to makr decisions stick, central authority usually resides with the OR committee, most often populaccd by physicians, senior nurses, and administrators.