Operating Li8st for Allied Health Sciences - OT Technicians

1. OPERATING LIST
MS.D.SELVARANI M.SC (N)
ASSOCIATE PROFESSOR
SRMTCON, TRICHY.

2. Operating List :
 Facts To Be Taken Into Consideration When Booking An
Operation List,
 Particulars Should Appear In Operation List,
 Common Mistakes While Planning Operation List,
 Clinical Urgency For Placement Operating List
 List Out Emergency And Routine Cases.

3. Introduction
 The purpose of this list preparation is to facilitate the
appropriate surgical intervention for all patients who require an
elective or emergency procedure on a 24 hour, 365 day basis.
 Facilitation will include the provision of, an appropriate
environment, staff with the required skills / knowledge and the
availability of equipment that is fit for purpose to ensure
patient safety is paramount.

4. Facts To Be Taken Into
Consideration When Booking An
Operation List
 Time and date of booking of surgical case.
 The presence of significant co-morbidities.
 The availability of in house specialist surgical or anesthetic cover.
 The presence of an adequately composed nursing team (numbers and skills mix).
 The type, degree of complexity and duration of the surgical procedure intended.

5. Contd…
 Case cancellation and postponement: Performance dashboard for a
surgical suite .
 Start-time tardiness is the mean tardiness of start times for elective
cases per OR per day Case cancellation rate on day of surgery
Contribution margin per OR hour.
 An OR suite that puts up with excessive surgical times can
schedule itself efficiently but still lose its financial shirt if many
surgeons are slow, use too many instruments, or expensive
implants, etc.
 Turnover time is the time from when one patient exits an OR until
the next patient enters the same OR.
 Prediction bias in case duration are expressed as estimates per 8 hr
of OR time.

6. Information required by the
person taking the booking is as
follows
 Patient’s full name
 Folder number
 Age
 Sex
 Procedure to be performed with the
 Diagnosis
 Case categorization (according to case categorization guidelines-see below)
 Date and time of the booking to be captured on the slate
 Name and contact details of the surgeon
 Emergency cases cannot be ‘pre-booked’ to be operated on at a particular
time or date of the surgeon’s choosing.

7.  THE OPERATION THEATER LIST
 To prepare for the surgical procedures, it is important to provide the
nursing staff in advance with a meticulous operation theater (OT) list
which gives the following details:
 ••Date of the surgery
 ••Patient details: Name/Age/Sex/Contact Number/Ward and Bed
number of the patient
 ••Diagnosis of both the eyes
 ••Systemic illness (if any) such as diabetes mellitus, hypertension,
asthma, coronary artery disease, etc.
 ••Need for oxygen supplementation
 ••Presence of high risk factors such as HIV/HbsAg/HCV
 .

8.  ••Surgical plan: A clear description of the type of operation to be
performed and the eye to be operated. This is important to prevent
an operation being performed on the wrong side or the wrong
operation.
 ••Surgeon details: Name of operating surgeon and assistant
 ••Any investigation which needs to be checked on the day of
surgery
 ••The scheduled time for the operation should also appear on the
list. If the surgeon decides to do a patient earlier or later on the
scheduled list or cancel an operation, the OT nurse must inform the
nurse in the particular ward of the change on the operating list
immediately.
 ••Mode of anesthesia: Local anesthesia/Topical anesthesia/Cardiac
monitoring/General anesthesia

9. Common Mistakes While
Planning Operation List
Booking of elective cases:
 When planning elective theatre sessions it is the responsibility
of the Consultant to whom the session belongs to ensure that,
as far as is reasonably practicable allocated operating session
times are not exceeded, in order to effectively utilise theatre
resources. PAAU (Pre-Assessment & Admissions Unit) will
use informed booked in order to fill lists to their allocated
session length.
 PAAU will fill lists first based on indicated clinical priority and
thereafter in waiting list date order. They will be responsible
for ensuring across the operating day that there is an
appropriate gender mix, given the constraints of day surgery,
and that total day surgery unit or inpatient ward capacity is not
exceeded.

10. Catagories of cases
 Emergency surgical case: An emergency surgical case is admitted to a health
institution in an unplanned and unscheduled manner, either via the emergency
unit, from an outpatient clinic or as a transfer from another health institution.
Patients usually present with acute surgical conditions that require prompt and
focused treatment in order to avoid increased morbidity and mortality.
 Elective surgical case: An elective surgical case is admitted to the hospital from
home for a scheduled surgical procedure.
 Triage/Categorization: Triage is the process of determining the priority of
patients’treatment based on the severity of their condition and the availability of
resources (as regards this policy initiative, the available resource is prompt
access to emergency theatre).

11. Icon Case Category parameters
Red Immediate Immediate life-saving operation, resuscitation
simultaneous with surgical treatment e.g.
resuscitative laparotomy, ruptured aortic aneurysm,
threatened airway, cord prolapse, foetal
bradycardia
Orange Hot emergency Operation as soon as possible after resuscitation
(within 1 to2 hours) - e.g. ruptured ectopic
pregnancy, leaking aortic aneurysm, cranial
decompression, positive DPL in multiple trauma,
threatened limb, emergent foetal concern
Yellow Cold emergency Operation within 6 hours of booking e.g. compound
fractures, appendicitis, incarcerated
hernia/intestinal obstruction, EUA for non-
accidental injuries
Green Urgent Operation not immediately life or limb saving but to
be done within 24 hours of booking e.g. ORIF of
simple fractures, bleeding haemorrhoids, I&D
abscess

12. The most common types of general surgical emergencies
include:
(1) Acute Abdominal Emergencies;
(2) Urinary Obstructions; And
(3) Respiratory Obstructions And Pleural Disease.

13. Routine surgical procedures
• oral and ENT major:
Tooth extraction • Tonsillectomy and/or adenoidectomy •
Septoplasty, turbinectomy and rhinoplasty • Pharyngeal or
laryngeal biopsy or minor excision by laser or other means •
Middle ear surgery, mastoidectomy, cochlear implantation •
Endoscopic sinus surgery • Small resections of benign and
malignant masses, done on an ambulatory basis (i.e.
mandibular tori, brachial cleft cyst, small tongue cancer) •
Thyroidectomy

14. General surgery
 Breast lumpectomy or mastectomy with or without lymph node
biopsy or axillary dissection
 • Inguinal or umbilical hernia repair by laparoscopic or open
approach
 • Laparoscopic cholecystectomy
 • Hemorrhoidectomy

15.  Gynaecology
 Dilation and curettage
 Diagnostic hysteroscopy, laparoscopy
 Endometrial ablation by thermal balloon
 Tubal ligation
 Laparoscopy – limited endometriosis
 Transvaginal tape insertion

16.  Neurosurgery and Spine Surgery
 Discectomy
 Ophthalmology
 Cataract extraction and most other ophthalmological procedures
 Orthopedic Surgery
 Arthroscopic surgery including ACL repair
 Routine hardware removal, not for infection
 Tendon surgery
 Bunionectomy
 Discectomy

17.  Thoracic Surgery
 Bronchoscopy
 Urology
 Cystoscopy, Ureteroscopy, Renoscopy for stone, stricture or
biopsy
 Hydrocele and varicocele excision
 Vasectomy
 Circumcision
 Vascular Surgery
 Varicose vein excision