3343555 operation theatre management

8/9/2019 3343555 Operation Theatre Management

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OPERATION THEATRE MANAGEMENT

PAPER-402

Ms. SUSMITA BHAUMIK


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An OT is that specialised facility of the hospitalwhere life saving or life improving procedures arecarried out on human body by invasive methods under

strict aseptic conditions in a controlled environmentby specially trained personnel to promote healing andcure with maximum safety, comfort and economy


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Function

Operating theaters had a raised table or chair of some sort at the centerfor performing operations, and were surrounded by several rows of seats(operating theaters could be cramped or spacious) so students and otherspectators could observe the case in progress.

The surgeon wore his street clothes with an apron to protect them from

blood stains, and he operated bare-handed with unsterile instruments andsupplies. (Gut and silk sutures were sold as open strands with reusable,

hand-threaded needles; packing gauze was made of sweepings from thefloors of cotton mills.)

In contrast to today's concept of surgery as aprofession that emphasizes cleanliness and conscientiousness, at thebeginning of the 20th century the mark of a busy and successful surgeon

was the profusion of blood andfluids on his clothes.
http://en.wikipedia.org/wiki/Apronhttp://en.wikipedia.org/wiki/Sterilization_%28microbiology%29http://en.wikipedia.org/wiki/Suturehttp://en.wikipedia.org/wiki/20th_centuryhttp://en.wikipedia.org/wiki/20th_centuryhttp://en.wikipedia.org/wiki/Suturehttp://en.wikipedia.org/wiki/Sterilization_%28microbiology%29http://en.wikipedia.org/wiki/Apron


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OPERATION THEATRE


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The operating theatre is based on whole system thinkingand includesa whole of hospitalperspective on effective and efficient theatre utilisation.

Goals

Key elements to efficient use of operating theatres are:

Effective management

Good communication

Well trained staff

Appropriate facilities and equipment

Operational layout that allows flow of patients.

Support services play a large part in maximising efficiency by providing: Pre-operative preparation and assessment

Available beds Sterile theatre equipment Portering, cleaning and maintenance staff.

Effective planning and scheduling systems will enable smooth patient flow thus

increasing capacity, improving patient and carer experience, improved employeesatisfaction and morale


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The operation theatre complex consists of four main systems,

Surgical support system (the environment)

Traffic and commerce (the activities)

Communication and information (the records)

Administration ( the management)


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ADMINISTRATION


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Overview and strategy

Theatre

Management

structure

Planning patient

pathways

Staffing

Operating list

management

Effective useof theatre time

Theatre design

Trauma and

emergencies

Postponements

Key elements


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Planning patients pathways

Patients pathways should take into account ways to maximiseuse of theatres and bed availability.

Patients admitted to pre-operative units can be transferred to

wards following surgery allowing time for discharge of previous

patients.

Integration of pre-operative assessment and day case recovery

area located adjacent to theatres provides an efficient use ofspace, skilled staff and may aid patient transport to and from

theatres. This scheme also reduces time on ward rounds for

surgeons and anaesthetist as patients are in one place.


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Staffing

Department should provide a system of staffing that works locally

and is acceptable to staff

Department staffing should match clinical activity, with sufficient

cover for elective and emergencies

A lead anaesthetic consultant should be identified to support thetheatre management team and trainees

Adequate orientation of new or locum staff should be made a

priority

Adequate staffing should be available to cover governance

tasks of note recording and data entry.


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Operating list management

Close communication and coordination between pre-op area and theatre

using agreed procedures is essential

A nominated person should liaise with wards and transport staff fromtheatres

A suitable holding area staffed and equipped will assist with smooth flow

Agreement should be made for preparation and transport of patients to

and from theatres Policies on fasting, anticoagulation, shaving, dentures, jewellery,

appropriate underwear and removal of make-up should be developed

Units should agree the level of training needed to escort patients to and

from theatres

A documented system of handover and identification of patient should bein place

A system to book critical care beds for elective admissions should be in

place and booking confirmed before anaesthesia for surgery.


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Theatre design and operational layout

Design of operating theatres is essential for maximising patient flow,

consideration needs to be made for:

Large multi-purpose accommodation to enable increase in complexity

and equipment

Transport routes that flow through stages of theatre care Internal communication IT systems that facilitate appropriate

communication and supervision.


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Trauma and emergency surgery

Effective planning for emergency and trauma surgery is needed to prevent

cancellation of elective surgery.

Provision of exclusive emergency list will assist in preventing cancelled

elective surgery.

Good communication enables clinical decisions to be made rapidly, increasing

the number of surgical procedures carried out in a safe time and environment.Time should be allowed for the Anaesthetist to assess emergency patients to

their satisfaction.

Experienced surgical staff should prepare patients who have multiple and

complex medical problems, this can prevent cancellation at anaesthetic

assessment.

Pre-operative assessment for patients who are elderly, have multiple and

complex medical problems can benefit from a team approach between

anaesthetist, surgeon and physician.


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Cancellations of surgery

It is extremely distressing and stressful to patients who are postponed

surgery, many cancellations can be prevented by assisting patient flow with

good planning in:

Pre-operative assessment Increased communication

Regular review of cancellation can assist with target areas for redesign and

innovation.

Cancellation data should be collected and reviewed weekly with agreedaction plans.


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It is essential for operating theatre innovation to have a skilled, trained

and committed innovation team.The team should consist of

representatives of all theatre staff groups.

Management clinical/non clinical

Nursing Pre op and theatres, including operating department

practitioners

Clinical Anaesthetist/SurgeonsAdministration Admin and Portering


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Processes

AdmissionReceive patient to

ward following operation

Administration Processes will also need to map demonstrating

process from:

Initial recording of overall patient processes should be made covering:

Allocation to

theatre list

Theatre reception

on day of operation


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Processes

Theatre

Recovery

Home

Theatre

Recovery

Bed

Home

Bed

Theatre

HDU/ITU

Bed

Home

ICU

Theatre

ICU

Bed

Home

Theatre

ICU

Bed

Home

Process map groups


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Scheduling

The realistic building of theatre lists start in processes outside of theatre

environment, essential validation of how lists are made needs to be

undertaken to maintain effective and efficient operating theatres.

Agreement can be made on average time per procedure to enable

effective booking of theatre lists.

Average time per operation can be agreed and used to assist buildingtheatre templates.

Case 1

Case 2

Case 3

9.00 am 12.30pm

P


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Process steps examples

Processes

5Theatre hands over patient to

ward

5Patient taken to ward

20Patient in post op

5Patient taken to recovery area40Surgery completed

5Patient positioned onto theatre

table

10Anaesthetic given

2Patient taken to anaesthetic

room

5Patient checked in to theatre

5Patient transported from ward

Time per

step (min)

Step


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Process steps examples

Processes

5Theatre hands over patient to ward

5Patient taken to ward

20Patient in post op5Patient taken to recovery area

40Surgery completed

5Patient positioned onto theatre table

10Anaesthetic given

2Patient taken to anaesthetic room

5Patient checked in to theatre

5Patient transported from ward

COLOURTime perstep

Step


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Build your schedule

Processes

Use graph paper with one square per minute to sequence time

scales per procedure.

1 MINUTE102

MINUTES


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Core data set

Suggested Measures

Late Starts (e.g. >15mins) / Early Finishes (e.g. >60mins) / Overruns (e.g. >30mins)

Example For ten Orthopaedic sessions with a scheduled start time of 8:30am the

sample showed four (or 40%) started >15mins late.

Number of Major Procedures (>1hr) v Minor Procedures (


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ResourcesAim: To increase the utilisation and quality of care within operating theatres.Change Concepts

Review operating theatre utilisation

Scheduling

Identify system to report delays daily via agreed criteria

Remove delays, complexity and hand offs within administration process

Smooth process from Emergency Department / Inpatient wards to Operating Roomand back to ward

Review stages of Transfer from ward /Emergency Department, recovery to ward

Review capacity and demand for emergency and elective theatre

Review role of theatre coordinator and joint work with Pre-Operative and bedmanagement

Review equipment turn around times via Central Sterilising Services Departmentand booking of equipment

Review recovery and transfer procedures develop appropriate pull process to

theatre/wards


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PLANNING AND DESIGNINGPLANNING AND DESIGNINGOF OPERATION THEATREOF OPERATION THEATRE

PAPER-402PAPER-402 MS.SUSMITA BHAUMIKMS.SUSMITA BHAUMIK


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OBJECTIVES OF PLANNING

Promote high standards of asepis

Ensure maximum standard of safety

Optimum utilisation of OT and staff time

Optimize working conditions

Patient and staff comfort in terms of thermal, acoustic and lightingrequirements

Allow flexibility

Facilities coordinated services

Minimize maintenance Ensures functional separation of spaces

Provide a smoothing environment

Regulate the flow of traffic


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DESIGN PARAMETERS (OPTIMAL RELATIONSHIP BETWEENVARIOUS FUNCTIONAL ZONES)

CIRCULATION SPACE

STAFF CHANGING

AND RESTINGPATIENT RECEPTIONAND RECOVERY

CIRCULATION SPACE

OPERATING SUITES

THEATRE

STERILE

SUPPLY

CIRCULATION SPACE


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DESIGN PARAMETERS

Avoidance of unrelated hospital traffic flow Convenient functional flow between related departments like

ICU,ITU ETC Avoidance of outdoor noise Provision for future expansion Sliding doors

Desirable floors to be smooth and non-slippery Ceilings to be painted with washable paints Taps in scrub room should be knee/elbow operated /infrared operated. Provisions of high speed autoclaves Essential pharmaceutical storage X-ray films illuminators Emergency communicators that can be activated without the use of

hand Toilets


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PHYSICAL EVIRONMENTPHYSICAL EVIRONMENT

TEMPERATURETEMPERATURE HUMIDITYHUMIDITY

VENTILATIONVENTILATION


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Areas with higher hygienic requirements for air quality.

Areas with high clean-air requirements include the operating theatre, anysterile preparation and pre-operative areas,

sterile storage, the anesthesia and equipment storerooms and the

entrances and the exits. The highest clean-air requirements apply to the

operation area and the sterile preparation area.

With respect to air treatment, the operating theatre and a number of

adjacent areas have to comply with the provisions of the working

conditions policy regulation.


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From a technical point of view, the protective effect of the air

surrounding the patient, operation team and instrument table, can be

achieved by installing a large Laminar Air Flow (LAF) device

(plenum).

This LAF device with a downflow has a surface area of 8 to 9 m2

(e.g. square or octagonal 3 x 3m, rectangular 2.8 x 3.2m).

The air velocity from the downflow plenum is 24 to 30 cm/sec and

flow temperature from the LAF device is 1 to 2C lower than the

ambient air.

There are also possible solutions and satisfactory results in

environmental control using special LAF devices in which the supplied

air has different speeds and temperatures and which also improved the

thermal comfort of the surgical team.


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In order to be able to safeguard the requisite air quality in the

operating theatre, a very large air flow is necessary. A re-

circulation downflow system can be installed for this purpose. Part

of the air from the down flow system is recirculated via fans tothe HEPA filter. (HIGH EFFICIENCY PARTICULATE AIR)

In order to be able to evaluate whether the air system, the air flow

profiles are correctly functioning, a CFD calculation isrecommended at the design stage. This also makes it possible to

ascertain whether, at a specific internal heat load, the selected

diffused air temperature and the selected air velocity will not lead to

an excessively high level of cooling in the operating theatre. Thiswill also reveal at an early stage any short-circuiting between air

supplied from the plenum and the site of the intake openings for air

recirculation


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Assuming that the air from the HEPA filter is sterile, the only

possible emission source will be the operation team, the OT staff,

the patient, the material used and the equipment.

With respect to the sterile preparation

area with direct access to the operating theatres, a higher pressure is

recommended compared to all rooms adjacent to this area.

POSSILE AIR CLEALIESS:

The desired germ level of less than 10 colony forming units (CFU)per m3


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Air DistributionAir Distribution

TurbulentTurbulent or mixing air distribution system

Downward displacement piston system

Unidirectional air flow system (laminar flow)


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Basic quality requirements for the technical facilities are:

The surgical department has to be equipped with a mechanical

ventilation system.

The operating theatre has to be equipped with a laminar downflow

system with a large air plenum (8 to 9 m2). Under working conditions

with operation lights switched on and the presence of the operation

team, the air supply and blast air profile are chosen in such a way that

the air does not pass through any sources of contamination beforeflowing into the operation area or over the instrument table.

There must be no windows that can be opened and outside walls

must be completely sealed.


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The most important basic quality requirements concerning spatial

relationships are:

The surgical department is independent of traffic flows in the

rest of the hospital; through traffic is not permitted through this

department.

Airlocks physically seal a surgical department from the rest of

the hospital.

Staff working in the operating theatre complex can move from

one clean area to another without needing to pass through non-

clean areas.


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20patient airlock or holdingarea

42Operating theatre, specific(orthopaedics, cardiac surgery,

neurosurgery)

36Operating theatre, general

Min. usablearea in m2Description of the area

15preoperative area

BASIC QUALITY REQUIREMENTS: SPATIAL NEEDS


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TEMPERATURE AND HUMIDITY

Normal person at rest (unclothed) 240

-270

c with relativehumidity of 50%

Body looses heat during anesthesia.

So,So, R.H 45-60% recommended (adults 40% , children and infants

55%-60%)

In UK, 200 220 c with R.H. 50% to 60%

In US, 210 -24.50 c with R.H 50-60%

Other basic quality requirements


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Other basic quality requirements

The following basic quality requirements apply to the use of equipment, operational

reliability of installations and finish in a surgical department:

Health risks to staff such as exposure to microbiological and chemical

Contamination, and lasers and ionizing radiation can be avoided as far as

possible by drawing up guidelines and protocols.

Operational reliability of the technical installations and an optimal indoor

environment for both patients and staff form the basis for the design

and maintenance of the mechanical engineering and electro technical installations.

The finish of floors, walls and ceilings must be smooth, flawless or closed.

Corners and transitions between floors and walls will be rounded to prevent

accumulation of dirt. The different areas should be constructed and furnished in such

a way as to allow effective cleaning and if necessary disinfection with commonly

used cleaning agents and permitted disinfectants.


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ZONING IN OT


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CONSISTS of 4 zones

A. OUTERZONE - Areas for receivingpatients messengers,toilets,administrative Function

B. RESTRICTED ZONE OR CLEAN ZONE

- Changing room- Patient transfer area

- Stores room

- Nursing staff room-Anaesthetist room

- Recovery room


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C. ASEPTIC ZONE

Scrub areaPreparation room,Operation theatre,

Area for instrument packing andsterilization.

D. DISPOSAL ZONE

Area where used equipment arecleanedand biohazardous waste is disposed


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OPERATION ROOM

3. Big enough for free circulation4. Two openings (optional)

Towards scrub area

Towards sterile area

3.Openings fitted with swing doors.

4.Marble or polished stone flooring

5.Glaze tiled walls

6.No false ceiling


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OPERATING ROOM

PATIENT IN

STERALIZINGDEPT

STERILEPEPARATION

DISPOSAL

SCRUB

STAFF

CHANGEPATIENT-OUT

OT SHOWING TRAFFIC FLOWS


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NUMBER OF OPERTINGSUITES


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Number and type ofNumber and type of

surgeonssurgeons

Type of hospitalsType of hospitals Hospital policy and

procedure

Bed strength Number and type of

surgery patients

Number of operations

per day

Time aTime allowed for staff

breaks

Average time foroperations

Time allowed for

maintenance of OT Expected ALOS

Size of an average OT

list


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LOCATION

GROUND FLOOR/ TOP FLOOR/ ANYWHERE INTHE HOSPITAL


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LIGHTING IN OT

O T Light
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O.T. Light

Hospital furniture is important aspect owing to its specialized

design. This furniture has certain functions needed to supportpatients who have decreased mobility. In such cases the specialized

design of hospital furniture serves the need of providing the required

support.

Operation theatre (OT) light comes with the following features:

perfect

comfortable

Lights brilliant Exclusive design

Trouble free

Mounting is economic
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Shadow less Ceiling Operating light

combination that provides the superior

performance for all kinds if surgeries.

Compact, Light weight and sealed dome

made of aluminium consists of glass

diachronic reflector to provide cool, bright

and homogenous illumination.

OT Lights are made to spot light the

operation table area. They illuminate the area

to the right level of brightness with effectiveheat absorbing and color correcting provided

for cool, white and brilliant light field for

operational convenience

Venus O.T. Lights
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WORKFLOW

2. Singe corridor system

4. Double corridor system

disposal traffic

Patient and disposal traffic

Patient and staff traffic


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EQUIPMENT PLANNING

The most efficient type of operating suite in terms of maximum utilisation of resources as


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The most efficient type of operating suite in terms of maximum utilisation of resources as

well as the most cost-effective, will display the following characteristics:

2. It will be without a separate anesthetic room

3. It will have shared scrub facilities between theatres

4. It will have a disposal bay or room servicing two theatres

5. It will have a centrally located supply room servicing a no. of theatres

FURNITURES & GADGETS

Special fixtures: anesthesia cabinet, instrument storage cabinet, scrub station, x-rayviewing, writing board, inter-communication.

Special furniture: instrument trolley, bowl stand, infusion stand, step stair, disposal bag

holder, stool, endoscopes,

CCTV

Assembly tables, sterilization equipments, patient monitoring and resuscitation

equipments

Medical gases

Anesthesia equipments


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THANK YOU

3343555 operation theatre management

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