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Case Scheduling Outpatient Surgery Center - Operating Room (1.42)

Case Scheduling Outpatient Surgery Center - Operating Room (1.42) - Policies, Clinical, UWHC Clinical, Department Specific, Surgical Services, Administrative

1.42

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

APRIL 1990
ORIGINAL
 REVISION

SEPTEMBER 2016
PAGE 1
OF 7
POLICY #

1.42
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services - UH
TITLE
CASE SCHEDULING
OUTPATIENT SURGERY CENTER - OPERATING ROOM


I. PURPOSE

A. To describe the system for scheduling and completing surgical cases in Outpatient Surgery Center
Operating Room at the University Hospital.
B. To define a standard of practice for the care of outpatients designed to meet the needs of patients and
to operate effectively.
C. The following policies and procedures, which will govern the administration of the Outpatient
Surgery Center Operating Room (OSC-OR), 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: Surgeon Advisory Group
C. Part III: Policies and Procedures
1. Section 1: Types of Surgery Cases Scheduled
2. Section 2: Assignment of Prime Time Blocks
3. Section 3: Assignment of Unused Prime Time
4. Section 4: Operating Room Scheduling Procedure
5. Section 5: Starting Time and Surgeon Availability
6. Section 6: Procedure for Dealing with Extra Cases
7. Section 7: Cancellation of Cases
8. Section 8: Request to make Time Changes after Schedule Final
9. Section 9: Adjudication Procedure


UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

APRIL 1990
ORIGINAL
 REVISION

SEPTEMBER 2016
PAGE 2
OF 7
POLICY #

1.42
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services - UH
TITLE
CASE SCHEDULING
OUTPATIENT SURGERY CENTER - OPERATING ROOM


III. PART I: DEFINITIONS

A. Prime Time:
1. 0730-1700 (7 rooms) Monday, Tuesday, Thursday, Friday
2. 0830-1700 (7 rooms) Wednesday
..

B. American Society of Anesthesiologists - Classification of Physical Status
1. Class 1: The patient has no organic, physiologic, biochemical, or psychiatric disturbance. The
pathologic process for which operation is to be performed is localized and does not entail a
systemic disturbance. Examples: a fit patient with inguinal hernia; a fibroid uterus in an otherwise
healthy woman.
2. Class 2: Mild to moderate systemic disturbance, caused either by the condition to be treated
surgically or by pathophysiologic processes. Examples: non-limiting or only slightly limiting
organic heart disease, mild diabetes, essential hypertension, or anemia. Some might choose to list
the extremes of age here, either the neonate or the octogenarian, even though no discernible
systemic disease is present. The patient with extreme obesity and chronic bronchitis, or perhaps the
patient with a long-standing history of heavy cigarette smoking, may be included in this category.
3. Class 3: Severe systemic disturbance or disease from whatever cause, even though it may not be
possible to define the degree of disability with the finality. Examples: severely limiting organic
heart disease; severe diabetes with vascular complications; moderate to severe degrees of
pulmonary insufficiency; angina pectoris or healed myocardial infarction.


UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

APRIL 1990
ORIGINAL
 REVISION

SEPTEMBER 2016
PAGE 3
OF 7
POLICY #

1.42
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services - UH
TITLE
CASE SCHEDULING
OUTPATIENT SURGERY CENTER - OPERATING ROOM


4. Class 4: Severe systemic disorders that are already life-threatening, not always correctable by
operation. Examples: patients with organic heart disease showing marked signs of cardiac
insufficiency, persistent anginal syndrome, or acute myocarditis; advanced degrees of pulmonary,
hepatic, renal, or endocrine insufficiency.
5. Class 5: The moribund patient who has little chance of survival but is submitted to operation in
desperation. Most of these patients require operation as a resuscitative measure with little, if any
anesthesia. Examples: the burst abdominal aneurysm accompanied by profound shock; major
cerebral trauma with rapidly increasing intracranial pressure; massive pulmonary embolus.
6. Emergency Operation (E): Any patient in one of the classes just listed who undergoes operation
in an emergency situation is considered to be in poorer physical condition. The letter E is placed
beside the numerical classification. Thus, the patient with a hitherto uncomplicated hernia, now
incarcerated and associated with nausea and vomiting, is classified 1E.
C. Scheduled Case: A procedure which is assigned a starting time on the Outpatient OR schedule. All
cases done in the OSC-OR must have a scheduled start time and must meet the criteria as defined in
Part III - Section 2.
D. 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).
E. The OSC-OR is designed for the care of surgical patients undergoing procedures requiring short-
term hospital care (23 hours or less). OSC-OR surgical procedures will be performed under
general, regional or monitored anesthesia care
F. Temporary (23 hour stay) patients should always be scheduled last unless not medically feasible or
operational needs dictate otherwise.

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 UWHC.
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 Administration
c. Director of Surgical Services
d. Hospital Administration

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

APRIL 1990
ORIGINAL
 REVISION

SEPTEMBER 2016
PAGE 4
OF 7
POLICY #

1.42
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services - UH
TITLE
CASE SCHEDULING
OUTPATIENT SURGERY CENTER - OPERATING ROOM


e. Director of Perioperative Services
f. Director of Surgical Operations
g. Surgical Services management team members
B Section 2: Surgeon Advisory Group
This may be discussed and approved if necessary by the Operating Room Committee. The
Committee is made up of active surgeons, representing each service and nursing administration.

V. PART III: POLICIES AND PROCEDURES
A Section 1: Types of Surgery Cases Scheduled
1. The Outpatient Surgery Center is primarily intended for patients who meet the requirements for the
American Society of Anesthesiologists Physical status I or II (ASA-I or ASA-II).
a. No patient in other than ASA-I or ASA-II class will be accepted for general, regional, or
monitored anesthesia care, without prior consultation with the Outpatient Surgery Center
Medical Director or designated staff anesthesiologist.
b. If the patient is not classified as ASA-I or ASA-II, the surgeon should notify the OSC
Medical Director prior to scheduling the procedure. (Please call paging operator at 262-
2122 or Preoperative Anesthesiology Assessment Center 3-9483, 2-0870, 3-8008, or the
Main OR 3-8595.)
c. For patients in the ASA III or IV classification who are approved by the OSC
Medical Director, consultation with the OSC/APC Pre/Post Op Nursing leadership
is needed to plan appropriately for post operative care. Patients requiring mechanical
ventilatory support or who are hemodynamically unstable are more appropriately cared
for in the Inpatient PACU, where staffing ratios and nursing competency are aligned with
this level of patient acuity. This would apply to patients on either the “A” or “B” side.
2. To ensure optimal patient care, the Outpatient Surgery Center requires smooth
coordination between many hospital departments. All operations are scheduled with the
goal that patients will be discharged from the unit by 2000.
a. It is intended that patients undergoing general anesthesia, regional or monitored
anesthesia care will have their procedure completed by 1700.
B. Section 2: Assignment of Prime Time Blocks
Prime time blocks will be assigned by the surgical divisions, Surgeon Advisory Group and approved
by the OR Committee.
C. Section 3: Assignment of Unused Prime Time
If any Service or Division’s allocated time is not scheduled by 1200 of the block release date, the
unused prime time will be made available to all services on a first-come, first-serve basis.
D. Section 4: OSC-OR Scheduling Procedures
Procedures will be scheduled Monday - Friday in pre-established prime time prior to block time

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

APRIL 1990
ORIGINAL
 REVISION

SEPTEMBER 2016
PAGE 5
OF 7
POLICY #

1.42
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services - UH
TITLE
CASE SCHEDULING
OUTPATIENT SURGERY CENTER - OPERATING ROOM


release.
a. Procedures scheduled after blocks are released will be on a first-come, first-serve basis.
b. All procedures must have a scheduled start time assigned and meet the previously stated
guidelines for completion.
c. All cases must be scheduled during the operational hours of the OSC.
E. Section 5: Starting Time and Surgeon Availability
1. Anesthesiology Personnel: Induction of anesthesia will not start until a staff surgeon is
confirmed to be in the hospital. Anesthesia personnel must have rooms set up no later than 15
minutes before starting time (0715 for a 0730 start). Staff anesthesiologists are expected to
arrive in the OSC by 0700, at the latest. Unless it is known that the surgery team will not be
present at the scheduled time, patients should be in the OSC-OR at the scheduled time.
2. Surgery Personnel: Those services having a 0730 start time must have a surgical resident or staff
physician who contacts the OR by 0715 and is physically present in the OR by 0730, at the latest.
The resident should be capable of positioning and preparing the patient to the satisfaction of the
responsible staff physician. The staff surgeon must notify OR that he/she is in-house no later than
0730 (it will expedite cases to notify the OR before 0730). All patients with first case starts will
be brought into the room at the scheduled time.
3. Nursing Personnel: All patients with first case starts will be brought into the room at the
scheduled time, unless it is known that the surgery team will not be present at the scheduled time.
A surgical resident or staff surgeon should be present (without being paged) when the patient
enters the room. Once it is confirmed that the staff surgeon is in house, induction can begin. If
no surgical resident or staff surgeon is present when the patient enters the OR and a time period
of 5-10 minutes has lapsed, efforts should be made to contact them via the pager or phone system
so the surgery is not further delayed. These incidents will then be reported to the OSC-OR
Surgical Services Supervisor or designee, who will relay them to the Director of Surgical
Services for review.
4. If surgeons are unavailable at the scheduled start time of the procedure, the room will be held for
20 minutes. After that time, the case may be postponed, or canceled.
a. If the schedule allows a later scheduled start time and if the patient chooses to wait, the
procedure may be rescheduled later that day (during prime time only). If it is unable to be
scheduled during prime time, the patient chooses to wait and the surgeon is available, the
procedure may be added as an e-case in the Inpatient Operating Room.
b. If the surgeon will not be available later that day, the patient will be informed that the
surgeon is unavailable and that their procedure will be rescheduled for a later date.
F. Section 6: Procedure for Dealing with Extra Cases
1. Extra cases will receive convenience priority and will be scheduled in the next available room
during prime time after elective scheduled cases are completed.

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

APRIL 1990
ORIGINAL
 REVISION

SEPTEMBER 2016
PAGE 6
OF 7
POLICY #

1.42
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services - UH
TITLE
CASE SCHEDULING
OUTPATIENT SURGERY CENTER - OPERATING ROOM


2. The OSC-OR Charge Nurse will inform the staff physician of the approximate time the case can
start.
3. The staff physician is responsible to inform the patient that the extra case is tentative and
depends upon availability of time.
G. Section 7: Cancellation of Cases
1. When learning that a scheduled case will not be performed, the surgeon or resident should notify
the OSC Scheduler or OSC-OR Charge Nurse with the reason for cancellation.
2. The surgical resident should notify the responsible staff surgeon and OSC-OR Scheduler of any
cancellations, or of any changes in the schedule or patient status. After business hours of OSC-
OR, call the Inpatient OR (263-8595) with any cancellations and they will notify the appropriate
people.
3. The surgical resident/staff surgeon or their secretary calling the change to the OR, is the one
responsible for calling the patient and any other pertinent staff or departments who need to know
of a schedule change or cancellation. It is recommended that the person taking the call about the
change remind the person calling of this expectation and to record that person’s name.
4. If a particular service or division knows in advance that its allocated time will not be utilized
because of vacations, attendance at conferences, etc., an email or phone call to this effect shall be
immediately sent to the OSC Scheduler.
H. Section 8: Requests to Make Time Changes After the Schedule is Final
Late schedule changes frequently cause problems for all disciplines and have resulted in frequent
patient complaints. A schedule is published 0900 two days prior to surgery. This schedule is used by
all disciplines as a tentative plan for that day. Starting at 0900, first day surgery and outpatients are
called and based on the schedule instructed when they need to arrive at the hospital.
I. Section 9: Inaccurate Procedure Estimates and Repetitive Cancellation
Recurring inaccurate estimates of procedure lengths and repetitive cancellations by individual
surgeons will be reported by the OR Director and Medical Director of Perioperative Services to the
OR Surgeon's Advisory Committee for review and actions.


J. Section 10: Adjudication Procedure
Should there be a disagreement whether a procedure should be done, the following conflict
resolution process will be followed.
1. Anesthesia Coordinator and OSC-OR Nursing Supervisor
2. Medical Director of Outpatient Surgery Center, Director of Surgical Operations or Director of
Surgical Services
3. Chairs of Department of Surgery and Anesthesiology


UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

APRIL 1990
ORIGINAL
 REVISION

SEPTEMBER 2016
PAGE 7
OF 7
POLICY #

1.42
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services - UH
TITLE
CASE SCHEDULING
OUTPATIENT SURGERY CENTER - OPERATING ROOM


REVIEWED BY

Surgical Services Policy and Procedure Committee 9/2016
Lynn Linton, Surgical Services Supervisor Outpatient Surgery 6/2016
Suzanne Morris, Surgical Services Clinical Operations Manager 6/2016

SIGNED BY

Rhonda Beane, MSN, RN Director, Surgical Services Department

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

APRIL 1990
ORIGINAL
 REVISION

SEPTEMBER 2016
PAGE 8
OF 7
POLICY #

1.42
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services - UH
TITLE
CASE SCHEDULING
OUTPATIENT SURGERY CENTER - OPERATING ROOM


J