Scheduling Patients for Surgery

1.0 PURPOSE
 
1. To provide guidelines for the Surgical Booking Office in scheduling urgent and elective patients surgery
2. To provide a system whereby surgical patients are scheduled within the time frame prescribed by the OR Booking Committee.
3. To ensure the efficient use of OR time, the OR facility and its equipment, without overscheduling available resources.
4. To provide a system that enables all surgeons' reasonable predictability of OR time.
 
2.0 POLICY
A.	ELECTIVE PATIENTS
Definition:  Procedure scheduled within an average of 65 days
1. Prior to scheduling any patient the physician submits:
- Scheduling Request form
- Completed History
- Physicians' Order form

B.	URGENT PATIENTS
Definition: Procedure scheduled within an average of 14 days
1. Prior to scheduling any patient the physician submits:
? Scheduling Request form with status of history noted
? Physicians' Order form

C.	IN-HOUSE PATIENTS
Definition: In hospital bed when scheduled for procedure
1. In-house scheduling request forms are submitted to the Surgical Booking Office.
2. Telephone requests will be accepted only in extenuating circumstances.
3. Urgent in-house patients that cannot be slated within 4 days and are not suitable 

D.	SURGEON'S SELF SCHEDULE (Otolaryngology, Plastics, Obstetrics/Gynecology)

1. List of confirmed patients and completed scheduling request form for elective surgery is submitted to Surgical Booking Office four weeks in advance, or time will be reallocated.
2. Surgical booking Office reserves the right to adjust the submitted list and some time must be allocated for urgent cases.
3. Available OR time, turnover time, patient type, and procedure must be considered when booking.
4. Patients waiting more than six periods are returned for reassessment.

E.	ALLOCATION OF OPERATING ROOM TIME

1. For maximum efficiency, OR time is organized in blocks and assigned by the OR Booking Committee.  No department or division "owns" a block.
2. OR time is allocated to departments and divisions on the basis of need.  The goal is to have a range of waiting time of .7 to 1.3 of the average wait of 1.0.
3. Each surgeon requires a minimum amount of OR time to maintain surgical skills.
4. Surgeons will notify Surgical Booking Office four weeks in advance of a planned absence or vacation.
5. Vacations are used to adjust waiting times.  Time will be allotted to surgeons within the division with waiting times greater than 1.0.  If no surgeons waiting time is greater than 1.0, the time will be distributed to other divisions with longer waiting times.  Surgeons can switch blocks within divisions as long as their average waiting times are greater than 1.0.
6. Elective OR time for locums will be based on the surgeons average waiting times and the degree of urgency of the cases. 
7. The Surgical Booking Office adjusts blocks to accommodate in-patient booking, urgent bookings and unanticipated events.
8. Request for changes in OR block assignments are submitted in writing to the OR Booking Committee by the Surgical Division Head.
9. Adjustments should be made within divisions to accommodate blocks that are disadvantaged by Corporate Days and Statutory Holidays.  Problems with adjustments should be brought to the OR Booking Committee.
 

F.	REQUESTED SURGICAL DELAY (RSD) AND CANCELLATIONS

1. Requests for a surgical date greater than 12 months will not be accepted.
2. If a patient cancels 48 hours prior to surgery, a surgeon may substitute a similar patient from their waiting list.
3. Same Day Surgery requires one week prior notification for interviews
4. If an assigned OR Block is not filled one week prior to date, the Surgical Booking Office will reallocate the time to the Division with the longest waiting time.
5. Schedule request forms are returned to the surgeon's office when a surgical date has been refused twice.
 
G.	SCHEDULING ECT'S

1. ECT's are scheduled from 0745 to 0815 hours on Monday, Wednesday and Friday with the #5 position Anaesthetist.  The OR is scheduled to commence at 0830 hours and finish by 1530 hours.
- Maximum of five ECT's are scheduled per day
- ECT's on Corporate Days must be booked on Emergency Slate unless arrangements are made with on-call Anaesthetist to start at 0730.  Emergency cases put off from 2300 hours have priority at 0800 hours.
- A2 telephones the number of ECT's to the Surgical Booking Office by 1130 hours the day prior.
 
H.	GENERAL REQUIREMENTS
 
1. The Surgical Booking Office requires an Anaesthetic Rota that covers 16 weeks in advance and is submitted monthly.
2. It is the responsibility of the surgeon's office to arrange for surgical assists.
3. All patients identified as latex allergic by the surgeon will have formal skin testing performed by an Allergist prior to submitting scheduling request form.
- Scheduling request form will not be processed for surgery until Surgical Booking Office has received necessary documentation regarding positive latex allergy status.
- Untested patients with a known or suspected latex allergy after confirmed scheduled date will be canceled