Surgical Procedures

Surgical events challenge information systems and users alike: workflows can be complex and it is important that current and anticipated orders occur at the right time and place. Patients have needs, locations and teams that differ in pre-operative, surgical suite, intensive care and surgical ward settings. The concept of "Phases of Care" is meant to facilitate coordination of actions needed in these different contexts.

The skills needed to take full and safe advantage of Emergency, Inpatient, OpTime and critical care toolsets are covered elsewhere in guides linked to Surgery learning home dashboards. This section highlights  norms that are important when navigating surgical workflows. 

Surgical Preparation

Some Connect Care tools can help anesthesiologists and surgeons managed specific peri-operative challenges. A number of tipsheets can be found in the surgical learning home dashboards, with some re-linked here:

• Tip: Flagging patients with difficult airways

Surgical Operating Room Workflows

• • Flow: Surgeon Pre-Op Orders

  • Flow: Surgeon Post-Op Orders

ADT (Admission, Discharge, Transfer) Orders for Day Surgery Class Patients

• Place in Outpatient/Hospital Ambulatory Surgery: This is an ADT order that should only be used for Day Surgery patients. 

  • • Using the Prep for Procedure navigator, the order can be found in the Surgical Admission order sets.

    • Should be selected for patients expected to discharge after surgery.   

• Admit to Inpatient: This order should ONLY be used for a Day Surgery class patient if they require an inpatient admission (i.e., they are no longer a Day Surgery patient). 

  • • Once the admit order is placed, it cannot be undone by placing a Place in Outpatient/Hospital Ambulatory Surgery order. 

    • The patient class will update to Inpatient after the admit order is placed, which will require surgeons to complete a discharge summary and full medication reconciliation. 

    • To facilitate patient movement for Day Surgery patients into inpatient spaces (keeping them as Day Surgery class), use the extended stay workflow. 

      • • Tip: OpTime Extended Stay Workflow

Surgical Patient Movement (OR to ICU)

• • Tip: Surgical Patient Movement - OR to ICU

Surgical Order States

Surgical orders accumulate in the order "shopping cart" where there are three possible actions with different implications post-op:

• 1. Sign - this makes orders active right away

     •  Use when the intent is for actions to be taken at this time in the current phase of care.

  2. Save Work - this keeps the orders visible to others in the shopping cart or orders queue; leaving oneself or others the opportunity to enact, change or reject the orders later upon review.

     • Use when suggesting post-operative orders for ICU consideration.

     • Used in complex surgical pathways

  3. Sign & Hold - this keeps orders inactive until "released"

     • Use to empower (enact) orders for release (activation) when appropriate

     • Typically, a receiving post-op unit will release the orders upon receipt of the patient

Surgical Order Norms

Transplantation Procedures

• • • Pre-op orders are done by transplant coordinators

    • Post-op orders are done by the Transplant Surgeon for liver, kidney, pancreas transplants

    • Post-op orders are done by the ICU physician for heart and lung transplants

Paediatric Procedures

• • • All ordering (pre and post-op) is done by the paediatrician