Plummer Memorial Public Hospital/Sault Ste. Marie General Hospital NURSING STANDARDS MANUAL - PROCESS STANDARDS TITLE: O.R. UTILIZATION - GUIDELINES NUMBER: PAGE : APPROVED BY: JULY 1998 PURPOSE: To maximize utilization of the Operating Room during the day, improve the efficiency of shift utilization and minimize overtime hours in the O.R. SUPPORTIVE DATA: The guidelines are developed to provide appropriate patient care, to ensure responsible use of resources and to accommodate individual surgical staff schedules. Cases in the Operating Room are categorized as follows: 1. Red - life, limb threatening 2. Orange - must be done same day 3. Green - may be delayed a day or two 4. Elective - may be delayed weeks to months Reference - Booking Guidelines for Surgical Procedures CONTENT: 1. Elective blocks run from 0800-1530 hours, with the following exception: ? Wednesday Medical Staff meetings - all blocks 0900-1530 2. Clinical Staff, Surgeons and Anaesthetists are expected to be present in the Operating Room and ready to start at 0745 (0845 on Wednesday). Lateness may result in cancellation of the last elective case of the day. Chronic lateness will result in disciplinary action (eg. loss of elective surgical time). 3. Emergent/Urgent cases are to be placed on the Wait and See List as soon as the surgeon is aware surgery is necessary. Patient must be ready for surgery, including history and physical, consent obtained and appropriate lab work completed. Exceptions will be made for “Red” cases. Patient may be out of hospital awaiting surgery as a cost saving measure. (See Procedure for contact patient........) 4. Surgeons should be available for surgery over office. Once O.R. time becomes available, either during elective day time hours or during the evening hours, the surgeon should cancel his/her office. The surgeon will receive at least 30 minutes notice of the O.R. calling for the patient. 5. If the surgeon is not available to perform the surgery then it is the responsibility of the surgeon to a) arrange for another surgeon to perform the surgery, b) request that a surgeon with a case booked later on the board move his/her case up, 3) rub the case off the Wait and See List. Exceptions may be made in consultation with the Surgical Suite Manager, if the urgent load is light. 6. Board Prioritization: ? Cases are done sequentially except: ? Red cases are done in the next available room ? Orange cases pre-empt green cases if there is reasonable doubt that not doing so would result in overtime hours being used to complete the orange case(s). Note: Any disagreements regarding priority are to be resolved between physicians. 7. Green cases still on the board at the end of the shift are cancelled and rebooked into available service time. If no time available, the Surgeon will negotiate a booking time with his/her peers. 8. It is the responsibility of the surgeon performing a Red or Orange case to personally inform all surgeons who are being delayed by his/her case. 9. All elective bookings will be made sequentially starting at 0800 h (0900 h on Wednesday). All elective procedures must be completed on time. Day surgery cases should be started as early as possible in the day to allow for patient recovery. Wherever possible, inpatient procedures should be booked later in the day to allow for bed management. Cases requiring lengthy setup time should be booked first on the list, eg. Total joint, aortic aneurysm, carotid endarterectomy. 10. The Surgical Suite Manager has a responsibility to monitor booking times and after discussion with the surgeon, adjust requested times in keeping with the surgeon’s average procedure time. 11. Gaps within the same service should be eliminated if possible. For example, Ortho service - if surgeon in a.m. finishes at 1000, surgeon booked at 1200 must start early. All other services following should attempt to move up. 12. Elective Caesarean Sections will be booked at 0700 hours. Should a request be made for a second elective Caesarean Section on the same day, the Obstetrician will first make an attempt to find an alternative free date within a few days of his/her original choice. Should no appropriate 0700 time slots be available, the section will be carried out at the end of the O.R. list. When other emergent or urgent procedures are scheduled at this time in the O.R., a second Anaesthetist will be available for Caesarean Sections. 13. If the O.R. staff are called in after regular hours for an emergency case, it is then appropriate to follow with an urgent case if this case falls within the 4 hour call-back time. 14. When a Surgeon calls the Anaesthetist and Nursing Staff after hours for urgent cases, the Anaesthetist should check the activity level in the Labour and Delivery unit to ensure the O.R. case does not conflict with urgent needs in Labour and Delivery. 15. The Anaesthetist On-Call will, in consultation with surgeons involved, co-ordinate all requests from Surgeons to do emergency/urgent cases. Prioritization of urgent/emergent cases is managed by the Anaesthetist On-Call and based on urgency of the procedure. 16. Anaesthetists should remain available to complete all elective and known emergencies, before leaving the Hospital. 17. Elective cases will be cancelled if time runs out at the end of the day. Cancellations will be made at the discretion of the Surgical Suite Manager. 18. If the room in which the on-call anaesthetist is working runs late, and the cause of the lateness is, in the opinion of the Anaesthetist and Manager, due to on-call demands made on the anaesthetist, then the room will be allowed to run to the completion of the elective list pre-empting the urgent cases on the board. 19. The evening on-call O.R. Nursing Staff will check with the Emergency physician prior to leaving the hospital following an emergency/urgent case. 20. All utilization will be reviewed by service and Surgeon for adherence to these guidelines and chronic abuse will be formally reported to the Surgical Program Committee.