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:
Surgical Operating Room Workflows
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 pre-procedure 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.
If plans have changed post-procedure and the patient requires extra recovery time on a unit, the surgeon can modify the existing Place in Outpatient/Hospital Ambulatory Order and select "Yes" to "Is this patient expected to stay later than regular business hours?".
The Place in Outpatient/Hospital Ambulatory Surgery order is not required to move a Day Surgery patient from a day surgery/cath lab to an inpatient unit. The nurse can simply create a bed request from the status board to facilitate this patient movement. For more information on how to facilitate bed planning on an inpatient unit for day surgery/extended stay patients, see the tip sheet.
Support: Place in Outpatient/Hospital Ambulatory Surgery Order
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:
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.
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
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
Panniculectomy Case Ordering Requirements
For panniculectomies, surgeon offices will be responsible for: (a) completing a Clinical Indications form in Connect Care (or on paper and scanned into Connect Care), which will identify those patients whose clinical assessment is within the guidelines to have their surgery funded under AHCIP, or whether the patient is outside inclusion criteria and must incur the costs of the surgery privately; and (b) indicating on the Case Request order the appropriate funding indication (Fully Insured or Fully Uninsured). Surgeons/MOAs will be able to connect with the Hospital Billing department to determine status of patient payment. For workflow details, see the guide.