The Operating Room: It’s a Small World (and Scale Free Network) After All

Introduction: An operating room’s (OR) organizational behavior, including its susceptibility to certain types of failure, may partially reflect its structural features. We report the results of a structural analysis of a composite OR suite in a tertiary-care teaching hospital. Methods: We conducted a simulation study of the OR interaction network in a 900-bed teaching hospital. A composite OR network was built from a singleday operating room schedule encompassing 32 anesthetizing sites. There were two aims: (1) to compare the composite, or prototypical, OR network to three network types: random, scale-free, and small-world; (2) to calculate the total degree centrality, eigenvector centrality, and betweenness centrality for each node within the prototypical OR network, and to compare these metrics by level of physician training and by OR role. Results: The complete prototypical OR network included 146 nodes linked by 329 edges. Results indicate that the OR is a scale-free network with small-world characteristics. The chief anesthesiologist, OR charge nurse, and recovery room charge nurse had the highest total degree centralities. There were significant differences in total degree centrality scores between nurses and anesthesiologists, nurses and surgeons, and anesthesiologists and surgeons; attending physicians had greater perioperative total degree centrality than did resident physicians. Conclusion: Given the homogeneity of certain scale-free network characteristics throughout nature, such a designation has potentially critical implications for coordinating anesthesiologists and nurses, whose roles will be impacted by the continued growth of operating rooms. These implications will be tested at the next stage of the project. Authors Patrick J. Tighe is an Assistant Professor of Anesthesiology at the University of Florida College of Medicine in Gainesville, Florida. Sephalie Stephanie Patel is a Resident in Anesthesiology at the University of Florida College of Medicine in Gainesville, Florida. Nikolaus Gravenstein is a Professor of Anesthesiology at the University of Florida College of Medicine in Gainesville, Florida. Laurie Davies is an Associate Professor of Anesthesiology at the University of Florida College of Medicine in Gainesville, Florida. Stephen Lucas is an Assistant Professor of Anesthesiology at the University of Florida College of Medicine in Gainesville, Florida. H. Russell Bernard is a Professor of Anthropology, emeritus, at the University of Florida College of Liberal Arts and Sciences in Gainesville, Florida.