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 Operating Room Workflows
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
- 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
- All ordering (pre and post-op) is done by the pediatrician