Operating Theatre Management Solution

Operating Theatre Management Solution - OTIS

A Comprehensive Operating Theatre Management Solution

OTIS is a system for managing operating suite staff, and resources and regulating patient throughput. The software provides support for both pre and post operative phases. OTIS covers the following functions:

1 Elective/Emergency Booking

Referral

When a Patient is referred for elective surgery they are booked via the Admission Transfer Separation ((ATS) in use at the hospital. ATS information is then available via HL7 messaging or other direct type of interface.

Elective and Emergency Theatre Bookings

To complete the booking function, the ATS process requires a ‘planned theatre date’ be added to the booking record. This date is used to indicate to the patient when they are likely to receive surgery.

The Theatre System provides booking staff with a planned theatre date for use when processing the booking. Booking staff scan a surgeon’s waiting list schedule and provide possible dates based on all available information.

Information captured by the booking process is used to create a Waiting List record in the Theatre System database.

HL7 messaging will detect the adding of booking entries to the ATS and create corresponding Waiting List entries. Subsequent changes to those entries will be promptly reflected in the Waiting List entries in the Theatre system.

Pre-admission Clinic

Patients attending day-only or same day surgery are often required to attend a pre-admission clinic to receive advice on their preparation for surgery. Patients requiring a pre-admission clinic booking can be flagged on the ATS system at the time of referral.

The setting of a pre-admission appointment date will only occur after the patient has been scheduled onto a theatre list.

After the patient has been contacted and an appointment made, the pre-admission clinic attendances are tracked on a daily basis.

Finally the attendance of the patient at the clinic is recorded. This process will update a pre-admission status for the patient that indicates to theatre staff that the clinic has been attended. Patients who require pre-admission and have not presented at clinic will be identified by a report.

Waiting List Management

2 Waiting List Management

The allocation of a planned theatre date indicates the patient is ready for surgery but has not been given a confirmed theatre date. The date can be used for long range planning of theatre facilities and for assisting communications with the patient. The waiting list also indicates urgency and number of days the patient has been ready for care. If the patient status isset to "not ready for care" this period does not contribute to days waiting for surgery. This is an enquiry facility only; you cannot use it for scheduling.

The theatre management and booking team manages the waiting list. The team will have the use of the OTIS system to help determine planned dates by way of a range of reporting and filtering functions.

Some of the analysis functions that the team may use to manage the setting of dates include:

determining the next available and successive available future session dates for a nominated surgeon.
testing a possible operation date by entry of the date together with the surgical procedure to determine available scheduled session times for the surgeon to indicate if the date is acceptable.
identifying patients who are either scheduled, on standby or wait listed for a given day

Theatre Date Assignment

The 'scheduling' of a patient may occur either via ATS function or via a Theatre system scheduling process. Under normal circumstances, booking staff will print and review the waiting list detail report and add theatre dates to elective surgical patients that have been booked (ie on the waiting list).

Control of patient scheduling will continue to be via the ATS system, up to an agreed cut off time prior to the commencement of the theatre session. After this time, changes are no longer accepted from the ATS. After the cut off time theatre staff via the Theatre Scheduling process performs all changes.

Session Scheduling

3 Session Scheduling

Session Time Scheduling

Session time is regular time when theatre facilities are available for allocation to an individual surgeon's cases. In most instances surgeons are allocated regular blocks of session time well in advance of the scheduled session date. In other instances (smaller regional hospitals) session time is allocated as cases are scheduled for theatre. An anaesthetist may optionally be allocated to these session times although they are usually associated with the availability of a surgical team and facility. A Session time is defined by:

· Surgeon – Admitting Medical Officer (AMO) who has been allocated the surgical time. This may be different from the surgeon actually performing the procedure.
· Type (Emergency or Scheduled)
· Theatre facility,
· Operating theatre room (optional),
· Session date,
· Session start time,
· Session end time,
· Identification that this is a regular time slot repeated each week or a single reservation,
· Anaesthetist (optional).

Surgeon's Session Scheduling

Session times for a theatre facility can be allocated to individual surgeon's cases by defining a Surgeon's Session. Note that it is not necessary for a surgeon's session to be scheduled during theatre session time. Emergency cases that occur out of normal theatre session time, will cause the creation of scheduled session entries with no corresponding session time.

A surgeon's session is defined as an operative team and theatre facility (room, instruments etc) that has been reserved for a surgeon between certain times and dates. A distinction is made between scheduled session times and those times when facilities are used for emergencies. A session entry in the latter case will be identified as emergency rather than a scheduled session.

Patients who receive operative procedures are always linked to a session schedule entry, be it scheduled in advance or created after an emergency. This forms the basis for calculation of accurate facility utilisation statistics.

In practice, registrars often perform operations within a surgeon's session. Note that the surgeon's code will not change irrespective of who finally performs the operation.

The session code is an invisible code that ensures that each surgeon's session is unique and each scheduled patient can be linked to a session without ambiguity.

Surgeon's Schedule & Session time Creation

Theatre booking staff create, amend and delete Surgeon's session schedule entries as well as Session time entries.

A Session time is available for each weekday and surgeons and anaesthetists are scheduled for operating rooms for each day. Both the session time allocations and surgeon's schedule for a specified period can be extended into the future. This process assumes the existence of all or part of a session time allocation and surgeon's and are driven by:

Date increment from current date (usually one day)
Number of days to copy
Number of weeks into the future to copy schedule

The Scheduled Session entry provides useful summary information on the linked surgical cases on the booking list (i.e. before the procedure occurs) and the Theatre Episode, which is added after the procedure has been completed.

The Booking List links to patients before the session, the Theatre Episode links patients after the session is completed and the post-operative report added.

Detail Session Reporting

Facility diary detailing Theatre rooms by date and time. Each entry indicates the booked surgeon and anaesthetist.

Individual surgeons diary detailing scheduled sessions

Individual anaesthetists diary detailing scheduled sessions

Session delay analysis report

Utilisation analysis

Theatre utilisation analysis is carried out by theatre management to identify room utilisation. This can be used to allocate underutilised time to surgeons, identify areas of improvement and plan for future developments. The department of Health also use this information for benchmarking exercises.

Theatre List Management

4 Theatre List Management

Finalising Draft Theatre Lists

The theatre elective bookings are checked against the draft theatre list and additional cases added at this time. The list order is complete according to surgeon/hospital priorities and then distributed either in hard copy or by direct access to OTIS depending on site specific procedures.

Scheduling Emergency/Unbooked Theatre Episodes

In an emergency there may be no booking list entry that is correctly linked to a session schedule for the date indicated. (note that there may exists a waiting list entry for the patient or even a scheduled booking entry linked to a different session schedule entry).

For unbooked cases it is important to attach the theatre episode to the correct session schedule entry. If a session is scheduled for the surgeon on the day of the operation then the theatre manager must choose whether the emergency is part of the existing session (added to the end or beginning of the list) or constitutes a new session entry. A new session schedule entry would be added if the surgical team has been especially assembled for this emergency case.

The theatre manager can pick the session schedule from a list of entries for the date of operation, or elect to create a new session schedule entry.

Daily theatre list management

Booking staff and Theatre management staff work together to achieve a smooth administration of both waiting and theatre lists. The cut off time is when responsibility for the Theatre list passes from Booking staff to the operating theatre staff. It is a system definable parameter usually some time during the afternoon prior to the date of the theatre session.

Patients are scheduled from the waiting list by specifying the actual date of operation and informing and confirming (usually by phone) the date with the patient. The stability of a given theatre list, plus the Hospital/Area policy will dictate how far in advance of the date of operation this process can occur. It will vary for differing surgical strands but in most cases it will be not more than about 60 days.

Certain waiting list patients can be flagged as 'stand by' patients. These patients will be notified in advance of the likely date for surgery. They are then contacted the day before, if session time is available, and they are scheduled into a session. If no time is available they are returned to the waiting list with 'stand by' patient status.

Patients can be admitted directly onto a theatre list. These patients will either be surgical patients who are on a waiting list, have been admitted to a ward, but are not yet ready for surgery, or medical patients who are flagged as scheduled emergency cases. It is important to note however, that medical patients are always admitted directly.

Ideally booking staff in consultation with the surgeon, perform case scheduling.

Communication and Organisation

5 Communications and Organisation

Generation and Distribution of Surgical Lists

Information concerning patients who are to receive operative procedures is made available to various groups within the hospital. That is, information is displayed that is relevant to the recipient’s needs. Patient movements must be recorded and broadcast immediately prior, and following their operation. The following diagram gives an example of the target audience and possible variants of this list. Please refer to your organisation’s site manual for details relevant to your site.

Due to the volatility of operating list information the lists are be made available on-screen with only a minimum of printing.

Theatre List Generation and Distribution

There are a number of administrative and clinical groups within the hospital who need to know current information about patients on the DOL. These groups may not require all the above information, and only a selection of patients may be of interest. These groups are:

Group	Key information
Surgical teams	procedure, start time
Theatre administrative staff	procedure, start time, special requirements, status flags
Orderly patient collection	Ward, start time, theatre, status flags
Central Sterilisation Department	preference card text, procedure, surgeon, date required, special requirements & needs.
Anaesthetists	procedure, start time, ward, admission status, status flags
Wards staff	procedure, start time, theatre, surgeons, ward, admission status, status flags
Imaging	Theatre, surgeon, start time, ward, procedure
Pathology	Theatre, surgeon, start time, ward, procedure

Theatre Status & Location Tracking

Theatre staff need to track the progress of patients through the theatre department. This location/status information is also be useful for ward staff either preparing patients for theatre or anticipating their return to the ward.

A prototype Theatre Episode record must be created as soon as the first event is recorded (ie the patient is sent for). The Theatre Episode record is then progressively updated as subsequent events occur.

Preference Cards

Theatre management maintain information in the form of preference cards for surgeons and procedures. Each preference card is a list of the material requirements or 'kits' to be set up for a patient prior to the operation. Information can be stored by surgeon code and indicated procedure code or whichever designated pre-operative code system is used.

Record-of-Operation

6 Production of a Record of Operation

The requirement to record operative details commences at the time the patient first enters the operating theatre area. The information to be collected is structured as in the diagram below.

A series of processes relate to collecting the data identified in the diagram but not limited to:

Information is be, for the most part, entered post operatively from the hard copy nurse's operative record (see appendix). All consortium hospitals have different formats for this record but the information gathered is controlled by common standards of clinical practice so the contents are similar. For example:

Form	Hospital
MR18	Central Coast Health
U4D	Royal North Shore Hospital
MR 100	Illawarra Area Health Service
MR 380	Wentworth Area Health Service
MR 040	Western Sydney Area Health Service

In most instances information will be entered from these forms within one or two days of the completion of the procedure.

Managing Booked Theatre Episodes

A theatre episode is created to uniquely identify the delivery of services within the theatre. It constitutes the minimum information that will be recorded for each operation. This data includes:

Theatre Episode	Source/Calculation
Medical record number	Entered
Booking Status	Emergency/Booked
ATS Episode number	Query Booking list and/or ATS
Surgeon code	Query Session Schedule table via Booking List table
Date of operation	“
Session schedule index	“
Theatre episode number	Booking List
Date/time patient requested from ward (or sent for)	Entered
Date/time patient arrived in theatre	Entered
Date/time theatre set up commenced	Entered
Anaesthetic type	Selected from table list
Anaesthetic setting (theatre or anaesthetic bay)	Selected from table list
Pre-anaesthetic assessment completed	Yes/No
Relief of respiratory distress required	Yes/No
Respiratory or cardiac arrest	Yes/No
Core temperature < 35 degrees C	Yes/No
Severe pain management by anaesthetist	Yes/No
Discharge status	Select from table list
Date/time anaesthetic commenced	Entered
Date/time anaesthetic completed	Entered
Date/time patient returned to recovery bay	Entered if required
Date/time patient returned to ward	Entered if required
Date/time theatre clean up completed	Entered if required
Unplanned return flag	Yes/No
Unplanned return theatre episode link	Original theatre episode
Financial class	ATS
Pain management indicator	Entered
Delay reason code	Entered

Reporting

Many screens within the system allow printing of the details displayed. Standard reports are created using the Crystal report writer and can be accessed from the 'Reports' menu option. In future reports may be produced by another report writer such as Business Objects.

The reporting option will only allow anyone with rights to see data from a particular hospital to view the data from that hospital. If a user has rights to view data from more than one hospital the user will have to select the hospital for each report. The additional selection criteria will only visible when the user has rights to all hospitals.