Wondogenet Primary

Hospital

Surgical Scheduling
Protocol
 January, 2016E.C
Wondogenet

Wondogenet Primary Hospital Surgical

Scheduling Protocol

I. Purpose of Protocol
The purpose of this protocol is to define the scheduling
policies and functions of Peri-operative Services at
Wonodgenet primary Hospital.

II. Protocol Scope

This protocol is inclusive of the staff of the Main
Operating Room (MOR), the Outpatient Surgery Clinic
(OSC) and all surgical scheduling staff of Wondogenet
Primary Hospital.

III. Definitions
• Block Time: Block(s) of time in the MOR and OSC that
are allocated to surgical services for the scheduling of
elective surgical cases/procedures; surgical services then
assign their services blocks of time to their surgeons for
individual use.

• Case: Surgical case or procedure.

• Combo Case: Surgical case that requires more than
one primary attending surgeon.

• Case Grade: A guide to assigning priority and urgency

from A to G to a case, with “A” being urgent/emergent
requiring critical care.

Grade, Classification, and Example of Case Chart

GRADE: CLASSIFICATION EXAMPLE OF CASE
A patient who requires Rupturing aortic
surgical intervention in aneurysm with
“A”
the next hypotension and ST
30 to 60 minutes elevation
A patient who requires
surgical intervention in
“B” Appendectomy
the next
2 hours
A patient who requires
Fractured humerus with
surgical intervention in
“C” no neurologic
the next
or vascular compromise
6 hours
A patient who requires
surgical intervention in
“D” Fractured hip
the next
24 hours
Elective inpatient ‘work
“E” ins’ in the next 1 to 3
days
 Elective outpatient in
“F” Non-inpatient
the next 1-3 days
“G” All other elective cases

• Schedulers: there are three types of

schedulers:
o Centralized Scheduler: Master OR Schedulers
who are embedded within MOR and OSC
o Decentralized Scheduler: Master OR
Schedulers who are embedded within the
individual
surgical sections.
o Procedural scheduler: Off-site scheduler for
non-OR procedural areas; such as Cath Lab,
etc.
• AFR: Anesthesia Floor Runner.
• Designated Perioperative Authority: (in order of
preferred contact) Manager of Surgical
Scheduling, Nursing Daily Operations
Manager, AFR, Clinical Director, V.P. of
Perioperative
Services.
IV. Protocol Statement
A. Commitment to Scheduling that Ensures Quality,
Efficiency, and Sustainable Patient Care
• This protocol guides management,
surgeons, schedulers, and all staff involved in
case scheduling in
holding the highest standards and providing
high quality patient care.
• All scheduling procedures and job aids
reflect direction within this protocol. For
particular types of
scheduling, procedures inform staff of the
actual process used to maximize resources
and optimize
utilization.
B. Documentation of Patient Information & Consent,
Required to Schedule a Surgical Procedure
• Date of procedure and preferred time of
day, if applicable
• Patient name
• Medical Record Number (MRN)
• Date of birth (DOB)
• Requesting surgeon
• Patient status day of surgery: (Outpatient,
Inpatient, Day of Admit)
• Surgical Consent
o A plan must exist for all elective cases to
have an executed and accurate consent in
time for the patient to enter the OR without
any delay.
o Obtaining a signed consent should preferably
be accomplished at least the day before
surgery, except in the instance of emergency
add-ons, or for patients who were referred
urgently without being seen in clinic.
• Pre-op diagnosis (description)
• Case Grade
o If urgent add-on, please see “Case
Scheduling and Management” for required
additional
steps
• Request for technical support and/or special
equipment
• Post-op bed reservation
o If the patient is an outpatient but is to be
admitted post-operatively or is an inpatient
who
needs a change in location after surgery (e.g.,
now in ward but requires an ICU bed after
surgery).
C. Scheduling of Cases Based on Hours of Operations in
Perioperative Services (MOR and OSC)
• The MOR is staffed to run 24hrs , Monday
through Monday including for holidays.
o The elective schedules in the MOR and OSC
all begin at 2:30 am Monday through
Fridays.
• The OSC is staffed to run one rooms,
Monday through Friday except for holidays.
• No elective case may be scheduled if it
causes the OR to run past the room’s
assigned time, unless
prior approval by designated Perioperative
Services authority.
D. Staffing Impact on Nights,Days, Weekends and Holidays
for Surgical Scheduling
• Weeknights and day (Mon-Fri): Two Shift,
day and night team, the MOR staffs with one
on-site
team for urgent and emergent cases
o Two RNs and one CST; one charge RN with
on OR team at each shift
o One staff person on call for same shift; can
be called in to run second room with charge
RN
should the need arise
• Weekends day and night, two shift, the MOR
staffs with one on-site teams for urgent and
emergent
cases
o Two RNs and one CSTs; one charge RN with
three OR teams
o one person call team available
Can be called off by if low predictive demand
Can be kept on call or brought in on shift if
demands increase or to cover weekend
sick calls
• All cases for weeknights, weekends (day
and night) and holidays will be put on the
Pending List and
will be added to the schedule on day of
according to priority and urgency, and as
staffing and
demands are assessed.
E. Case Scheduling and Management
• Elective surgical procedures are scheduled
through surgeon clinics by the decentralized
schedulers.
A. The centralized scheduling offices confirm
and manage the coordination of the final OR
schedules.
• The decentralized scheduler and the
centralized scheduling office collaborate to
finalize case orders
by 12 noon two days prior to date of surgery.
A. Preferred case order should be:
All outpatients first.
All inpatients/admissions to follow.
• The elective OR schedule ‘soft closes’ at 12
noon the day prior in order to assure minimal
changes
once patient phone calls begin.
A. Switching case order/substitutions after the
closing of the schedule is not allowed except
by
permission, which must be obtained from the
designated Perioperative Services authority.
B. Add-on cases are allowed after this soft
closure.
Any add-on case must fit into the room’s
block schedule, or it should be put on the
pending list.
Add-on cases must go at the end of the day
unless case order change approval has
been received as noted above.
C. A surgeon must be available to perform an
add-on procedure at the time offered or
another
case may be placed in front of that case at
the discretion of the AFR.
D. The AFR makes every effort to place all
add-on cases on the schedule, but that cannot
be
guaranteed.
• For urgent add-on cases for day of:
A. Surgeon or Gynecologist calls Main OR desk
to discuss case and urgency.
B. Surgeon or Gynecologist pages the AFR to
discuss case, urgency and pertinent medical
information.
C. An accurate Case Grade must be assigned
in order to allow the OR to appropriately
prioritize
all add-on cases.
• The surgeon/Gynecologist is
as responsible for communicating special
wel equipment and/or implant needs,
 l as
post-op bed management requirements (e.g.,
at the time the case is reserved (“booked”).
A. Special equipment and or vendor supplied
instruments or implants must be
communicated to
the decentralized scheduler in the surgeon’s
clinic who then will communicate in the case
booking for the OR to see.
F. Block Time
• Block time in the operating rooms is
resource and is managed by Perioperative
Executive
• resources; including the potential impact on
equipment, sterilization, supply chain,
nursing, anesthesia
and post-op bed capacity, as well as to
determine the overall impact to the rest of the
block schedule
allocation.
• Allocation:
o Surgical services are allocated block time

based on historical utilization data combined

with
future projected volumes and growth. Blocks
are allocated to service; the service then has
autonomy to allocate amongst its own
surgeons as best fits with clinic and other
schedules.
o Flex/Combo Flex time is block time that is

staffed by OR and Anesthesia, but is not

allocated
to a specific service. This time is utilized on a
‘first come, first serve’ basis.
fashion except case requests must be for
combo cases until 2 weeks prior to date of
surgery.
• Automatic Release of Block Time:
o A block or any portion there of that remains

unscheduled by the given release time is

considered open time and is available to be
scheduled by any service on a first-come-
firstserved basis.
.
• Manual Release of Block Time:
o If an assigned surgeon is going to be away

and cannot use their allocated OR time by

their
section, the section should first look to see if
another surgeon within the section can use
the
OR time. If another surgeon cannot use the
services allocated block time, the
decentralized
scheduler must inform to the centralized
scheduler as soon as possible to release the
block time for another services use.
G. Bed Management - Scheduling Elective Cases to Match
Bed Capacity
• Inpatient beds are a scarce resource. In
addition, placing patients on the ward most
often associated
with type of surgery is important to ensure
the highest quality of care. For this reason,
there are
quotas (“caps”) on elective procedure patient
beds on each ward for each day of the week
that must
be observed when scheduling elective
procedures that lead to inpatient admission.
• No elective procedure is to be scheduled
without first insuring that a bed is available
below or at the
cap on that day in a location that is
acceptable to both the surgeon and the
inpatient nursing service.