blue 725 operating theatre list

Royal United Hospital Bath NHS Trust Operating Theatre List

OPERATING THEATRE LIST POLICY

725 2007 Reference Number:

Heather Cooper Author / Manager Responsible: Charlotte Hamilton

Deadline for ratification: October 2010 (Policy must be ratified within 6

months of review date)

April 2009 Review Date:

Theatre Users Group Ratified by:

April 2007 Date Ratified:

Patient Access Policy Related Policies

Author : Heather Cooper Job title: Theatre Manager

Date: April 2007 Version: 1

of 29 Review date: April 2009





INDEX Section Page Consultation and ratification schedule - - - - 3 Policy - - - - - - - - - 4 Introduction - - - - - - - - 4 Aims, Objectives and Area of Policy - - - - 4 Scope of Policy - - - - - - - 5 1. List Compilation, Notification & Submission - - 6 2. Responsibilities - - - - - - 7 3. Procedure for Changing Patient Details on Operating Lists 9 4. Surgical Booking Process Flow Chart - - - 11 5. Procedure for Notification of Change to Theatre Timetable 13 5.1 Procedure for Change of Surgeon on Operating Lists 14 5.2 Procedure for Cancellation of Operating Lists 14 5.3 Reallocation of Cancelled Sessions 16 6. Record Keeping & Data Requests - - - 18 APPENDIX 1 Minimum Standards for Elective Surgery 19 APPENDIX 2 Theatre List Scheduling Guidance - 20 APPENDIX 3 List Submission Timetable - - - 21 APPENDIX 4 Notification of Change to Theatre Timetable 23 APPENDIX 5 Loan Equipment Request Sheet - - 25 APPENDIX 6 Reasons for Cancellation - - - 28 Consultation checklist - - - - - - 29





CONSULTATION AND RATIFICATION SCHEDULE Name and Title of Individual Date Consulted

Date policy e-mailed to policy co ordinator Name of Committee Date of Committee





POLICY INTRODUCTION The Trust is committed to developing systems and processes that seek to match demand and capacity for elective and emergency surgery. Effective planning and management is essential to improve services to patients and ensure optimum use of operating theatre capacity. More efficient use of the operating theatres and effective scheduling will reduce waiting times for patients and avoid cancellations. Early notification of operating lists can allow sessions to be fully utilised by surgeons and enable the Theatre Manager to ensure any specialist equipment and staff are available. AIMS OF THE POLICY

To ensure that the ‘Minimum Standards for Elective Surgery’, as agreed by the Surgical Division, are adhered to.

To establish an agreed set of procedures for formulation and submission of

elective, emergency and trauma operating lists;

To ensure, wherever possible, full utilisation of available operating sessions;

Identify responsibilities of key staff involved in the compilation and submission of elective and emergency operating lists;

To establish an agreed set of procedures for identifying and listing PTL, cancer

and private patients;

To establish methods of identifying lists where specialist equipment or staff is required, allowing time for the necessary arrangements to be made; and

To identify teaching lists and facilitate case mix adjustment where necessary.

AREA OF POLICY Surgical and Anaesthetic Directorates under the management of the Surgical Division. OBJECTIVE To facilitate forward planning of the operating lists for the theatre departments, Main Theatres and Day Surgery Theatres ensuring maximum utilisation of available resources whilst meeting the activity and performance targets of the Trust.





SCOPE OF THE POLICY The policy covers:

The timetable for the notification of elective, emergency and trauma operating lists to the theatre department;

Responsibilities for compilation, notification and submission of all operating lists;

Distribution flow for operating lists;

Identification of PTL, cancer and private patients;

Identification of teaching and training lists;

Procedure for cancellation of operating sessions;

Guidelines for the re-allocation of operating sessions;

Timescale of notification of surgeon and anaesthetist leave;

Identification of specialist requirements, staff and equipment; and

Procedure for changing operating lists after submission to the Theatre

Department.





1. LIST COMPILATION, NOTIFICATION AND SUBMISSION

1.1. Every booking coordinator and medical secretary will have access to the

up-to-date theatre timetable on the Theatre Timetable web page. This will be updated regularly to reflect any changes to the planned format. The Theatre Timetable web page may be found at:

http://webserver.ruh-bath.swest.nhs.uk/departments/main_theatres/home_menu.htm 1.2. The elective surgery operating list will be produced on the theatre ORSOS

system. 1.3. Emergency and trauma lists will be accepted in hand written form but

should be booked to ORSOS theatre system prior to the patient being called to theatre.

1.4. All patient details must be recorded including:

1.4.1. Patient name 1.4.2. Date of birth 1.4.3. Hospital number 1.4.4. TDS episode number 1.4.5. Wait list priority, including patient status e.g. cancer, PTL, private

etc. 1.4.6. Surgeon name 1.4.7. Date of operation 1.4.8. Theatre procedure to be performed in 1.4.9. ORSOS Session ID 1.4.10. Full procedure name and code, including any sub-procedures 1.4.11. Site of procedure 1.4.12. Anaesthetic information, i.e. GA, LA etc. 1.4.13. Any specialist equipment required 1.4.14. Any special conditions relating to patient or procedure 1.4.15. Information regarding any previous complication or cancellation

1.5. All questions regarding the patient and their operation should be

accurately and comprehensively answered when booking patients to the ORSOS theatre system.

1.6. Elective operating lists must be submitted by 10am, 3 working days before

planned surgery. 1.7. Emergency lists should, where possible, be formulated with as much

notice as possible. It is accepted that this will not always be possible due to the nature of the surgery.

1.8. Theatre One staff will enter all emergency lists on the theatre ORSOS

system at the earliest opportunity.

http://webserver.ruh-bath.swest.nhs.uk/departments/main_theatres/home_menu.htm

http://webserver.ruh-bath.swest.nhs.uk/departments/main_theatres/home_menu.htm





1.9. The Trauma Coordinator will be responsible for ensuring that all trauma lists are entered on the theatre ORSOS system at the earliest opportunity.

1.10. All emergency and trauma patients require a priority rating / NCEPOD

classification at the time of listing. 1.11. Booking coordinators will compile the list according to the guidelines set

out in Appendix 2.

1.12. All PTL, cancer and private patients must be identified on the theatre list using the appropriate column.

1.13. PTL patients should, where possible, be listed first on the operating list.

1.14. Clinical priority will supersede PTL status in the list order.

1.15. Any specialist equipment required should be highlighted on the operating

list and a Loan Equipment Request Sheet (Appendix 5) completed.

1.16. Loan Equipment Request Sheets should be completed in full at the earliest opportunity and submitted to the G Grade theatre nurse responsible for that speciality or theatre department.

1.17. All lists must be agreed with the operating surgeon before submission.

1.18. Electronic / hardcopy lists for elective surgery must be made available to

all clinical, nursing and management staff within the agreed timescale. 2. RESPONSIBILITIES

2.1. Booking coordinators will ensure that elective theatre lists are compiled and submitted according to the List Submission Timetable in Appendix 3, and that sign off by the relevant surgeon is received prior to submission date.

2.2. The Elective Admissions Manager is responsible for ensuring list

compilation and submission is maintained during booking coordinators’ leave.

2.3. The medical secretaries are responsible for providing their surgical teams

with access to up to date theatre lists.

2.4. The Theatre Information Team will monitor the receipt of lists within the specified timescale.

2.5. The Theatre Information Team will inform the Elective Admissions

Manager of any missing or late list submissions via email.





2.6. The Theatre Manager, the Day Surgery Manager and Band 7 theatre nurses will review the case mix of the operating lists on a daily basis, highlighting any potential under utilisation or cancellations due to “list overrun”.

2.7. The Theatre Manager and Day Surgery Manager will accept responsibility

for downward and outward dissemination of information pertaining to forthcoming operating lists to all senior staff.

2.8. The surgical teams will accept responsibility for ensuring that a Loan

Equipment Request Sheet is completed and submitted for any specialist equipment required.

2.9. Senior theatre staff / team leaders will be responsible for monitoring any

special requirements for forthcoming lists for the forthcoming week.

2.10. The Theatre One staff will enter the emergency lists onto the ORSOS system at the earliest opportunity.

2.11. The Trauma Coordinator will ensure that the trauma lists are entered onto

the ORSOS system at the earliest opportunity.

2.12. The Theatre Information Team will retain primary responsibility for making any changes to the operating lists after the submission date.

2.13. The Booking coordinators will immediately inform Theatre Reception via

Cancelled Ops Group email address if any changes are made to the operating lists after the submission date. New lists will then be printed and circulated by the Theatre Information Team.

2.14. The Theatre Information Team will ensure adequate copies of the daily

operating list are available for all staff.

2.15. Senior theatre staff will be informed immediately by the Theatre Information Team of any changes to forthcoming lists.

2.16. At the end of each operating session one list will be returned to the

Theatre Information Team detailing any changes in list order and any cancellations.

2.17. Theatre Reception / DSU Recovery must e-mail details of all cancelled

patients to the appropriate booking co-ordinator to facilitate re-booking via the Cancelled Ops e-mail address.

2.18. Remaining lists should be disposed of in Recovery or the Theatre

Information Office using the shredders or the blue confidential bins provided to protect patient confidentiality. No other means of disposal should be used.





3. PROCEDURE FOR CHANGING PATIENT DETAILS ON OPERATING LISTS

Changes to operating lists are inevitable and can be made at any time provided the following procedure is followed.

3.1. List changes including all cancellations should be entered onto the

ORSOS system at the booking coordinators’ earliest opportunity.

3.2. The Theatre Information Team is responsible for making any last minute (within three working days) changes to operating lists. Any last minute changes required by the surgical or anaesthetic teams should be requested by clinicians via Theatre Reception.

3.3. Should the Theatre Information Team or a booking coordinator make any

changes to an operating list after it has been submitted they will immediately inform Theatre Reception via email who will print and circulate new copies of the list.

3.4. The Theatre Information Team will inform the relevant manager and senior

nurses for Main Theatres and Day Surgery Unit of any changes to the relevant department’s lists.

3.5. Ward clerks or senior ward staff should immediately inform Theatre

Reception / Day Case Unit of all hospital and patient initiated cancellations. This information will immediately be passed on to the senior theatre staff for the relevant area and the changes noted on the operating lists.

3.6. Any changes in the order of the operating list must be highlighted to the

Theatre Team Leader, surgeon, anaesthetist, Patient Admissions Centre and ward staff immediately.

3.7. Any changes regarding specialist equipment requirements should be

detailed on a Loan Equipment Request Sheet and submitted to the appropriate Band 7 theatre nurse at the earliest opportunity.

3.8. Theatre Reception will ensure that all appropriate staff have an up to date

copy of the operating list incorporating any alterations.

3.9. All operating list changes must be documented on the master copy which is returned to the Theatre Information Team at the end of the session.

3.10. All Booking coordinators and the Theatre Information Team must ensure

that all cancelled operations are immediately and accurately recorded on ORSOS.

3.11. Cancelled operations must be recorded on ORSOS on the date which

they occur.





3.12. Cancelled operations must be accurately recorded. A list of reasons for cancellation may be found in Appendix 6 and are displayed in each theatre and booking office. Should guidance regarding the reason for cancellation be required, please contact the Theatre Manager or Day Surgery Unit Manager/Elective Admissions Manager.

3.13. No PTL patients may be cancelled without authorisation from the Elective

Admissions Manager. The Elective Admissions Manager must immediately be informed of all PTL patients who potentially may be cancelled by the hospital for non-clinical reasons. All PTL patients must be offered a new treatment date, in accordance with the Trust Access Policy, before they are discharged.

3.14. Wherever possible all patients cancelled by the hospital on the day of

surgery or after their admission should be offered a new treatment date before they are discharged.

3.15. The Trust procedure for compliance with the NHS Plan 28 Day Guarantee

must be followed for all patients cancelled by the hospital at the last minute for non-clinical reasons.

3.16. The Elective Admissions Manager and booking coordinators will ensure

that all 28 Day Guarantee patients are offered a new treatment date within 28 days.





4. SURGICAL BOOKING PROCESS FLOW CHART

Booking Co-ordinator Surgeon /

Anaesthetist Surgical Secretary Theatres

Patient booked to theatre list in accordance with Trust Access Policy

TCI & operation date recorded on TDS

Patient booked to ORSOS

All booking questions to be answered & special conditions noted including all information available on T-card/TDS

Theatre lists should be ordered according to the Theatre List Scheduling Guidance set out in Appendix 2

Patient & operation details recorded in speciality/consultant diary

Information to include wait list date, urgency, date patient confirmed operation, any previous cancellations & whether 28 day guarantee patient, ORSOS number & any special

conditions/additional information as appropriate

Any changes to the theatre list, including cancellations, should be recorded immediately on TDS, ORSOS and in diary to ensure that PAS data is accurate at all times

Medical secretary / Anaesthesia Directorate Coordinator to provide surgical and

anaesthetic teams with access to up to date operating lists as required.

Surgeon & anaesthetist to review theatre list at least 3 working days prior to surgery to ensure that lists are booked appropriately & information is accurate

Theatre Information Team / booking coordinator to be informed of any changes required

Theatre staff to review theatre list at least 3 working days prior to surgery to ensure that theatre lists are booked appropriately & efficiently

Surgeon, anaesthetist & theatres to be informed of any changes to or cancellations from

the theatre list within 3 working days of surgery

Theatre Information Team to record all changes to theatre list & reasons for cancellation within 3 working days of surgery. New copies of updated lists to be printed and

circulated.

Theatre list to be returned to Theatre Information Team on day of surgery to ensure that PAS data is accurate at all times

Theatre Reception / Recovery to e-mail details of all cancelled patients to Cancelled

Operations Group to facilitate re-booking





C h ancellation to be recorded on TDS & patient rescheduled to theatre list in accordance witTrust Access Policy





5. PROCEDURE FOR NOTIFICATION OF CHANGE TO THEATRE TIMETABLE The Notification of Change to Theatre Timetable Form (Appendix 4) must be used to record ALL changes to the standard four week theatre timetable. The timetable must be reviewed on receipt of surgical rotas and any changes reported as appropriate. It is the responsibility of the booking coordinators and the Elective Admissions Team to cover all theatre lists (with the exception of Theatre 1 and Theatre 2) on notification of surgeon leave or unavailability. It is the responsibility of the Orthopaedic Project Manager to cover all trauma lists (Theatre 2) on notification of surgeon leave or unavailability. It is the responsibility of the Theatre Manager / Assistant Divisional Manager for Surgery to cover all emergency lists (Theatre 1) on notification of surgeon leave or unavailability.

Booking coordinator informed of surgeon leave or a change to theatre timetable (at least 6 weeks notice)

DAY 1 Booking co-ordinator must attempt to cover the theatre list

within speciality by e-mailing all surgeons, including registrars & staff grades to ask if anyone is available to cover that theatre list.

DAY 5 If the booking co-ordinator has been unable to cover the

theatre list within 5 working days they must contact, by phone, all surgeons who have not responded to their earlier email.

DAY 6 Booking coordinator to complete a Notification of Change to

Theatre Timetable Form and email it to the Changes to Theatre Timetable Group. A copy of the email must be retained by the booking co-ordinator for record.

DAY 7

Team Leader to print Notification of Change to Theatre Timetable Form and action as appropriate. On notification of a cancelled session Elective Admissions team leaders should approach other specialties in an attempt to cover the theatre list.

DAY 9 Appropriate team leader to seek authorisation from the Theatre

& Anaesthetic Departments and inform the Theatre Information Team of all changes at the earliest opportunity.





5.1. PROCEDURE FOR CHANGE OF SURGEON ON OPERATING LISTS

5.1.1. Booking coordinators must complete a Notification of Change to

Theatre Timetable Form for any change in the operating surgeon for a list.

5.1.2 The Elective Admissions Team Leader will inform the relevant

manager for Main Theatres or Day Surgery Unit and the Anaesthesia Directorate Coordinator of all changes at the weekly Theatre Meeting.

5.1.3 The relevant theatre manager and Anaesthesia Directorate

Coordinator must authorise a Notification of Change to Theatre Timetable Form for all agreed changes.

5.1.4. Once an authorised form has been received, the Theatre

Information Team will update ORSOS and the Theatre Timetable Web Page with the details of the change of surgeon.

5.2. PROCEDURE FOR CANCELLATION OF OPERATING LISTS

5.2.1 Cancellation by Surgeon

At least six weeks notice must be given for the cancellation of theatre sessions for reasons of annual leave or study leave. If cancellation is unavoidable the consultant surgeon, with the appropriate manager, is responsible for arranging cover, or an additional theatre session to replace the lost one, within an acceptable time scale if this is possible.

5.2.2 When a surgeon is unable to undertake a planned operating session the speciality should make every effort to cover the list internally (e.g. another consultant or junior surgeon). If this process is successful a Notification of a Change to Theatre Timetable Form should be completed. The appropriate theatre manager and Anaesthesia Directorate Coordinator should be informed of the surgeon using the list and any issues relating to case complexity or any specialist equipment required.

5.2.3 It is the responsibility of the surgeon to inform their booking

coordinator of sessions cancelled in both Main Theatres and Day Surgery Theatres.

5.2.4 Booking coordinators will complete a Notification of Change to

Theatre Timetable Form and confirm the cancellation with their team leader.





5.2.5 The following information must be included in any correspondence relating to the cancellation of an operating list – date of session to be cancelled and reason why session is being cancelled (e.g. annual leave, study leave, court appearance, etc.).

5.2.6 Information regarding the cancelled session must then be

authorised by the appropriate theatre manager and the Anaesthesia Directorate Coordinator.

5.2.7 Once an authorised Notification of Change to Theatre Timetable

Form has been received the Theatre Information Team will update ORSOS and the Theatre Timetable Web Page.

5.2.8 When reallocation within the speciality is not possible, the Elective

Admissions Team, subject to six weeks notice, will be offered the opportunity to offer any available sessions to alternative directorates or the Private and Overseas Patients Coordinator.

5.2.9 Should an alternative directorate or the Private and Overseas

Patient Coordinator wish to utilise an available session, the appropriate booking coordinator will complete a Notification of Change to Theatre Timetable Form. The form must detail the intended operating surgeon and any issues relating to case complexity or specialist equipment required.

5.2.10 All reinstated sessions must be authorised by the appropriate

theatre manager and the Anaesthesia Directorate Coordinator.

5.2.11 Once an authorised Notification of Change to Theatre Timetable Form has been received the Theatre Information Team will update ORSOS and the Theatre Timetable Web Page.

5.2.12 Cancellation by Anaesthesia Directorate, Main Theatre

Department or Day Surgery Unit Every effort to find alternative cover for anaesthetic or theatre staff should be sought prior to requesting that an operating session be cancelled. The use of locum medical staff, bank or agency nursing staff, or the payment of overtime or waitlist initiative rates must be approved in advance by the Divisional Manager for Surgery.

5.2.13 The Elective Admissions Manager must be informed immediately of

all potential cancellations. No theatre sessions or patients may be cancelled without the authorisation of the Elective Admissions Manager, Assistant Divisional Manager for Surgery or Divisional Manager for Surgery.

5.2.14 Should cancellations be required, the Elective Admissions Manager

will review all theatre lists, prior to any cancellations being made, to ensure that the most appropriate session and / or patients are cancelled.





5.2.15 The clinical urgency of patients on the list to be cancelled should be

considered and new dates or spaces on alternative lists sought by the booking coordinator prior to any cancellations being made.

5.2.16 The contractual waiting times of patients on the list to be cancelled

must be reviewed and new slots identified as a priority for all PTL patients prior to any cancellations being made.

5.2.17 If no alternative solution is available and a theatre session is to be

cancelled the surgeon for the list and the relative booking coordinator must be informed immediately.

5.2.18 Steps 5.2.4 to 5.2.7 of the Procedure for Cancellation of Operating

Lists should be followed.

5.3 REALLOCATION OF CANCELLED SESSIONS

5.3.1 The appropriate theatre manager and Anaesthesia Directorate Coordinator will be responsible for the reinstatement and reallocation of cancelled theatre sessions.

5.3.2 The Theatre Information Team will ensure the Theatre Timetable

Web Page displays up to date information regarding available operating lists, and inform members of the Elective Admissions Team of available sessions.

5.3.3 All surgical directorates and the Private and Overseas Patient

Coordinator will be invited to take up any of the cancelled sessions, subject to adequate notice.

5.3.4 Medical staff wishing to use a vacant session should inform their

booking coordinator who will apply for allocation of the session.

5.3.5 Booking coordinators should complete a Notification of Change to Theatre Timetable Form and inform their team leader of any application for a session and subsequent allocation.

5.3.6 Booking coordinators will be responsible for ensuring that

anaesthetic cover is available for the session. If no anaesthetic cover is available the possibility of a Local Anaesthetic only list will be investigated.

5.3.7 The Elective Admissions team leader will be responsible for ensuring that

there is bed availability before they request additional theatre sessions.

5.2.19 All reinstated sessions must be authorised by the appropriate theatre manager and the Anaesthesia Directorate Coordinator.





5.3.8 Once an authorised Notification of Change to Theatre Timetable Form has been received the Theatre Information Team will update ORSOS and the Theatre Timetable Web Page.

5.3.9 A weekly meeting will be held on Thursday mornings to discuss

vacant sessions and to facilitate the optimum utilisation of theatre resources.

5.3.10 In general, no “to be confirmed” sessions will be re-allocated after

11am on the Wednesday three weeks prior to the vacant session. However, it is recognised that the Trust needs to ensure that theatre resources are optimally utilised. Therefore, in exceptional circumstances, all requests to fill these lists after the deadline should be directed to the appropriate theatre manager and Anaesthesia Directorate Coordinator who will assess the feasibility of filling the session by liaising with all relevant parties.





6. RECORD KEEPING AND DATA REQUESTS

6.1. The Theatre Information Team will monitor and record all cancelled operating sessions.

6.2. The Theatre Information Team will, on a weekly basis, inform the appropriate

theatre manager and Elective Admissions Manager of the number of theatre sessions utilised and cancelled in each theatre department according to speciality. This information will be reported to the PTL Meeting, on a weekly basis, and to the Surgical Division and Theatre Management Group, on a monthly basis, highlighting the amount of potential operating hours not utilised by the Trust.

6.3. The Theatre Information Team will ensure that an accurate record of the start

and finish time of each procedure and theatre session is maintained, including any reasons for delay.

6.4. The Elective Admissions Manager and Main Theatres Manager will monitor and

analyse the start and finish times of each operating session. This information will be reported to the Surgical Division and Theatre Management Group, on a monthly basis, highlighting the amount of potential operating hours not utilised by the Trust.

6.5. The Theatre Information Team will ensure that an accurate database of

cancelled operations is maintained.

6.6. The Elective Admissions Manager and Main Theatres Manager will monitor and analyse all cancelled operations. This information will be reported to the PTL Meeting, on a weekly basis, and to the Surgical Division and Theatre Management Group, on a monthly basis. Cancelled operations data will also be made available to all Trust employees as part of the monthly Performance Pack.

6.7. All requests for electronic operating logs or theatre data should be addressed to

the Theatre Information Team with reasonable notice. Requests should detail the specific information required.

6.8. Patient information may not be emailed to a non-RUH email address. A

computer disc or CD-Rom should be provided in conjunction with any data request. Theatre data information will only be printed in hard copy by the Theatre Information Team in exceptional circumstances.





APPENDIX 1 – MINIMUM STANDARDS FOR ELECTIVE SURGERY The following minimum standards will be applied to all elective surgical lists from 1 November 2003. Where these standards are not met the list will not be able to start and postponements of cases are likely to result. It is the responsibility of all members of the team to ensure these standards are met. 1. Operation lists must be available by 10:00 three working days before the date of

surgery (as per operational practice). 2. No subsequent list changes may be made without discussion with the relevant

theatre team leader, senior anaesthetist, senior surgeon and ward staff. 3. Patients must be in hospital before the list start time and must arrive in sufficient

time to allow the preparation required before anaesthetic assessment. 4. Provision must be made for patients to be seen in an appropriate clinical area. This

area should provide privacy and a site for examination. 5. All hospital notes and x-rays must be available. 6. Baseline results must be available in the notes (where indicated this includes ECG,

FBC and U&E). 7. Pre-medication and routine drugs must be given by the ward staff, as prescribed. If

they are not given the anaesthetist must be contacted directly before the patient is transferred to theatre.

8. A recent set of observations must be available before the patient leaves for theatre. The anaesthetist should be informed of any abnormalities noted.

9. An appropriate bed must be available and irreversibly allocated before the patient is transferred to theatre.

10. The patient must have been seen and marked appropriately by the operating surgeon before induction of anaesthesia.

11. If appropriate post-operative care (both in terms of site and nursing) is not available anaesthesia and surgery cannot proceed.

Guidelines: These are strongly encouraged but do not form a minimum standard. 1. Patients will receive written information about their anaesthetic before admission. 2. Any patient about whom there is reason for concern should be discussed with an

anaesthetist (for example but not only: any patient with disease that limits exercise tolerance, BP systolic > 180, diastolic >100, predicted difficult airway, gross obesity).

3. The guidelines on anaesthesia monitoring and PACU as published by the AAGBI are adopted.





APPENDIX 2 - THEATRE LIST SCHEDULING GUIDANCE

1st ON THEATRE LIST

LATEX ALLERGY PATIENTS Always first on a morning list to facilitate theatre preparation

PAEDIATRIC PATIENTS With the exception of latex allergy patients paediatric cases should always be listed

first

DIABETIC PATIENTS Listed first if neither of the above cases are scheduled

PTL / URGENT PATIENTS To be listed immediately after patients with clinical requirements. To be listed first if

none of the above cases are scheduled

DAY CASE PATIENTS ON IN-PATIENT LISTS To be listed as early as possible to facilitate prompt discharge

LOCAL ANAESTHETIC CASES To be placed at the end of a general anaesthetic list should none of the cases below be

scheduled

“DIRTY CASES” (INFECTIONS, DEBRIBEMENTS, ABSCESSES ETC.) To be listed last to prevent the spread of bacteria & infections

LAST ON THEATRE LIST

Where possible DSU request that similar operations be listed together e.g. Tonsillectomy Hysteroscopy EMEAs STOPs Vein surgery etc.





APPENDIX 3 - LIST SUBMISSION TIMETABLE In order to gather useful, accurate and timely information for bed, duty, theatre and waiting list management purposes, the following points have been suggested and agreed:

Operating Theatre Lists will be submitted at least 3 working days prior to the list date

Changes to the Operating Theatre List must be entered onto the ORSOS system

Any changes to the lists after submission must be e-mailed to the Theatre

Information Manager after updating the ORSOS system The table below has been produced as an aide memoir:

Day of Surgery List to be Submitted by:

Monday Wednesday - 10 am

Tuesday Thursday - 10 am

Wednesday Friday - 10 am

Thursday Monday - 10 am

Friday Tuesday - 10 am

Saturday Wednesday - 10 am

Royal United Hospital Bath NHS Trust Name of Policy and Procedure


Date: October 2007 Version: 1

of 29 Review date: October 2012

APPENDIX 4 - NOTIFICATION OF A CHANGE TO THEATRE TIMETABLE Change requested by: Date:

CHANGE OF SURGEON CANCELLED

SESSION REINSTATED SESSION

Date: Theatre:

am pm All day Main

Theatres PAW DSU

Session start time:

Scheduled Surgeon: Replacement

Surgeon:

Specialty: Specialty:

Reason for Change:

Please complete the following information, as applicable: No. of patients booked to session

In-patient

LA

Day case GA

Mixed Mixed

Paediatrics

Authorisation & notification: Team Leader Signature & date Theatre / DSU Manager Signature & date





Anaesthetic Department

Signature & date

Please note that changes to the theatre timetable will only be made once this form has been authorised and returned to the Theatre Information Team Theatre Information Team Signature & date





APPENDIX 5 - LOAN EQUIPMENT REQUEST SHEET Patient number

Patient name

Surgeon

Operation date (if known)

Equipment required

Please return form to Band 7 Theatre nurse for appropriate specialty or department

Supplier:

Order number:

Date ordered: Signature:

Delivery date:

Collection date:





Checking In of Loan Kits

Date received into department:

Checked in by: Signature:

Signature: Name:

Date & time sent to DSDU:

Date: Time:

Tray labeled as:

Received from DSDU to theatres:

Date: Signature





Prosthesis Used Date:

Patient number:

Prosthesis Stickers





APPENDIX 6 - REASONS FOR CANCELLATION The ORSOS system code for each reason for cancellation is listed accordingly. HOSPITAL CANCELLATION: CLINICAL68 Pre existing medical condition (hospital cx) 69 Unfit due to acute illness (hospital cx) 70 Pre-operative guidance not followed 80 Patient not starved 79 Latex allergy 25 Operation not necessary (hospital cx) 3 Further tests required

10 Procedure done on ward/outpatients 65 Procedure done in X-ray department 21 Patient transferred to another hospital 12 Unsuitable for day surgery 56 Patient requires GA

HOSPITAL CANCELLATION: NON-CLINICAL6 ICU/HDU beds unavailable

35 Ward beds unavailable 44 Emergencies / trauma 4 List overrun

22 Surgeon unavailable 26 Anaesthetist unavailable 72 Theatre staff unavailable 34 Anaesthetic assistant unavailable 18 Equipment failure/unavailable 20 DSDU Problem 42 Administrative error 73 Operation date brought forward 7 Other (PTL/Cancer) cases took priority - Elective only

PATIENT CANCELLATION 66 Appointment inconvenient (patient cx) 2 Unfit for surgery (patient cx) 5 Operation not required (patient cx)

77 Patient had operation privately 78 Patient treated by Alternative Provider (APO) 16 Patient died prior to theatre 17 Patient refused operation 76 Unable to contact patient 1 DNA

CHANGES TO ORSOS 36 Patient transferred to another theatre 41 Clerical error (not a cx)





CONSULTATION CHECKLIST Author; please attach this to each copy of the policy being sent to a meeting for comments. Dear Chairman, please would you review this policy at your committee and return any amendments / comments to ____________________________ by _____ / _____ / _____ Title of meeting ______________________________________ Date of meeting ______________________________________ Name of policy ______________________________________ Name of author ______________________________________ Yes No N/A Are there any elements of this policy which present operational issues that require further discussion? If yes, please provide a contact name for the author. ___________________________________

Is the policy referenced? Does the policy include a training plan? If you are the appropriate forum, have the necessary resources been agreed to implement this policy?

Is there a plan for policy implementation? Does your meeting recommend further consultation with groups or staff other than listed at the front of the policy?

Other comments from meeting.

Policy accepted without further comment. (Please circle) Yes / No Policy needs further amendment. (Please circle) Yes / No Name of Chair __________________________ Signature ______________________________ Date _____ / _____ / _____ For Human Resources Policies only Name of Staff Side ______________________ Signature ______________________________ Date _____ / _____ / _____

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