Anesthesia Patient Safety Podcast

#282 Building Safer Anesthesia Teams In A Locum-Driven World

• Anesthesia Patient Safety Foundation • Episode 282

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Ever walked into a new OR and spent the first ten minutes hunting for an airway bougie or a computer log-in that actually works? We dig into the hidden safety risks of a transient anesthesia workforce and share practical, fast-moving fixes that keep patients safe while keeping rooms open. With staffing shortages reshaping coverage models across the United States and beyond, locum clinicians are essential—but inconsistent environments, unclear escalation paths, and fragmented communication can turn small friction points into big hazards.

We unpack what the current evidence says—and doesn’t—about locum-related outcomes. A UK qualitative study surfaces predictable threats like unfamiliar systems and weak team integration, while primary care data shows prescribing differences without higher adverse events. In anesthesia, large safety studies are scarce, so leaders must rely on smart design: targeted orientation, standardized room setups, and shared mental models that don’t depend on who’s on the schedule. We also talk dollars and sense, highlighting a simulation-based break-even estimate for when full-time hiring outperforms locum coverage, and how to weigh cost without compromising safety.

From the main OR to higher-risk non-operating room anesthesia sites, we outline concrete steps that work across settings. Limit initial deployment to oriented locations, add locum staff to all communication channels from day one, and use checklists, cognitive aids, and universal timeouts to reduce variability. Establish clear role definitions and escalation trees posted in every anesthetizing location, and fold temporary clinicians into audits, feedback loops, and ongoing education. The aim is simple: compress the ramp-up, eliminate guesswork, and make the safe action the easy action—even when teams change daily.

If you care about perioperative safety, access, and team resilience, this conversation gives you a playbook to act now. Subscribe, share with a colleague who onboards locums, and email your best orientation tip so we can feature it on a future show.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/282-building-safer-anesthesia-teams-in-a-locum-driven-world/

© 2025, The Anesthesia Patient Safety Foundation

SPEAKER_00:

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Allie Bechtel and I'm your host. Thank you for joining us for another show. The October 2025 APSF newsletter is out with all new articles as we continue to work towards improved anesthesia patient safety. But before we cover the new newsletter articles, we have a special Article Between Issues show so that we can cover some of the articles that have been published on APSF.org since the June newsletter. And there are some really good ones. Before we dive further into the episode today, we'd like to recognize Merck, a major corporate supporter of APSF. Merck has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, Merck. We wouldn't be able to do all that we do without you. Our featured article today is Patient Safety with a Transient Workforce Navigating the Terrain of a Locum Tenants-Driven World by George Tufik and colleagues. This article was published online on June 30th, 2025. We often talk about how important communication and teamwork are when it comes to anesthesia patient safety. And this article focuses on what happens when our teams are comprised of new and frequently changing team members. There are staffing shortages in the United States and around the world, which may make it difficult to provide anesthetic services on a day-to-day basis and cover all the call duties and on a larger scale to be able to implement complex policies and procedures. This has led to the use of locum tenants or per diem anesthesia professionals to fill gaps caused by attrition, retirement, and expansion, and to help maintain adequate availability of anesthetic care services. Let's start with the definition and some background information. Locum tenants are short-term healthcare professionals that are usually used to cover clinicians for leave during periods of high demand or in areas facing clinician shortages. In 2022, 88% of surveyed healthcare facility managers reported using locum tenants physicians, with 28% of those using locum anesthesiologists or certified registered nurse anesthetists in the prior 12 months. Does your institution use locum tenants clinicians? Advantages of having an available temporary workforce include the following. Making sure that services remain available, especially in underserved or rural areas, filling gaps during clinician shortages or when regular staff are unavailable, alleviating the workload of permanent staff to help decrease the risk for overwork and related errors. Disadvantages may include locum tenants professionals being unfamiliar with hospital-specific protocols leading to communication errors or mismanagement, variability in the quality of care, and with frequent changes, there may be disruptions in established workflows and communication. And all of these are important considerations that may have a downstream effect on patient care and patient safety. For example, there may be a situation where a locum anesthesia professional does not know who to contact for help in an emergency situation or may not know where to go in the hospital to respond to an emergency in a different department. There may be a significant difference between part-time or full-time staff and locum staff when it comes to orientation, continuing education, mandatory training sessions, grand rounds and didactics, quality improvement measures, and evaluations. And now it's time for one of our favorite segments on the podcast. It's time to dive into the literature. We are diving into the shallow end, though, since there is not a lot of data. First up, let's look at the 2024 qualitative study based on interviews with locum tenants clinicians in the United Kingdom. You can find the citation in the show notes. Results from this study revealed threats to patient safety for locum clinicians that included unfamiliar environments, policies, and computer systems. Have you ever witnessed a locum clinician struggling just to log on to the computer? Another important threat to patient safety is the lack of clear direction and leadership when there are a lot of locum clinicians on staff. In addition, team dynamics may be compromised if locum clinicians are excluded from the team, and there is the potential for lack of accountability with independent contractors. Another study in England looked at general practitioner visits over a 12-year period. There were no statistically significant effects on patient safety parameters, including emergency emissions. Interestingly, patients who saw a locum practitioner were 22% and 8% more likely to receive prescriptions for antibiotics and opioids respectively. But consultation with the locums practitioners decreased return visits by 12% within one week and decreased referrals and additional tests by 15% and 19% respectively. Let's turn our attention to patient safety data on locum tenants and anesthesiology. Unfortunately, at the time of this article, there are no major studies that assess the impact on patient safety and quality specific to anesthesia care. Hiring locum tenants clinicians usually comes down to a financial decision or to provide coverage quickly. There is a 2024 study by Cross and colleagues that addresses a financial consideration for hiring. The investigators developed a Python simulation model to evaluate costs between hiring locum tenants and full-time anesthesiologists. The break-even point was found to be 665 hours or 11 weeks at an average of 60 hours per week. After this point, it is more cost-effective to hire a full-time anesthesiologist. There is evidence that locum tenants physicians do not have a higher mortality rate, adverse event rate, or malpractice payout rate. Another area where data is lacking is on the impact of patient safety for locum tenants clinicians, including certified registered nurse anesthetists who may be hired to fill staff shortages. There are challenges inherent in building a robust safety program that may be increased when relying heavily on temporary workers. But there is some good news. There are steps that can be taken to improve patient safety to help address each of these threats. We hope that you will check out Table 1 in the article to see this list, and we're going to go through it now. The first barrier is lack of familiarity with the environment. The potential solutions include the following site-specific orientation, consider limited deployment, and standardization of environment and available resources. The next barrier is limited involvement with clinical governance. Here are some potential solutions: use of regular clinical audits, requirements for professional development, and mechanisms in place for feedback from locum tenant staff. Another barrier is non-compliance with policies and procedures. Potential solutions may include regular education for all staff, and use of systems that mandate compliance with all staff, including checklists and attestations. Scope of practice effects may be another barrier to patient safety. Here are a couple potential solutions. Clear delineation for clinicians regarding responsibility, and orientation of all staff, temporary and permanent, regarding roles. The last barrier that we are going to cover today is inhibited information exchange with these potential solutions, use of checklists and cognitive aids, establish clear communication pathways between staff, and include locum tenants in department communication. Outside agencies are often responsible for credentialing and medical licensing for their locums tenant staff. But before these clinicians engage in patient care, it is vital to provide appropriate orientation to the physical space, available equipment, resources, policies and procedures, and electronic health record documentation. Another consideration may be to deploy locum tenants' anesthesia professionals only to areas where they have been oriented, like the main operating room, and not send them to remote non-operating room anesthesia locations where they may be unfamiliar and far away from help if needed. We have talked about it before in this show, but we know that patients undergoing non-operating room anesthesia and procedures are at higher risk for severe adverse events. If we add clinicians who are not familiar with the environment to the equation, there may be an even higher risk for patient safety. Communication and teamwork are critical ingredients for patient safety for all staff. So it is important to consider how to improve communication for all staff, including locum tenant staff. Do you have a clear communication pathway in your department? This may involve integrated electronic health record messaging, Slack, WhatsApp, or alternative communication technologies. It is critical that locum staff are included in routine departmental or group communications, which may include information about changes in workflow or equipment or new expectations for staff. The goal is to make sure that all anesthesia professionals in the department are on the same page when it comes to policies, procedures, and expectations. Another important consideration for improved patient safety is standardization and accessibility of resources such as medication and equipment. Lack of standardization in perioperative care, such as for documentation, stocked medications, available airway equipment, demands that every new clinician must orient to new surroundings, and this goes for temporary and permanent staff. There is a time cost here as well, since when more aspects of clinical care are standardized, less time and effort are required for orientation. The authors provide an example of the use of the Joint Commission Universal Protocol, which requires a pre-procedure verification process, procedure site marking, and timeout for any Joint Commission site. This is an expected and anticipated component of perioperative patient safety, and since it is standardized, it is easy to implement across different sites and institutions. Going forward, the staffing shortages are likely to continue in medicine and anesthesiology, and the use of locum tenant staff will likely increase. The authors leave us with this call to action. Understanding these unique factors that may affect patient safety more significantly with use of locum tenants staff and addressing these factors is the first step to mitigating the effects and successfully incorporating locum tenants professionals into a group's overall strategy to improve perioperative patient safety. Are you using locum tenants clinicians at your institution? What steps have you taken to help maintain your group's overall strategy to improve perioperative patient safety? Let us know by sending us an email at podcast atapsf.org. We want to hear from you and we can share your story right here on the podcast. If you have any questions or comments from today's show, please email us at podcast atapsf.org. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit apSF.org for detailed information and check out the show notes for links to all the topics we discussed today. Have you checked out the newest APSF newsletter? The October 2025 APSF newsletter marks the 40-year anniversary of the APSF newsletter. We are so excited to start talking about these articles on the podcast in the coming weeks, so we hope that you will continue to tune in. Can you tell one friend, colleague, or trainee about the show too? We would love to continue to spread the latest news, research, and more about perioperative patient safety with an even bigger audience. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.