SIP 3

1
SIP 3
Patient Source (IP/PAV)
Patient arrival in Pavilion PreOp
Arrives at check in
PT
Place paperwork in Black file
Receptionist
Check into HYPERSPACE
Copies Insurance form
Fill in forms Witness form
Confirms info

Checks to see if patient has arrived
Escorts Patient to room
PreOp RN
Case times change
Confusion between Surgery Clinic and
Pre-Anesthesia Clinic
Receptionist cannot update insurance, Next of Kin
info lacking Spelling names/birthdates wrong
PSR Home at 2 pm. No staff support later
Looks through window to see if patient arrived
no notification
Patient may arrive at different time than
specified May be called in earlier than
anticipated
Receptionist cannot enter Medicare info, must use
paper Must get forms if left out of packet
2
SIP 3
Pavilion PreOp Activities
Stop the patient until all paperwork is done
suggestion
Bag belongings Talk with family
Verifies consent Allergy With RN
Talks with surgeon Verifies site
Changes clothes Opens curtain
Waiting in Pav Pre-op Area
PT
PreOp RN
Checks pt into area Paperwork/Insurance
Gets old chart
Gets Yellow packet
Checks Orders
IV start
Documents in CIS
DOS Lab
TEDs
Instructs MA
DOS Medications
Answers phone determine pt ready or not Relays
If pt not ready calls back when is ready
Blood Draw, EKG, Watches Hyperspace, Phone
Vital signs Instruct pt to Gown
Gives Black Bag
Marks Communication Board
MA
Surgeon
Talks with Patient
Marks site
Completes HP
Pt for the Main OR, Surgeon performs activities
in the Holding area
Expedited Cases
No systematic stopping the line until all
paperwork is done
Surgeon looks for pt in main Pre-op or Pav Pre-op
Switch care providers during critical times
After 5 pm Staff
Nurse checks in several patients and may or
may not be aware of MD visit
3
SIP 3
Patient Source (IP/PAV)
Patient arrives in Pre-Op Main
Waiting in Pav Pre-op Area
Patient
Calls for Pt,
OR RN
Pre-op RN
Pre-Op RN calls RN in Unit
Calls for Pt,
Anesth
Calls Transport HA
Calls pt source to check if pt is there ready
for transport
PreOp HA
Transport HA
Mark Board
Checks correct pt id
Pick up gurney
Pick up patient, chart, card, belongings, family
Crosses of pt from board in PAV Pre-Op
Calls Circulator in the room to see if it is okay
Front Desk
Calls for Pt,
Calls for Pt,
Surgeon
Unit/Floor RN unaware of TBA case start time
(some for scheduled cases)
Surgical Resident
Calls for Pt,
No specific person or time to call for next
patient
Front board is hard to interpret
Unit/Floor does not have access to updated
schedule/ESI
4
SIP 3
Pre Op Hold (Main)
Main Or
1stPt leaves room
PT
Scrub RN
Call Circ RN
RN
TBAs may or may not be seen beforehand
Talks to pt, marks site, HP
Surg
Drop pt off marks board stamp paperwork Put pt
belongings in back of PACU
HA
Anesthesia may have seen the pt but different
provider different plan
Call Anesth
Reviews plan, check pt plan,interviews pt, IV
start, lines blocks
Anesth
Exchanging anesthesia tray with An Tech,
Dispensing drug box to Rooms, dispensing Rx per
case
Pharmacy
PreOp RN
Check pt in, HP, consent,charts
Assistance as needed
IV started in another area - maybe
SIP1? Surgeon has information but not sure who
to provide the information to.
Interpreter, EP staff, isolation, developmentally
delayed, latex allergy information not
available until last minute (may change plan)
Circ RN, surg Rep Anes Rep, - no sequence
Patient may not have been seen by an
Anesthesiologist, especially if In-Patient. Plan
must be made
???
5
SIP 3
Pre Op Hold (Main) 1st pt left OR, In Room
activitiy after pt gone
Main Or
Roll into OR
PT
Scrub RN
Check next Case cart
Clean instr and take to SIP
Overhead pages for HA A. Tech
Turns specimen to Pathology, turn in X-ray
1000 item check
Bathroom break
Check next pt allergy, site marking, paperwork
Escorts to PACU
Pick up Op report
Sometimes, Write equip variation on board or talk
to HA
RN
Talk to family, waits in room, bathroom break,
dictate
Highly variable
Surg
Restock linen, clean room, garbage, setting up
operative bed, procuring equipment
Receive pager message
Go to room with Roll Royce (cleaning cart)
Check with RN about Bed need for any other
equipment
HA
Anesth Tech
Cleans, replenish equipment, get drug tray, take
out trash
Lines, blocks etc
Dump drug, get new drug, check equip, finish
equip prep
Anesth
Case cart location variable
When is OR ready for pt? How do we know when the
OR is ready for pt? How does the surgeon know
when the pt is in OR?
Communication about room status and pt status
labor intensive
Issues
6
SIP 3
Intra-operative
Surgery
PT
Put on table- cir RN and Aneth
Pt asleep
Scrub RN/ Surg Tech
Drape patient
Finish case prep
Time out Huddle
Foley, cliper, position, etc.
Finish case prep with Scrub RN
Assist moving pt to bed, safety strap
Skin prep
RN
Surgeon appears
Someone pages surgeon
Surg
Monitors blocks, lines, induces anesthesia
Assist moving pt to bed, safety strap
Anesth
Surg Res
Expected to show up when pt arrives in room
(indeterminate time)
Surgeon appears
Surgical Team must come to an agreement about
when the pt should arrive in the OR
Multiple phone communications on phone, wasted
travel time, and search time
???
7
SIP 3
Patient arrival in Pavilion PACU
In OR
Enter PACU Goes to assigned spot
Surgery
PT
Notifies PACU of est. arrival time to PACU
Wheel in pt to PACU
Look on window to see where pt is assigned
RN
Surg
PACU HA
PACU RN
No standardization of PACU notification.
Potential gaming of system.
Surgical team does not know where in PACU to
place the patient
No phone call
Surgical team drops off patient. Not enough PACU
staff