Transcript SIP3_Process_Flow3-1..

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