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 Changes clothes Opens curtain Bag belongings Talk with family Verifies consent Allergy With RN Talks with surgeon Verifies site 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 TED’s 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 H&P 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 PreOp HA Calls pt source to check if pt is there & ready for transport Transport HA Mark Board Pick up gurney Checks correct pt id Crosses of pt from board in PAV Pre-Op Pick up patient, chart, card, belongings, family 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 TBA’s may or may not be seen beforehand Talks to pt, marks site, H&P 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, H&P, 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 Overhead pages for HA & A. Tech Clean instr and take to SIP Turns specimen to Pathology, turn in X-ray Check next Case cart 1000 item check Bathroom break Escorts to PACU Pick up Op report Check next pt allergy, site marking, paperwork Sometimes, Write equip variation on board or talk to HA RN Highly variable Talk to family, waits in room, bathroom break, dictate Surg Receive pager message Go to room with Roll Royce (cleaning cart) Restock linen, clean room, garbage, setting up operative bed, procuring equipment Check with RN about Bed need for any other equipment HA Anesth Tech Cleans, replenish equipment, get drug tray, take out trash Dump drug, get new drug, check equip, finish equip prep Lines, blocks etc Anesth Communication about room status and pt status labor intensive 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? Issues

6. SIP 3 Intra-operative Surgery PT Put on table- cir RN and Aneth Pt asleep Scrub RN/ Surg Tech Finish case prep Drape patient Time out Huddle Assist moving pt to bed, safety strap Finish case prep with Scrub RN Foley, cliper, position, etc. Skin prep RN Someone pages surgeon Surgeon appears Surg Assist moving pt to bed, safety strap Monitors blocks, lines, induces anesthesia 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