OPERATION THEATRE MANAGEMENT

An OT is that specialised facility of the hospital where life saving or life improving procedures are carried out on human body by invasive methods under strict aseptic conditions in a controlled environment by specially trained personnel to promote healing and cure with maximum safety, comfort and economy.

Function
Operating theaters had a raised table or chair of some sort at the center for performing operations, and were surrounded by several rows of seats(operating theaters could be cramped or spacious) so students and other spectators could observe the case in progress.

 The surgeon wore his street clothes with an apron to protect them from blood stains, and he operated bare-handed with unsterile instruments and supplies. (Gut and silk sutures were sold as open strands with reusable, hand-threaded needles; packing gauze was made of sweepings from the floors of cotton mills.)

 In contrast to today's concept of surgery as a profession that emphasizes cleanliness and conscientiousness, at the beginning of the 20th century the mark of a busy and successful surgeon was the profusion of blood and fluids on his clothes.

OPERATING THEATRE
The operating theatre is based on whole system thinking and includes a whole of hospital perspective on effective and efficient theatre utilization. Goals Key elements to efficient use of operating theatres are: Effective management Good communication Well trained staff Appropriate facilities and equipment Operational layout that allows flow of patients.

Support services play a large part in maximizing efficiency by providing: Pre-operative preparation and assessment Available beds Sterile theatre equipment Portering, cleaning and maintenance staff. Effective planning and scheduling systems will enable smooth patient flow thus increasing capacity, improving patient and carrier experience, improved employee satisfaction and morale

The operation theatre complex consists of four main systems, Surgical support system (the environment) Traffic and commerce (the activities) Communication and information (the records) Administration ( the management)

ADMINISTRATION

Overview and strategy

Key elements Theatre Management Structure Planning patient pathways Staffing Operating list management Effective use of theatre time Theatre design Trauma and emergencies Postponements

Theatre management structure

Should be clearly defined with accountability for:
Full budgetary authority Adequate seasonal allowance Information systems Utilization Administrative, medical and nursing staff.

Day to day management should be provided by an experienced trained and skilled theatre manager, who is responsible for clear communication, ensuring competent staffing and suitable equipping of all theatres. Suitable systems for planning activity should be available to allow allocation of staff, and to respond safely and flexibly when changes take place to routines.

Policies should be developed to deal effectively with changes to operating lists. Operating lists should be clearly posted well in advance and in suitable locations. Theatre management team should regularly review utilization, cancellations, list overruns, late starts and waiting lists.

Planning patients pathways

Patients pathways should take into account ways to maximize use of theatres and bed availability. Patients admitted to pre-operative units can be transferred towards following surgery allowing time for discharge of previous patients. Integration of pre-operative assessment and day case recovery area located adjacent to theatres provides an efficient use of space, skilled staff and may aid patient transport to and from theatres. This scheme also reduces time on ward rounds for surgeons and anesthetist as patients are in one place.

Staffing
Department should provide a system of staffing that works locally and is acceptable to staff Department staffing should match clinical activity, with sufficient cover for elective and emergencies A lead anesthetic consultant should be identified to support the theatre management team and trainees Adequate orientation of new staff should be made a priority Adequate staffing should be available to cover governance tasks of note recording and data entry.

Operating list management

Close communication and coordination between pre-op area and theatre using agreed procedures is essential A nominated person should liaise with wards and transport staff from theatres A suitable holding area staffed and equipped will assist with smooth flow Agreement should be made for preparation and transport of patients to and from theatres Policies on fasting, anticoagulation, shaving, dentures, jewellery, appropriate underwear and removal of make-up should be developed

Operating list management

Units should agree the level of training needed to escort patients to and from theatres A documented system of handover and identification of patient should be in place A system to book critical care beds for elective admissions should be in place and booking confirmed before anesthesia for surgery.

THEATRE DESIGN AND OPERATIONAL LAYOUT

Design of operating theatres is essential for maximizing patient flow, consideration needs to be made for: Large multi-purpose accommodation to enable increase in complexity and equipment Transport routes that flow through stages of theatre care Internal communication IT systems that facilitate appropriate communication and supervision.

TRAUMA AND EMERGENCY SURGERY

Effective planning for emergency and trauma surgery is needed to prevent cancellation of elective surgery. Provision of exclusive emergency list will assist in preventing cancelled elective surgery.

 Good communication enables clinical decisions to be made rapidly, increasing the number of surgical procedures carried out in a safe time and environment. Time should be allowed for the Anesthetist to assess emergency patients to their satisfaction. Experienced surgical staff should prepare patients who have multiple and complex medical problems, this can prevent cancellation at anesthetic assessment. Preoperative assessment for patients who are elderly, have multiple and complex medical problems can benefit from a team approach between anesthetist, surgeon and physician.