Theatre Operating List Session Scheduling Policy

Documentation Control

Reference Date approved Approving body Implementation date Version Consultation undertaken Distribution: Review date Lead executive

CL/CGP/030 11 December 2007 Directors Group 11 December 2007 1 Directors Group All Clinical Areas March 2009 Director of Nursing, Midwifery, Service Improvement and Operations Liz Williamson Liz Williamson

Author Further Guidance/Information

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Contents Number 1. 2. 3. 4. 5. 6. 7. 8. 9. Appendix 1. Appendix 2. Title Policy Statement and Objectives Key Roles and Responsibilities Speciality First Steps Confirmation/cancellation of allocated operating sessions Theatre List Scheduling Elective Patient Booking and Elective Cancellation Guidelines Introduction to Green Lists Private Patient Scheduling Policy Equality and Diversity Statement Elective Patient Booking Pro-forma Employee Record of Having Read the Policy Page 3 4 5 6 9 14 16 17 17 18 19

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1. 1.1

Policy Statement and Objectives Policy Statement

Effective planning and management of operating sessions is essential to improve services to patients and ensure optimum use of operating theatre capacity. More efficient use of theatre lists and effective patient scheduling will reduce waiting times for patients and avoid unnecessary patient cancellations. Forward planning and early notification of planned operating lists allows Surgeons to fully utilise the time available to them. It also enables relevant theatre teams, e.g. Team Leaders, Anaesthetists, Sterile Services Department and other relevant members of staff, to ensure specialist equipment and appropriate staff are available to prevent patient delays and cancellations on the day. The ORMIS (Operating Room Information Management System) is the prime source of patient information for speciality performance reports, and supports effective management of the surgical patients journey. It also provides the mechanism to support the day-to-day operational management processes of the patient journey through theatres. 1.2 Policy Objectives

To optimise the use of theatre time and improve patient care through forward planning and organisation of elective admissions for day case and inpatient procedures Objectives To implement a standardised process for the management, formulation and submission of theatre operating lists, including negotiating temporary/permanent changes to allocation and timetable To achieve optimal utilisation of operating sessions To promote safe and efficient throughput of patients Identify responsibilities of key staff involved in the compilation and submission of theatre lists To minimise delays, prevent unavoidable patient cancellations on the
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day and maximise the use of staffing resource including Surgeon, Anaesthetist, Theatre Team, etc Maximise use and impact of ORMIS (Operating Room Management Information System) Key Elements Identifying a Co-ordinator in the speciality whose main responsibility will include the effective utilisation of theatre lists and checking to confirm theatre timetable/allocation Using ORMIS to book Theatre Lists ahead of time 2. 2.1 Key Roles and Responsibilities Theatres General Manager Co-ordinates requests for temporary/permanent changes to allocation and timetable Ensures availability of performance information for speciality and individuals 2.2 Directorate General Manager Liaises with Speciality Booking Co-ordinator to ensure theatre utilisation is optimised, including the use of elective lists for emergencies Formally requests temporary/permanent changes to planned timetable allocation to the Theatre General Manager Liaises with Theatre General Manager to agree additional capacity, initiative lists 2.3 User Speciality Clinical Director Reviews, monitors and actions performance utilisation information, in conjunction with Directorate General Manager 2.4 Surgeon Reviews theatre lists with Specialty Booking Co-ordinator to ensure time is used as efficiently as possible Communicates their availability to Specialty Booking Co-ordinator within given timeframes
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 Communicates patient booking requirements (especially nonstandard patient needs, equipment etc) to Specialty Booking Coordinator using pro-forma 2.5 Speciality Booking Co-ordinator (SBC) Informs ORMIS System Administrator of any temporary changes to the planned timetable within designated timescale Ensures all booking information recorded on ORMIS is accurate, especially the Operator Arranges cross cover of un-utilised operating sessions within own speciality within designated timescale Attends weekly scheduling meeting Takes action to address potential over- and under-utilisation of theatre lists Communication lead between speciality and Theatres Ensures all private patient activity is formally requested (see Private Patient management policy) and recorded accordingly on the patient category functionality within the ORMIS booking screen 2.6 ORMIS System Administrator (Theatre based) E-mails planned timetable to Directorate 3 weeks in advance of surgery Ensures ORMIS system has most up to date relevant timetable information Confirms requests for additional operating sessions (following approval from Theatre General Manager) 2.7 Theatre Co-ordinator Co-ordinates late additions to operating list, ensuring appropriate theatre staff, anaesthetic cover is available Ensures adequate resource is available for elective operating sessions 3. Specialty First Steps In order for the theatre scheduling policy to be implemented effectively, Specialties need to set up the following to support implementation of the standardised processes

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1. Identify a Booking Co-ordinator to lead the Theatre Scheduling processes 2. Agree timings for each common procedure in conjunction with relevant Consultant. The procedure times can be estimated automatically within ORMIS based on actual Surgeon and Anaesthetic performance times 3. Agree theatre booking criteria with each Consultant in conjunction with the relevant Theatre Team Leader 4. Arrange regular scheduling meetings as per policy guidelines (see page 10) 5. Ensure all theatre bookings are made using ORMIS (see ORMIS user guide) 6. Ensure a booking pro-forma is made available and is used by all staff including Consultants 7. Ensure that all Consultants and Secretaries are aware of the process for requesting private patient activity within the Trust 4. Confirming/Cancelling Allocated Theatre Operating Sessions

It will be assumed that all theatre sessions will be used by the allocated speciality and Consultant unless otherwise notified. However, some changes will always be required to meet specific (shortterm) demands. The process described below allows the specialty the opportunity to arrange cross cover before the cancelled operating session is offered to other specialities, or the theatre team re-allocated. The process also allows early identification of cancelled sessions that may become available for use by specialities who require additional theatre operating sessions. It is imperative that the information recorded on ORMIS matches the operating Surgeon if the specialty have arranged cross cover, as this will affect specialty information reports and is in line with clinical governance requirements.
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If the cancelled operating session is to be used for emergency cases, the session will need to be cancelled and re-instated as an emergency list. This will ensure that elective in-session utilisation data is properly amended and recorded and thus improve accuracy of the performance reports. If an elective list is regularly used for emergency patients, this must be formally reviewed by the specialty and redesignated as an emergency list, if deemed more appropriate to meet that specialtys needs. In order to maximise usage of allocated and staffed theatre operating sessions, a more robust process is required to enable this to be achieved. Any changes to the planned theatre timetable must be communicated to the ORMIS System Administrator to enable the relevant amendments to be made on ORMIS. This will ensure all activity is correctly coded to the final operating surgeon and is shown correctly in specialty information reports. In line with the Trusts policy for leave notification a minimum of six weeks notice of Consultant non-availability for their allocated operating session is required. Timetable confirmation Every week the planned timetable will be e-mailed to the Specialty Booking Co-ordinator. This will provide 1 weeks scheduled operating session information, 3 weeks in advance. It is the responsibility of the Directorate to confirm that the planned timetable information is correct. Any amendments or anomalies must be reported to the ORMIS System Administrator within 5 working days to ensure that the ORMIS/timetable information is correct.
Please see the flowchart on the following page.

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Confirming/Cancelling Allocated Theatre Operating Sessions

WHO Specialty Booking Co-ordinator

WHAT WHEN Notify ORMIS 6 weeks prior to System Administrator operating session of any operating date sessions that cannot be used by allocated Surgeon Notify ORMIS 4 weeks prior System Administrator if any sessions are to be utilised by other specialty Surgeons (cross cover) or are to be used for emergency E-mail template of planned operating sessions (including any changes due to theatre and Anaesthetic staff unavailability, start and finish time) and any other sessions that are still available for use Confirm template of planned operating sessions. Final notification of request for additional sessions (from other specialty) Confirm additional operating session requests. Lock down operating timetable 3 weeks prior

Specialty Booking Co-ordinator

ORMIS System Administrator

Specialty Booking Co-ordinator

3 weeks prior

ORMIS System Administrator

2 weeks prior

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Any additional requests or changes outside of the above process (i.e. within 2 weeks of the date of surgery) must be discussed and agreed with the Anaesthetic Department and the Theatre Co-ordinator to ensure that appropriate staffing and equipment is available. The Theatre Co-ordinator will then inform the ORMIS System Administrator to ensure that the operating session template is updated accordingly. 5. Theatre List Scheduling

Robust forward planning of theatre lists, using agreed criteria for list compilation, allows allocated theatre sessions to be more fully utilised and enhances the throughput of patients. Closer working relationships between the specialty and theatre teams enhances communication, team working and facilitates changes to practice and processes to improve patient care. 5.1 Principles of Theatre List Scheduling include: One person within the specialty must have responsibility for leading the scheduling process (the Booking Co-ordinator) Patient specific/clinical information to support scheduling must be documented at the time of the decision to operate, using the booking pro-forma (see appendix 1) The patient must be booked onto ORMIS as soon as the TCI date has been agreed with the patient (please see page 13) Private patient status must be recorded in the patient class functionality within the ORMIS booking screen Lists should be scheduled using actual operation timings (for each procedure and surgeon) from ORMIS, supplemented by experience of Surgeon and Team Leader. The additional information that has been supplied by the Surgeon on the booking pro-forma must also be used to enhance the scheduling process Lists should be compiled to facilitate patient throughput in a logical format, for example infected cases last on the list, latex allergy
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patients first on the list. Specific guidelines, developed by the specialty and theatre teams, would further enhance this process Where appropriate for the specialty some lists should not be filled completely, to allow the later addition of urgent cases. The lists and the percentage of time available should be agreed with the specialty team All theatre operating lists should be reviewed at the specialty Theatre scheduling meetings to allow any adjustments to order, timing, equipment, procedure etc. to be made. 5.2 Theatre List Scheduling Process Scheduling Meetings Scheduling meetings are required to ensure that a robust and timely process is in place. Requirements of the meeting include: Regular weekly timeslot Venue to have PC with ORMIS installed Representatives from both specialty and theatre e.g., Specialty Booking Co-ordinator, Theatre Team Leader/Senior Theatre Practitioner 3 weeks prior to operating session date Review and agree order of operating list Identify equipment requirements and availability Identify any unused theatre time or potential over run Agree actions for specialty and theatre lead

1 week prior to operating session date Finalise operating list including order Finalise equipment requirements and availability Ensure operating sessions are full (unless the specialty has allocated time for late addition of urgent/emergency patients) Confirm theatre team availability Agree actions for specialty and theatre lead

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48 hours prior to operating session date Specialty Booking Co-ordinator accesses ORMIS to check operating list and communicates any late additions or changes to the Theatre Co-ordinator, Anaesthetic Directorate and the Theatre Team Leader. Please note that reasons for change, especially late additions, within the 48 hour period must be clearly articulated to the SBC. If no list has been submitted, 1 week prior to the operating date, the SBC will be contacted to confirm whether the list is still scheduled to be utilised. If no patients are booked onto a list 48 hours before the scheduled date, the list will be cancelled and the staff re-allocated Changes to Operating List Up to 48 hours Changes after the 3-week co-ordination meeting should be confirmed with the Specialty Booking Co-ordinator who will liaise with the Theatre Co-ordinator, Anaesthetic Directorate and Theatre Team Leader to ensure that the changes can be accommodated and ORMIS is updated. Within 48 hours (2 working days) Changes at this stage must be notified directly to the Theatre Team Leader who will liaise with Main Theatre Staff to update ORMIS. Late additions which are added without notification, increase clinical risks and may cause such operational difficulties that the patient is more likely to be cancelled. All late additions (and whether direct notification was given) will be closely monitored and fed back to the Specialty/Directorate Changes made after 6pm or at weekends will not be actioned until the morning of the operating session. Non Cancellation of Operating Session Sessions that are not cancelled and then not utilised cause unnecessary planning difficulties and often waste valuable staffing
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resources. Specialities who regularly fail to utilise scheduled sessions without notification may be cross-charged for the wasted resources.

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THEATRE SCHEDULING - FLOW CHART OF ACTIONS 6 weeks prior to operating session date Specialty Booking co-ordinator prepares draft theatre lists List agreed by consultant

Speciality Booking Co-ordinator contacts patient and enter details on theatre booking system

3 weeks Scheduling meeting reviews and agrees list

1 week Scheduling meeting - final review

48 hours Specialty Booking Co-ordinator confirms list as final

Final confirmation on day of surgery Team Leader checks for late additions and notification

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6.

Elective Patient Booking and Elective Cancellation Guidelines Booking a patient onto ORMIS A complete guide on how to book a patient using ORMIS is available from the Theatre System Administrator. Only patients with an agreed TCI date should be booked onto the ORMIS system. All patients must be booked onto an agreed Consultant or specialty session and include the following information: Coded procedure with surgeon specific estimated time Any blood or equipment requirements Any Alerts identified on PAS or the patients notes e.g. MRSA (NB free text must not be used as this increases the clinical risk as not all staff have access to free text information and may potentially breach patient confidentiality All private patients must be clearly identified using the patient category functionality within ORMIS (see ORMIS user guide and Private Patient policy to follow) Use of a pro-forma to record the information required for effective and accurate scheduling assists with this process (see Appendix 1 for a suggested format) Booking a Patient in error in ORMIS If a patient is booked in error, they cannot be cancelled by the Specialty. The ORMIS System Administrator should be contacted to remove the patient. They will also provide assistance with any difficulties booking a patient onto ORMIS. Please see other cancellation reasons on the next page.

6.1

Patient Cancellations If the patient contacts the hospital to say that they are unable to attend the agreed operation date, the patient must be cancelled using the following reasons only.

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Cancellation Reason Appointment inconvenient

Reason for use The patient would like to change an already agreed booking date. This cancellation code is applicable from the time of patient booking until 7 days before the date of Surgery. Patient decides that they do not want to have the surgery. Any other short notice cancellation (within 7 days of Surgery). The reason for cancellation should be recorded in the cancellation field (for example family bereavement, illness, home tragedy).

Operation not wanted (by patient) Patient Cancellation

If an operation is cancelled by the hospital ahead of the scheduled date of surgery, the following reasons should be used.

Cancellation Reason Patient no longer requires operation (Operation not necessary)

Reason for use Patient has recovered / no symptoms since booking Patient has died Patient has delivered naturally. Cancelled by medical staff due to patient not being fit for Anaesthetic or surgery Unexpected urgent patient taking priority of existing elective booking

Medically Unfit for Surgery (Unfit with acute illness/Pre-existing medical condition). Priority given to urgent patient

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7. 7.1

Introduction to Green Lists What is a Green List? Green lists are elective operating sessions which have been scheduled to make them more predictable and streamlined. The philosophy is based on Lean Thinking principles, now being widely adopted within the NHS these guidelines and rules have been developed in conjunction with Surgeons, Anaesthetists, Theatre and Ward staff.

7.2

The Principle of a Green List The principle of the green list is to maximise theatre efficiency and patient throughput without additional resources. To work more effectively within the current resource, we need to think and work differently, not harder. Green lists work on the concept of repetition, for example the same Surgeon, Anaesthetist, Theatre staff, case mix, and equipment, start and finish time. This generates familiarity and allows staff to quickly grow accustomed to working within the same team and increase knowledge and speed. Careful planning and more streamlined working processes increases throughput and allows additional cases to be completed in the same operating time. Good pre-operative assessment is vital to identify suitable patients, and ensure all preparation and tests are complete, thus avoiding unnecessary on the day patient cancellations. Any unforeseen problems that arise on a green list will then be routinely reviewed at the Team de-brief, further improving the future process by solving problems as they arise.

7.3

Green List Guidelines Common characteristics include: The same number and type of cases Agreed anaesthetic and surgery times The same Theatre Team, wherever possible Clear understanding of individual and collective responsibilities for ensuring patient throughput is maintained Scheduled theatre lists at least 3 weeks pre-operation date

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 Patients are scheduled when they have fulfilled pre-assessment criteria The order of the Green List is not changed on the day All patients are admitted on the day of surgery The start time, finish and break times are identified by the Team Leader/Senior Theatre Practitioner Staff training is not undertaken on a Green List A Theatre team de-brief undertaken at the end of the session to record any issues which need to be actioned to enhance patient care and throughput 8. Private Patient Scheduling Policy To follow Equality and Diversity Statement The NUH Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation.

9.

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Appendix 1 Elective Patient Booking Pro-forma

Proposed surgical procedure/addition to the waiting list proforma (Example) (complete at decision to admit)

Consultant surgeon: . Date of surgical clinic: .

DEMOGRAPHICS

Procedure Primary diagnosis ... Proposed surgical procedure.. Priority Urgent Routine GA / Regional Duration of procedure: standard longer

Anaesthesia LA hours ITU required yes

Length of stay

standard longer days Day Case yes

HDU required yes

Procedure suitable for No Special requirements specific surgeon Yes If yes, who Consultant Anaesthetist Yes other Special equipment required Heavy table Image intensifier Implants specify

Other

Immediate pre-operative instructions / requests Non standard pre op tests / requests Yes specify..

anticoagulants warfarin: Yes Clopidogerel Yes aspirin: Yes Other

Microbiology MRSA currently pos previously pos

Patient availability Less than 7 days

Yes

Dates unavailable:

Minimum notice required:

Signature ..

Date

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Appendix 2 Employee Record of Having Read the Policy Infection Control Input into Building and Refurbishment Projects Policy I have read and understand the principles contained in the named policy.

PRINT FULL NAME

SIGNATURE

DATE

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