Contenu connexe


Operating List- ahs.pptx

  2. Operating List :  Facts To Be Taken Into Consideration When Booking An Operation List,  Particulars Should Appear In Operation List,  Common Mistakes While Planning Operation List,  Clinical Urgency For Placement Operating List  List Out Emergency And Routine Cases.
  3. Introduction  The purpose of this list preparation is to facilitate the appropriate surgical intervention for all patients who require an elective or emergency procedure on a 24 hour, 365 day basis.  Facilitation will include the provision of, an appropriate environment, staff with the required skills / knowledge and the availability of equipment that is fit for purpose to ensure patient safety is paramount.
  4. Facts To Be Taken Into Consideration When Booking An Operation List  Time and date of booking of surgical case.  The presence of significant co-morbidities.  The availability of in house specialist surgical or anesthetic cover.  The presence of an adequately composed nursing team (numbers and skills mix).  The type, degree of complexity and duration of the surgical procedure intended.
  5. Contd…  Case cancellation and postponement: Performance dashboard for a surgical suite .  Start-time tardiness is the mean tardiness of start times for elective cases per OR per day Case cancellation rate on day of surgery Contribution margin per OR hour.  An OR suite that puts up with excessive surgical times can schedule itself efficiently but still lose its financial shirt if many surgeons are slow, use too many instruments, or expensive implants, etc.  Turnover time is the time from when one patient exits an OR until the next patient enters the same OR.  Prediction bias in case duration are expressed as estimates per 8 hr of OR time.
  6. Information required by the person taking the booking is as follows  Patient’s full name  Folder number  Age  Sex  Procedure to be performed with the  Diagnosis  Case categorization (according to case categorization guidelines-see below)  Date and time of the booking to be captured on the slate  Name and contact details of the surgeon  Emergency cases cannot be ‘pre-booked’ to be operated on at a particular time or date of the surgeon’s choosing.
  7.  THE OPERATION THEATER LIST  To prepare for the surgical procedures, it is important to provide the nursing staff in advance with a meticulous operation theater (OT) list which gives the following details:  ••Date of the surgery  ••Patient details: Name/Age/Sex/Contact Number/Ward and Bed number of the patient  ••Diagnosis of both the eyes  ••Systemic illness (if any) such as diabetes mellitus, hypertension, asthma, coronary artery disease, etc.  ••Need for oxygen supplementation  ••Presence of high risk factors such as HIV/HbsAg/HCV  .
  8.  ••Surgical plan: A clear description of the type of operation to be performed and the eye to be operated. This is important to prevent an operation being performed on the wrong side or the wrong operation.  ••Surgeon details: Name of operating surgeon and assistant  ••Any investigation which needs to be checked on the day of surgery  ••The scheduled time for the operation should also appear on the list. If the surgeon decides to do a patient earlier or later on the scheduled list or cancel an operation, the OT nurse must inform the nurse in the particular ward of the change on the operating list immediately.  ••Mode of anesthesia: Local anesthesia/Topical anesthesia/Cardiac monitoring/General anesthesia
  9. Common Mistakes While Planning Operation List Booking of elective cases:  When planning elective theatre sessions it is the responsibility of the Consultant to whom the session belongs to ensure that, as far as is reasonably practicable allocated operating session times are not exceeded, in order to effectively utilise theatre resources. PAAU (Pre-Assessment & Admissions Unit) will use informed booked in order to fill lists to their allocated session length.  PAAU will fill lists first based on indicated clinical priority and thereafter in waiting list date order. They will be responsible for ensuring across the operating day that there is an appropriate gender mix, given the constraints of day surgery, and that total day surgery unit or inpatient ward capacity is not exceeded.
  10. Catagories of cases  Emergency surgical case: An emergency surgical case is admitted to a health institution in an unplanned and unscheduled manner, either via the emergency unit, from an outpatient clinic or as a transfer from another health institution. Patients usually present with acute surgical conditions that require prompt and focused treatment in order to avoid increased morbidity and mortality.  Elective surgical case: An elective surgical case is admitted to the hospital from home for a scheduled surgical procedure.  Triage/Categorization: Triage is the process of determining the priority of patients’treatment based on the severity of their condition and the availability of resources (as regards this policy initiative, the available resource is prompt access to emergency theatre).
  11. Icon Case Category parameters Red Immediate Immediate life-saving operation, resuscitation simultaneous with surgical treatment e.g. resuscitative laparotomy, ruptured aortic aneurysm, threatened airway, cord prolapse, foetal bradycardia Orange Hot emergency Operation as soon as possible after resuscitation (within 1 to2 hours) - e.g. ruptured ectopic pregnancy, leaking aortic aneurysm, cranial decompression, positive DPL in multiple trauma, threatened limb, emergent foetal concern Yellow Cold emergency Operation within 6 hours of booking e.g. compound fractures, appendicitis, incarcerated hernia/intestinal obstruction, EUA for non- accidental injuries Green Urgent Operation not immediately life or limb saving but to be done within 24 hours of booking e.g. ORIF of simple fractures, bleeding haemorrhoids, I&D abscess
  12. The most common types of general surgical emergencies include: (1) Acute Abdominal Emergencies; (2) Urinary Obstructions; And (3) Respiratory Obstructions And Pleural Disease.
  13. Routine surgical procedures • oral and ENT major: Tooth extraction • Tonsillectomy and/or adenoidectomy • Septoplasty, turbinectomy and rhinoplasty • Pharyngeal or laryngeal biopsy or minor excision by laser or other means • Middle ear surgery, mastoidectomy, cochlear implantation • Endoscopic sinus surgery • Small resections of benign and malignant masses, done on an ambulatory basis (i.e. mandibular tori, brachial cleft cyst, small tongue cancer) • Thyroidectomy
  14. General surgery  Breast lumpectomy or mastectomy with or without lymph node biopsy or axillary dissection  • Inguinal or umbilical hernia repair by laparoscopic or open approach  • Laparoscopic cholecystectomy  • Hemorrhoidectomy
  15.  Gynaecology  Dilation and curettage  Diagnostic hysteroscopy, laparoscopy  Endometrial ablation by thermal balloon  Tubal ligation  Laparoscopy – limited endometriosis  Transvaginal tape insertion
  16.  Neurosurgery and Spine Surgery  Discectomy  Ophthalmology  Cataract extraction and most other ophthalmological procedures  Orthopedic Surgery  Arthroscopic surgery including ACL repair  Routine hardware removal, not for infection  Tendon surgery  Bunionectomy  Discectomy
  17.  Thoracic Surgery  Bronchoscopy  Urology  Cystoscopy, Ureteroscopy, Renoscopy for stone, stricture or biopsy  Hydrocele and varicocele excision  Vasectomy  Circumcision  Vascular Surgery  Varicose vein excision