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Scheduling and Management of Operating Room Cases (1.25)

Scheduling and Management of Operating Room Cases (1.25) - Policies, Administrative, UWHC, Department Specific, Surgical Services, Administrative

1.25

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

August 1984
ORIGINAL
 REVISION

August 2017
PAGE 1
OF 7
POLICY #

1.25
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services UH
TITLE
SCHEDULING AND MANAGEMENT OF
OPERATING ROOM CASES AT UNIVERSITY HOSPITAL


I. PURPOSE

The purpose of this statement is to describe the system for scheduling and completing surgical cases at
University Hospital.

The following policies and procedures, which will govern the administration of the operating rooms, have
been developed and approved by the Operating Room Committee.

II. TABLE OF CONTENTS

A. PART I: DEFINITIONS
B. PART II: ORGANIZATION
1. Section 1: Operating Room Committee
2. Section 2: Executive Subcommittee
3. Section 3: Surgeon Advisory Group
4. Section 4: Surgical Triage Team
C. PART III: POLICIES AND PROCEDURES
1. Section 1: Assignment of Prime Time Blocks
2. Section 2: Operating Room Scheduling Procedures
3. Section 3: Prime Time Assignments
4. Section 4: Assignment of Unused Prime Time
5. Section 5: Starting Time
6. Section 6: Cases Scheduled for Prime Time, but not Completed at Finishing Time
7. Section 7: Coverage of Urgent/Emergent Cases After Prime Time on Weekdays
8. Section 8: Coverage of Urgent/Emergent Cases on Weekends and Holidays
9. Section 9: Trauma OR Coordination
10. Section 10: Held Add-On (E) Room
11. Section 11: Concurrent Surgeries
12. Section 12: Adjudication Procedure

III. PART I: DEFINITIONS

A. Prime Time:
1. 0830 - 1700, Wednesday
2. 0730 - 1700, Monday, Tuesday, Thursday, Friday
B. Scheduled Case: A procedure which is assigned a starting time on the OR schedule.
C. Elective Case: Procedures that can be performed at the convenience of the surgical schedule and
the patient will suffer no ill effects. (PRIME TIME ONLY)
D. Semi-Elective: Within 48 hours.

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

August 1984
ORIGINAL
 REVISION

August 2017
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1.25
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services UH
TITLE
SCHEDULING AND MANAGEMENT OF
OPERATING ROOM CASES AT UNIVERSITY HOSPITAL


E. Urgent - Stable: Within 12 hours.
F. Urgent - Unstable: Within 4 hours. Requires attending surgeon contact Anesthesiologist in
charge.
G. Emergency: Next available room. Will bump elective cases. Requires attending surgeon
contact Anesthesiologist in charge.
H. Critical or Key Portion: The “critical” or “key” portion of a case is that part of the case that is
most directly related to the expected outcome of the surgery and that in most cases is relatively
unique to that surgery within a given specialty. The attending surgeon is the judge of what
constitutes the critical or key portion.
I Concurrent surgeries: Concurrent surgeries occur when the critical or key components of a
procedure for which the primary attending surgeon is responsible occurs at the same time as the
critical portion of another surgery for which that same attending is also responsible.
J Overlapping surgeries occur when the non-critical portions of a surgery occur simultaneously
with critical or non-critical portions of another surgery, such as the closing of one case
occurring at the same time as the opening of another case or a major orthopedic surgery
overlapping with a brief hand procedure. Overlapping surgeries for this policy are defined by
the time from surgical incision (or procedure start) to incision closed. Dressing, casting, or
anesthesia times are not considered to be overlap time.
K Closing is that portion of the case where all critical portions have been completed and the only
remaining work is to reapproximate more superficial tissues to complete the surgery. Closing is
complete at the time of the last skin suture or staple.
L Immediately available means in the same or an attached building, reachable through a paging
system or other electronic means, and able to go immediately to the operating room.

IV. PART II: ORGANIZATION

A. Section 1: Operating Room Committee
The Operating Room Committee is appointed by the Medical Board to establish policies and
procedures which will govern the operating rooms at University Hospital and Clinics.
1. Responsibilities:
a. Define policies for assigning block time to the various clinical services.
b. Develop and amend any rules and regulations established for the safe and efficient
administration of the operating room.
2. Composition:
a. Chairmen and Section Heads from the clinical services utilizing the operating rooms.
b. Nursing
c. Director of Surgical Services
d. Hospital Administration
e. Director of Perioperative Services

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

August 1984
ORIGINAL
 REVISION

August 2017
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POLICY #

1.25
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services UH
TITLE
SCHEDULING AND MANAGEMENT OF
OPERATING ROOM CASES AT UNIVERSITY HOSPITAL


f. Operating Room Management Team Members
g. Director of Surgical Operations
B. Section 2: Surgeon Advisory Group
1. Responsibilities:
Review block time utilization, block time requests and recommends allocation of block time.
This may be discussed and approved if necessary by the Operating Room Committee. Identify
problems or opportunities for improvement in the OR environment and develop solutions.
2. Composition:
Surgeons, anesthesiologists, and nursing representatives involved in daily OR management
(both Inpatient and Outpatient). The Committee is made up of active surgeons, representing
each service.
C. Section 3: Surgical Triage Team
1. Responsibilities:
When there is a conflict regarding case prioritization that cannot be resolved by the daily
management team, a member of the Surgical Triage Team will be asked to facilitate.
2. Composition:
Five surgeons will be appointed by the OR Committee including the Director of Surgical
Operations.

V. PART III: POLICIES AND PROCEDURES

A. Section 1: Assignment of Prime Time Blocks
1. Prime time blocks will be assigned to the surgical divisions, based on the recommendations of
the Surgeon Advisory Group. The standard release time occurs at noon and for Inpatient OR it
is 72 hours, Outpatient it is two weeks, and AFCH is one week. Any exceptions to the standard
release times will be approved by the Surgeon’s Advisory Committee. Seventy-two hour
release includes business days only and follows the following schedule; on Monday non-used
time on Thursday’s released, Tuesday release occurs for Friday. Wednesday’s release occurs
for Monday, Thursday release occurs for Tuesday and on Friday release occurs for Wednesday.
B. Section 2: Operating Room Scheduling Procedures
1. All surgical schedule cards/electronic submission via Health Link are to be completed or
reviewed before submission by the attending surgeon and the accuracy of the information on
the scheduling cards is the responsibility of the attending surgeon. If card requests are
electronically submitted for the same day, the OR control station must be notified.
2. Surgery scheduling cards may be obtained at the front desk of the Inpatient Operating Room.
3. After card/electronic submission, any changes in planned case management, including
cancellations, must be communicated to all appropriate parties. Cancellations need to be
communicated to the OR charge nurse.
4. If a particular service or division knows in advance that its allocated time will not be utilized

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

August 1984
ORIGINAL
 REVISION

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OPERATING ROOM CASES AT UNIVERSITY HOSPITAL


because of vacations, attendance at conferences, etc., communication to this effect shall be
immediately sent to the OR Scheduling Office or Director of Surgical Services. Notification
must be made one month or more in advance to have the allocated minutes removed for
purposes of block time utilization statistics. If less then one month notification is given,
allocated minutes will be removed only once every two months per service.
5. The schedule closes at 1200 the work day before.
6. Requested time changes in the OR schedule must be made by 9:00 AM the work day prior to
surgery.
C. Section 3: Prime Time Assignments
1. Prime time is defined as 0830 - 1700 on Wednesdays and 0730 - 1700 Monday, Tuesday,
Thursday, and Friday.
2. Prime time allocation is by service.
D. Section 4: Assignment of Unused Prime Time
If any service or division's allocated time is not scheduled by the block release time, the unused
prime time will be made available to all services on a first-come, first-serve basis.
E. Section 5: Starting Time
Those services having a 0730 starting time (0830 Wednesday) must have a physician in the
assigned OR by 0730 (0830 Wednesday) who is capable of positioning and preparing the patient to
the satisfaction of the responsible staff physician. Staff surgeons must notify the OR (263-8595
Inpatient OR; 263-9482 Outpatient OR; 890-7200 AFCH OR) that they are in-house. The attending
surgeon must participate in one of two verifications of correct patient/procedure/site: immediately
in the perioperative areas or prior to induction of anesthesia. Active participation by staff surgeon
and anesthesiologist during all phases of the case is expected and will produce the greatest
efficiency.
F. Section 6: Cases Schedule for Prime Time, but not Completed at Finishing Time
All cases scheduled for prime time will ordinarily be completed that day. If significant delays or
changes in the schedule preclude this from occurring, an alternate plan will be developed in
collaboration with the staff surgeon, anesthesiologist coordinator, OR charge nurse and patient.
G. Section 7: Coverage of Urgent/Emergent Cases After Prime Time on Weekdays
Coverage will be provided as listed in the addendum.
H. Section 8: Coverage of Urgent/Emergent Cases on Weekends and Holidays.
1. Coverage will be provided as illustrated in the addendum.
a. Surgeon availability information must be indicated on the schedule request card. The
surgeons need to know this information is for case sequencing planning and does not
guarantee a 0730 start time.
b. The charge nurse and anesthesia charge will work in collaboration to facilitate the start of
cases.
c. The surgeon and resident shall be notified as soon as possible if the times are changed by
emergencies.

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

August 1984
ORIGINAL
 REVISION

August 2017
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OPERATING ROOM CASES AT UNIVERSITY HOSPITAL


2. General Guidelines
It is important to remember that safe patient care is always the most important principle to
follow. There may be times when patient safety demands single staffing by faculty
anesthesiologists and the full number of ORs cannot be opened even with the total complement
of faculty anesthesiologists in house. Each anesthesiologist will medically direct at any time
only that number of cases which they judge to be consistent with safe patient care and a high
standard of anesthetic and surgical practice. If an anesthesiologist cannot safely start another
non-emergency case at a particular time, they will delay the start of a non-emergency case. This
decision must be supported by all members of the medical staff. Efficiency and convenience
must never be allowed to compromise patient care.
I Section 9: Trauma OR Coordination:
1. Operating Room 21 is the designated trauma OR and will be cleaned and set up 24/7 to care for
trauma patients. This setup will include a surgical pack which will enable the Trauma Service to
provide life-saving care, even in the absence of Anesthesia or OR Nursing support.
2. The Trauma Service on-call faculty will determine when OR 21 is needed. In view of the expense
of using a trauma setup, its use should be avoided for cases of lesser acuity which could be safely
cared for in another OR. However, the judgment of the Trauma Attending will be the determining
factor in deciding when to use OR 21.
3. A trauma cart will always be available in OR 21 stocked with supplies necessary to initiate the OR
care of a trauma patient. The contents of this cart will be jointly agreed upon by the Division
Chief of the Trauma Service and the OR Nursing Supervisor for the Trauma Service.
4. In the event that a patient arrives in OR 21 before anesthesia or OR Nursing support is present,
ED personnel who have assisted with transport will remain with the patient until relieved by OR /
Anesthesia personnel and a handoff has been performed.
5. When OR 21 is in use, the next available OR will be set up and held open as a backup trauma
room. If unused the trauma cart described in #3 may be moved into the backup trauma room to
facilitate room preparation. In the event that this OR was being used by a Service other than the
Division of General Surgery, the OR will be held only until a General Surgery room becomes
available, at which time that room will become the backup trauma room and the previously held
room will revert to the use of the other Service.
6. OR 21 may be used for other emergent cases on a carefully selected basis, based upon the
judgement of the Attending Surgeon in consultation with the Anesthesiology Faculty in charge. In
order for a service to use OR 21 for a non-trauma case, either 1) massive hemorrhage and massive
transfusion must be anticipated or 2) the case must be of such an emergent nature that waiting
until another OR becomes available would jeopardize patient safety. If another service uses OR
21, the Trauma Attending should be notified by the OR Charge Nurse or his/her designee that OR
21 is in use, consideration should be given to consulting the Trauma Service to assist with
massive hemorrhage, and a backup trauma room should be set up as described above.
7. Cases using OR 21 will be transferred to SICU postoperatively for ongoing critical care unless the

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

August 1984
ORIGINAL
 REVISION

August 2017
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POLICY #

1.25
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services UH
TITLE
SCHEDULING AND MANAGEMENT OF
OPERATING ROOM CASES AT UNIVERSITY HOSPITAL


responsible attending surgeon for the case determines that other arrangements would provide
more appropriate care.
J. Section 10: Held Add-On (E) Rooms
1. E rooms will consist of:
a. Orthopedic Trauma Service
b. Acute Care Service
c. Abdominal Organ Transplants
2. E rooms will release to the overall add-on list if no case requests from the above groups have
been submitted by 0630. Cases will be allocated to these rooms based on acuity.
K. Section 11: Concurrent Surgeries
1. A primary attending surgeon’s involvement in concurrent surgeries on two patients is not
permitted. An attending surgeon must be physically present in the operating room for the
critical or key portions of a procedure except for procedure-related tasks or unanticipated
circumstances such as those cited in Reference 1. The critical or key portion of one case may
not overlap with the critical or key portion of another case. In the event of an emergency, an
attending surgeon may oversee more than one operation but only for as long as it takes for a
second faculty surgeon to arrive and assume care for one of the patients.
2. Surgeons are permitted to overlap no more than two surgeries. In general it is expected that
there will be minor overlap between the closing of one case and portions of another. The
surgeon may delegate non-critical parts of the operation to qualified practitioners including, but
not limited to residents, fellows, physician’s assistants, or another attending under his or her
personal direction. However, the primary attending surgeon’s personal responsibility cannot be
delegated. When a surgeon is scrubbed into another case at the same time s/he has delegated
non-critical portions of a second case to a qualified practitioner, another attending surgeon
must be identified who is immediately available to assume responsibility for the second case in
the event it is necessary. The name of this surgeon must be documented in the medical record
(such as in the op note) as being available in case of need. In cases where there are more than
one attending surgeon jointly involved in a case, those surgeons may be involved in another
case as long as an attending surgeon is wholly responsible for the initial patient at all times.
Patients should be informed regarding potential surgical overlap in a manner consistent with
UWHC Policy 4.17 “Informed Consent”.
L. Section 12: Adjudication Procedure
If there is disagreement whether a procedure should be done the following conflict resolution
process will be followed:
1. Anesthesia coordinator and charge nurse/OR Administrator.
2. Director of Perioperative Services and Director of Surgical Services.
3. Surgical triage team members.
4. Chairs of Surgical Departments and Anesthesiology.


UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

August 1984
ORIGINAL
 REVISION

August 2017
PAGE 7
OF 7
POLICY #

1.25
ADMINISTRATIVE MANUAL
NURSING MANUAL
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TITLE
SCHEDULING AND MANAGEMENT OF
OPERATING ROOM CASES AT UNIVERSITY HOSPITAL


VI. APPROVED BY

A. OR Committee 4/2017

SIGNED BY
Anne Mork, MHCDS, MS, RN, Director of Surgical Services University Hospital
Christopher R. Turner, MD PhD, MBA, Director of Perioperative Services
Charles Heise, MD FACS, FASCRS, Director of Surgical Operations