C&W Policy Template - B.C. Women's
IntroductionThe BC Women’s Hospital (BCWH) Gynecology Surgical Services OR booking policy covers all cases that are booked for elective surgical services at BCWH including Surgical Daycare and Procedural Sedation.PurposeThe purpose of this policy is to ensure Gynecology Surgical Services operate efficiently to improve the timely access to surgery for patients. CARE slates are exempt from the policies below due to the urgent nature of cases.This policy outlines:methods for submitting OR slates and booking packagesguidelines governing the submission of OR slates and booking packagespotential consequences, if any, for not meeting the guidelinesPolicyBooking PackagesOnly surgeons with current privileges in BCWH Surgical Program and physicians working within affiliated Ambulatory Clinics (EPAC and CARE) may book patients for Surgical Daycare or Procedural Sedation (including pooled bookings). To be eligible to perform Procedural Sedation, surgeons must maintain certification in Advanced Cardiac Life Support (ACLS).Fully completed booking packages are to be submitted to the BCWH Booking Office immediately upon completion by the surgeon. Patients will not be entered onto the surgical waitlist until the COMPLETE booking package is received. Patient availability: Submission of the booking package assumes that the patient is immediately available for surgery; specific unavailable dates (due to work, vacation, personal reasons) must be captured on the Regional OR Booking Form so that this can be recorded in waitlist tracking.Patient unavailability/cancellation: Patients that become unavailable or wish to be removed from the waitlist after submission of the OR package must be identified to the BCWH Surgical Booking Office in writing (email) so that these patients may be placed ‘on hold’ or removed from waitlist tracking.Removal from the waitlist: patients who have been unreachable by BCWH Surgical Booking Office after 3 attempts over 4 weeks will be removed from the waitlist as it will be presumed that the patient is no longer available for surgery. The booking surgeon’s office will be notified. If the patient subsequently wishes to be rebooked for surgery, submission of a new booking package will be required. Wait time will then be calculated based on the date of resubmission.Patients will not be assigned an OR date until the surgical package has been reviewed and approved by the Clinical Nurse Leader and/or Anesthesia as appropriate. In the event of an urgent case booking (bench time < 2 weeks), direct communication between the surgeon and Anesthesia is required in order to arrange expedited review of the booking package.The complete booking package includes:Regional OR booking formPre-Anesthesia QuestionnairePre-admission Patient DemographicsPre-op Order setBCWH Consent formPhysician consult letter and relevant investigations (Hb, endometrial biopsy, ultrasound reports, other specialist consultations)Additional pre-operative information is required depending on the nature of the procedure booked:Hb within 3 months for patients booked for diagnosis of menorrhagia or having myomectomy or endometrial ablation. Hb < 100g/L will require review with surgeon/anesthesia consultation as appropriate to ensure patient is optimized for OR.Ultrasound within 12 months for patients booked for myomectomy.Endometrial biopsy within 6 months for pooled Procedural Sedation patients having endometrial ablation. Exceptions may be made if sampling has not been possible for technical reasons (stenotic cervix) in which case biopsy can be carried out at the time of municationIn adhering to this policy, any communication around OR booking must be provided in writing to the BCWH Booking Office either by email or fax: Email: BCWHSSBooking@phsa.caFax number: 604-875-2740Contact number: 604-875-2958EligibilityAll patients must meet criteria established by Gynecology Surgical Services in consultation with Anesthesia for suitability at BCWH (Appendix A).Pre-anesthetic questionnaires will be reviewed by Anesthesia and patients scheduled for Anesthesia consult as necessary.It is the responsibility of the surgeon’s office to ensure that accompanying information is received with the booking package in order to facilitate this assessment. This may include any relevant specialist consults, ECG, Exercise stress test, Echo/MIBI scan, Sleep Studies as appropriate.If a patient is ineligible for BCWH, the booking office will directly notify the surgeon’s office, and the patient will be removed from the BCWH waitlist If a patient is ineligible for Procedural Sedation, the booking office will directly notify the surgeon’s office, and if eligible for Surgical Daycare, the patient will be moved to the appropriate waitlist Submission of Surgical SlatesSurgical DaycareSurgical Daycare procedures are booked with surgical times between 0800 and 1530 Monday to Friday. The last case of the day must be transferred to PACU by 1600 including post-operative anesthesia time. Slate booking will follow the principles of FIFO (first in – first out) i.e. scheduling cases which have waited longest for surgery according to their target wait times.It is the responsibility of the Surgeon’s office to submit the completed slate to the booking office a minimum of 15 business days (3 weeks) prior to the OR date.Slates not received 3 weeks prior to the OR day will be considered un-booked; these slates will be cancelled and the OR time re-allocated.If there are 30 or more minutes available on the slate for another case to be scheduled, it is considered an under-filled slate.If a physician anticipates that the slate will be under-filled, they must arrange for another physician to use their time or request the BCWH Booking Office to release their time at least 3 weeks prior to the OR date. Within 3 weeks, the BCWH Booking Office may book urgent cases in an under-filled slate if required.A penalty will be applied if a slate remains un-booked or under-filled 3 weeks prior to the OR date and the BCWH Booking Office has not been notified. The un-booked or under-filled time will automatically be released for another physician to fill and one of the physician’s slates in the next OR allocation round will be reduced. The surgeon will be notified as such in writing.4.1.2 Procedural SedationProcedural Sedation slates are booked 0800-1130 and 1300-1630 Monday to Thursday. Slate booking will follow the principles of FIFO (first in – first out) i.e. scheduling cases which have waited longest for surgery according to their target wait times.It is the responsibility of the Surgeon’s office to submit the completed slate to the booking office a minimum of 5 business days (1 week) prior to the OR date.A minimum of three and a maximum of five cases may be booked per slate. Any remaining time will be booked using the pooled booking procedure by BCWH Booking Office.Slates not received 1 week prior to the OR day will be considered un-booked; these slates will be cancelled and the OR time re-allocated.Waitlist ManagementAdherence to FIFO (first in – first out) booking is central to the booking process in order to meet Diagnosis Specific Surgical Targets (Appendix B). In addition, Ministry of Health Guidelines stipulate that >95% cases are to be completed within 26 weeks of booking. The BCWH Surgical Booking Office will assess surgeon specific waitlists monthly. Cases within 4 weeks of target times will be identified and patients booked by the BCWH Surgical Booking Office on the surgeon’s next available slate. The surgeon’s office and the patient will be notified by the booking office. Patients who are unavailable will be placed ‘on hold’ or removed from the waitlist as appropriate.Once patients approaching target times are accommodated on the slate, the surgeon’s office will be able to utilize any remaining time on the slate.E.g. All staff members are responsible for adhering to this policy and monitoring their activities in accordance with the policy. Staff members may warn others if they observe a violation of this policy. Failure by staff to comply with this policy may result in disciplinary action up to and including termination of employment, services or privileges.Supporting Documents 6.1 Related PoliciesGuidelines/Procedures/Forms Regional OR booking formGynecologic Surgical Services Pre-Anesthesia QuestionnaireGynecologic Surgical Services Pre-admission Patient DemographicsGYNE Procedural Sedation Pre-op Order setGYNE Surgical Daycare Pre-op Order setBCWH Consent formGynecologic Surgical Services Patient MapGynecologic Surgical Services Patient InformationAppendicesAppendix A: BCWH Anesthesia Consultation GuidelinesAppendix B: Diagnosis Specific Target Times for Surgical BookingAppendix C: GYNE Eligibility Criteria for Procedural SedationAppendix D: BCWH Fasting Guidelines Elective SurgeryVersion HistoryDATEDOCUMENT NUMBER and TITLEACTION TAKENdd-Mon-YearApproved at:DisclaimerThis document is intended for use?within?BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document.?This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.? ................
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