AUFMC

ANGELES UNIVERSITY FOUNDATION MEDICAL CENTER Angeles City, Philippines

SCHEDULING OF PATIENTS FOR SURGERY OBJECTIVE OBJECTIVE: To be able to properly coordinate all the scheduled surgical procedures to ensure immediate performance, patient safety, smooth flow of operation and efficient manner to address the needs of both the physician and the patient. SCOPE: This is applicable in the Operating Room-Delivery Room Complex, Admitting Section and Medical Affairs Department. PROCEDURE I. Requirements FOR PRE-OPERATIVE SURGERY 1. Patients for elective cases that are for admission shall: a. Be at the unit or room of choice for proper preparation the night before their scheduled procedures. b. Have the name of the attending anesthesiologist by 9pm Surgeons/Anesthesiologist shall coordinate with the OR Staff for specific instruments, supplies/medicines to be used on one day prior to surgery to ensure its availability. AVAILABILITY OF ROOMS OPERATING SUITE is a facility with in a hospital where surgical operations are carried out in a sterile environment. OPERATING ROOM 1 All eye surgeries

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OPERATING ROOM 2 Dirty Surgical Cases Contaminated Surgical Cases Minor Surgeries Cystourology Cases Bronchoscopy ERCP

OPERATING ROOM 3 Clean Surgical Cases Orthopedic Cases Neurological Cases Laparoscopic Cases Minor Surgeries PPI OPERATING ROOM 4 Dirty Surgical Cases Contaminated Surgical Cases Minor Surgeries Cystourology Cases Bronchoscopy ERCP OPERATING ROOM 5 Clean Surgical Cases Orthopedic Cases Neurological Cases Minor Surgeries PPI ENDOSCOPY ROOM Endoscopy Colonoscopy CARDIOVASCULAR OR All Open Heart Surgical Cases DELIVERY ROOM All OB-Gyne Cases AVAILABILITY OF INSTRUMENTS C-Arm is an imaging component which converts x-rays into a visible image. C-arm is used In operating suites that includes the following procedures: Orthopedic Cases Spine Surgeries ERCP Bronchoscopy Intra Operative Cholangiography Permanent Pacemaker Insertion Surgical cases requiring Visible Image for diagnostics

Zeiss Microscope is a specialized optical instruments designed to produce magnified visual or photographic (including digital) images of objects or specimens that are too small to be seen with the naked eye. It is used in operating cases such as

EENT Surgeries Neurovascular Surgeries Surgical Cases Requiring microscope to visualize the specimen/organ.

Cautery Machine is an equipment used for burning of part of a body to remove, which destroys some tissue, in an attempt to mitigate damage, remove an undesired growth, or minimize other potential medical harmful possibilities, also used to control bleeding in an ongoing surgery. SURGICAL TABLES sometimes called operating room table, is the table on which the patient lies during a surgical operation. STERIS SURGICAL TABLE Accommodates virtually all patients with generous weight and height ranges Provides unrestricted perineal access with removable leg section Optional Featherweight Leg Section complies with AORN Safe Handling principles Enhances lateral procedures with a powered, radiolucent kidney elevator Provides outstanding access for C-arm, permitting clear high-quality images crucial to MIS, cardiothoracic, orthopedic and neurosurgical procedures Facilitates quick and safe patient positioning with an easy-to-use, easy-to-read hand control Contours to virtually all patient postures with four section tabletop

The A.T.S. Automatic Tourniquet System is a dual-port, dual-cuff medical tourniquet system with microprocessor controls and dedicated ports for supplying and measuring pressure independently. With the innovative Limb Occlusion Pressure (LOP) feature, the A.T.S. 3000 Tourniquet combines the latest in advanced surgical tourniquet technology with the well-established Zimmer tradition of safety, reliability and convenience. This equipment is used in cases including extremities to control bleeding. 3. Limb Amputation Knee Surgeries Orthopedic Cases involving extremities

Patients who are 35 years old and above or 12 years and below shall secure a cardiopulmonary evaluation unless specified by the Surgeon. Note: The cardiopulmonary clearance shall indicate the objective /planned procedures and management for the patient and initial impression, 4. All OR/DR Patients for elective surgery shall be in a respective OR/DR Complex at least one hour prior to the scheduled time of operation. 5. The ward nurse in charge of the patient should be responsible for bringing the patient at OR/DR Complex one hour prior to the scheduled time of surgery. Prior to every surgery, the following should be accomplished/performed: Preoperative Evaluation by the OR Nurse Anesthesia Pre Op evaluation Form by the assigned anesthesiologist (This is required the night before the elective procedure for in-patients at least one hour before the scheduled operation for out patient)

Skin preparations and pre-operative (except for Opthalmology Cases) shaving to be done at the OR/DR Complex Induction of anesthesia shall be started only when the surgeon is physically present in the operating suite. All surgeons/Physicians order shall be in writing. Telephone orders are strongly discouraged but if unavoidable, should be coursed through a resident in charge and must be signed by the ordering physician within 24hours. Required diagnostic procedures shall be done in the Medical Center. Results of diagnostic Exams done outside shall be incorporated in the patients chart. SCHEDULING OF PATIENTS 1. All procedures shall be pre-scheduled except those that are considered STAT(Emergency/Life Threatening cases) which shall be prioritize. 2. Scheduled elective procedures at OR-DR Complex shall start at 6:00 in the morning up to 10:00 in the evening. THE SCHEDULED OR TIME IS THE CUTTING TIME. 3. Pre- Scheduling of surgical cases shall be complete with information about the patient. The OR staff who receives request for schedule shall log: Patients Name Age Procedure Surgeon Anesthesiologist Date and Time Schedule 4. The attending surgeon shall discuss the cost of the procedure, its complication and expected outcome (including the operating room charges and professional fees) with the patient prior the scheduling operation. 5. Operation may be preschedules as follows 1. OR/DR complex from Mondays-Saturdays 6:00am-10:00pm, Sundays 6:00am-10:00am. Note: Sunday is considered the day for general cleaning of all OR/DR Complex, filling of stocks, and updating of instruments and surgical/medical packs 2. Scheduling shall be first come, first serve basis taking into considerations the availability and preparation of the: OR Suite, Instruments, Machines and/or equipment, Non stock drugs, packed medical/surgical supplies and sterile items, and Required personnel. NO OR-DR SUIT SHALL BE RESERVED FOR ANY ONE AT ANY TIME. 3. One DR shall be kept free at all times for precipitous deliveries. In the vent however that there is no patient in labor at a given time, and there is a need to use this reserved DR, only minor emergency cases like D&C or any minor clean procedures requiring only 30 minutes or less to finish can be done 4. All infectious cases shall be preferably scheduled in the afternoon(after all clean cases). Infection control committee guidelines shall be taken into consideration. 5. Surgeons should notify the Head nurse or the Charge Nurse on duty on special needs for the surgery such as position, instruments and equipments, for proper coordination. The Residents on Duty should likewise check the availability of the needed instruments for the procedure. 6. Elective Operating days for OB-GYN Service patients will be scheduled every Tuesdays, Wednesdays and Thursdays. a. There should be conflict in scheduling with the pay patients. In such unavoidable circumstances, the pay patient is given priority in the chosen slot. b. In rare instances wherein OB-GYN consultant has to assist in the surgeries of the residents, the charity case may be given an OR slot outside of the usual OR discretion of the Department Chair or Training Officer c. In the event that the anesthesiologist had already consented to give anesthesia to the service patient especially for cases where the OB GYn consultant will be in attendance, he/she must

Not retract in favor of a pay patient in order to avoid disruption of the scheduled surgery, otherwise she or he should be responsible for getting her own reliever CONFLICTS 1. In cases of conflict schedule, attending Anesthesiologist may refer the case to another member or staff. However the attending surgeon shall have the prerogative to choose the replacement. The ROD must notify the concerned physicians 2. Anesthesiologist are discouraged to have simultaneous cases. SERIAL CASES 1. In cases of serial OR procedures, the next patient can only be induced by the anesthesiologist if the ongoing case is already on closing stage 2. Surgeons with consecutive cases shall stay in the OR/DR Complex until all his/her cases are done. The assigned OR staff shall confirmed the patients admission prior to cut off time by: 1. Calling the admitting section to verify patients admission 2. Admitting Section shall notify respective OR/DR complex of any late admissions of patients for surgery 3. Checking the list of admitted patients for the day (from admitting Section through computer network) The ward nurse shall be responsible for the flowing: 1. Confirming with the Billing Section Clearance for surgery 2. Calling the patients/Surgeon concerned for verification Surgeon found to have requested for schedule of ghost patients (non -existence)shall be reported to OR Committee for proper action.

Admission of Patients for OR 1. Admission of in-patients a. Patients for major elective surgery should be admitted at least one day prior to the scheduled surgery to give time for the anesthesiologist to do a pre-anesthetic evaluation. b. Patients for major elective surgery should be admitted at least six hours prior to the scheduled surgery c. Patients for minor elective surgery should be admitted at least three hours prior to the scheduled surgery d. Rescheduling of OR procedure will be initiated if the patient is not admitted or in the process of being admitted as required. e. Admitted patients shall have priority in terms of OR instrument and machines over pending admission. Admission of AMBULATORY/ OUT PATIENT in the OR/DR Complex a. Patients shall secure from the attending surgeon Doctors order Cardio-Pulmonary/ Medical Evaluation form and pre-op Anesthesia evaluation form(if applicable) Duty accomplished consent for operation Results of diagnostic test and other ancillary procedures requested pre-op b. All patients/relatives shall be asked to proceed to the Information and Concierge for registration and shall be advised to go directly to the operating room c. The charge nurse shall inform the attending surgeon and the anesthesiologist upon arrival of the patient in the OR/DR Complex d. If there is a need for admission post-operatively, the patients companion shall be referred to the admitting section with the surgeons admitting orders e. No patients shall be discharged without a signed physician order and out patient summary

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For DR patient shall be expected at the OR/DR complex at least two hours prior to the scheduled out patient elective cases Admission for EMERGENCY cases a. Emergency cases will have priority over all operations b. If a patient is to be brought directly to the OR from the Emergency Room the following should be followed The ER Officer/SROD shall notify the OR concerning the operative procedure and shall again inform the latter when the patient is to be brought to the OR The ER officer/ SROD shall relay the admitting section regarding the patients direct admission in the OR Patients life threatening conditions, as diagnosed by the surgeon /SROD, can be admitted directly to the OR. Otherwise all patients for surgery must be sent to the patients room for proper preparation prior to OR The admitting section shall prioritize the accommodation of these patients The OR nurse-in charge shall receive the endorsement form the emergency room nurse in charge Consent shall be signed by the patient or if incapacitated, by the closest relative of lega; age (at least 18 years old). c. PACU can function as holding area for patients who underwent emergency surgical procedures in case of unavailability of rooms. Ward room rate shall be applied. d. Life threatening emergency cases shall have priority over elective surgical cases Coordination of OR schedule with the concerned Unit: Before the end of every afternoon shift, the CN on duty shall submit a copy of pre scheduled operations for the following day to Admitting Section Billing Section Director, Nursing Service VP for Medical Affairs and Medical Director Director, Medical/Ancillary Department of Radiology Department of Pathology Dietary Department

CANCELLATION/ RE-SCHEDULING OF OPERATIONS OBJECTIVE: To ensure appropriate allocation of OR/DR Schedules taking into consideration and rescheduling. SCOPE: The policy Practitioners PROCEDURES: 1. OR/Dr procedures shall be cancelled or re scheduled if: a. Nursing units relay cancellationof scheduled operative cases of patients admitted to their unit. The reason for cancellation must be properly disclosed by filling up the cancellation/ re-scheduling from received and noted by the concerned units and department b. Patient for admission before the scheduled surgery was not admitted on the required time. Please refer to related policy on scheduling and admission of patients at operating Room c. Patients come 30minutes late for the scheduled procedure; the case maybe re-scheduled (except patients in labor) depending on the decision of the OR staff upon consultation with attending surgeon. applies to all Nursing Units, Admitting Section , OR/DR Complex, and all Medical

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The admitting section must report late admission of patients scheduled for surgery. Cases of late patients will either be cancelled or move to the next available time. Rescheduling of OR/DR cases shall depend on the availability of OR Slot/ Cases will be considered cancelled or will be moved to a later time if the OR, slip is not received by the OR/DR complex within the appropriate time of submission. Six hours prior to major surgery Three hour prior to minor surgery Doctors of patients opting for cancellation of procedures/cases shall properly inform the OR/DR Complex not later than 10pm to give the vacant slot to others. A cancellation form must be received by the OR/DR complex For In patients, the nursing unit and the assigned OR staff will immediately notify other concerned departments of the cancellation of procedure(e.g Department of Pathology-for cases with scheduled frozen section, Department for cases with scheduled needle localization of breast mass, use of C-arm, Portable Xray) The surgeon and anesthesiologist is given only a maximum of 30minutes allowance, from cutting time, unless there is a prior notice that they will be late. Failure to do so would mean that the OR Head Nurse or Charge Nurse on Duty, with proper notification of the concerned doctor, may change the schedule and move the case In latter time. If needed, scheduled OR cases may be allowed a delay beyond 30 minutes in cases where result of preoperative test are pending or further discussion with patients relatives is warranted. Assigned OR Staff shall document and maintain records of cancelled and re scheduled procedures daily basis The OR Head Nurse and Charge nurse shall have the authority to: Alter the schedule and move cases a needed after proper consultation, with all concerned Call the attention of all Medical Practitioners who violate the policies set by the Or Committee.