A space equipped for performing surgeries, where surgical procedures are carried out under strict aseptic and safety measures. It is included in the clinical support processes.

High level description #

Subprocesses #

Pre-Operative Processes #

Including patient admissions and preoperative verification.

Activities and estimated duration #

Patient Admissions

Verify patient personal and medical details, including medical history, allergies, current medications, and any relevant medical conditions. This information is crucial to ensure safe and effective medical care throughout the surgical process.. Approximately 15 minutes.

Preoperative Assessment & Preparation

Conduct a comprehensive assessment of the patient’s health status, including physical examinations, diagnostic tests, and risk evaluations. Additionally, prepare the patient physically and psychologically for surgery by providing information about the surgical procedure, associated risks, and postoperative measures.. Approximately between 30 minutes and 2 hours.

Preoperative Verification & Planning

Verify the accuracy and completeness of the information required for surgery, such as patient identification, surgical site, performed diagnostic tests, and planned surgical procedures. Additionally, plan the logistical details of the surgery, including necessary equipment, operating room setup, and required personnel.. Approximately  30 minutes.

Allocate pre-op room and assign personnel

Assign an appropriate pre-operative room to the patient, ensuring it is equipped with the necessary resources for surgery, such as medical equipment, sterile supplies, and supportive technology. Additionally, allocate the required medical and nursing staff for patient care during the preoperative period. Approximately 15 minutes.

Order additional tests or consultations

Request any additional diagnostic tests or specialized medical consultations necessary to thoroughly evaluate the patient’s health status before surgery. This may include laboratory tests, medical imaging studies, or evaluations by specialists in specific areas.. Approximately between 15 minutes and 1 hour.

Confirm patient has given informed consent

Verify that the patient has fully understood the risks, benefits, and alternatives of the proposed surgical procedure and has given their informed consent voluntarily. This ensures that the patient is adequately informed and in agreement with the treatment plan. Approximately 10 minutes.

Prepare patient for preoperative assessment

Physically prepare the patient for the preoperative assessment, which may include instructions on fasting, removal of jewelry and prosthetics, and changing into appropriate surgical attire. Additionally, provide emotional support to the patient to reduce anxiety and enhance cooperation during the process. Approximately 20 minutes.

Escort patient to preoperative area

Accompany the patient safely and comfortably from the waiting area or their room to the designated preoperative area. This ensures a smooth and safe transition of the patient to the surgical environment and facilitates ongoing communication with the medical and nursing staff. Approximately 10 minutes.

Handover patient to preoperative nursing staff

Transfer the responsibility of patient care to the preoperative nursing staff, providing relevant information about the patient’s status, procedures performed, and specific needs. This ensures continuity of care and effective coordination between different healthcare teams. Approximately 5 minutes.

Notify surgical team of patient’s arrival

Inform the surgical team about the patient’s arrival in the preoperative area and their readiness for surgery. This allows efficient scheduling of surgical procedures and adequate preparation of the necessary equipment and resources. Approximately5 minutes.

Update patient records

Record any new information or relevant changes in the patient’s medical record, including results of preoperative assessments, updated informed consent, and details of preoperative preparation. This ensures the integrity and accuracy of the patient’s medical documentation for future reference and treatment follow-up. Approximately 5 minutes.

Intra-Operative Processes #

Including team coordination, anesthesia administration (if required), the surgical procedure and the equipment and environment management. 

Activities and estimated duration #

Team Coordination

Coordinate the surgical team’s activities and communication throughout the intra-operative phase to ensure seamless collaboration and efficiency. This involves assigning roles and responsibilities, facilitating effective communication channels, and responding to any emergent issues or changes in the surgical plan. Approximately 30 minutes to several hours.

Anesthesia Administration (if required)

Administer anesthesia safely and appropriately to induce and maintain anesthesia during the surgical procedure. This includes assessing the patient’s anesthesia needs, selecting the appropriate anesthesia technique and medications, monitoring the patient’s vital signs and anesthesia depth, and managing any anesthesia-related complications. Approximately  from 1 to 4 hours.

Surgical Procedure

Perform the surgical procedure according to the established surgical plan with precision, accuracy, and adherence to aseptic technique and patient safety protocols. This involves executing surgical techniques, manipulating surgical instruments, controlling bleeding, dissecting tissues, and achieving the desired surgical outcomes while minimizing the risk of complications. Approximately from 1 to 6 hours.

Equipment and Environment Management

Manage the operating room environment and surgical equipment to optimize conditions for the surgical procedure and ensure patient safety. This includes maintaining a sterile surgical field, monitoring and regulating temperature, humidity, and lighting, troubleshooting equipment malfunctions, and coordinating the use of specialized surgical instruments and technology. Approximately from 30 minutes to 2 hours.

Post-operative processes #

Including the recovery unit coordination and the surgical documentation.

Activities and estimated duration #

Recovery Unit Coordination

Coordinate the transfer of the patient from the operating room to the post-anesthesia care unit (PACU) or recovery unit, ensuring a smooth transition and optimal post-operative care. This involves monitoring the patient’s vital signs, assessing their level of consciousness and pain, managing post-operative complications, and providing appropriate nursing care and support.  Approximately 1 to 4 hours. 

Patient Transfer

Coordinate the safe transfer of the patient from the operating room to the post-anesthesia care unit (PACU) or recovery unit. Approximately 15-30 minutes.

Vital Signs Monitoring

Continuously monitor the patient’s vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation. Approximately every 15-30 minutes for the first few hours post-surgery.

Pain Management

Assess the patient’s level of pain and administer appropriate pain relief medications as needed. Approximately 30-60 minutes.

Fluid Management

Monitor the patient’s fluid intake and output and administer intravenous fluids as necessary to maintain hydration. Approximately every 1-2 hours.

Airway Management

Ensure the patient’s airway is clear and provide oxygen supplementation if required. Approximately 15-30 minutes. 

Nursing Care

Provide ongoing nursing care, including wound assessment and dressing changes, repositioning to prevent pressure ulcers, and assistance with activities of daily living. Ongoing, with assessments and interventions performed as needed throughout the recovery period.

Post-operative Instructions

Provide the patient and their family with post-operative instructions, including information about diet, activity restrictions, and signs of complications to watch for at home. Approximately 15-30 minutes.

Monitoring for Complications

Continuously monitor the patient for signs of post-operative complications, such as bleeding, infection, respiratory distress, or adverse reactions to anesthesia or medications. Ongoing, with frequent assessments and interventions as needed. 

Surgical Documentation

Document all pertinent information and events related to the surgical procedure accurately and comprehensively for medical records and legal purposes. This includes recording details of the surgical procedure, anesthesia administration, intra-operative findings, post-operative care instructions, and any complications or unexpected events encountered during surgery. Approximately 30-240 minutes. 

Procedure Details

Document detailed information about the surgical procedure, including the type of surgery performed, surgical technique used, and any intra-operative findings. Approximately 30-60 minutes.

Anesthesia Records

Record details of anesthesia administration, including the type and dosage of anesthetic agents used, vital signs during anesthesia, and any complications or adverse reactions. Approximately 15-30 minutes.

Intra-operative Findings

Document any unexpected findings or complications encountered during surgery, such as anatomical variations, intra-operative bleeding, or surgical complications. Approximately 15-30 minutes.

Post-operative Care Instructions

Provide written instructions for post-operative care, including wound care, medication management, follow-up appointments, and activity restrictions. Approximately 15-30 minutes.

Patient Response

Document the patient’s response to surgery and anesthesia, including their level of consciousness, vital signs stability, and any immediate post-operative complications. Approximately 15-30 minutes.

Medication Administration

Record all medications administered during the surgical procedure, including anesthesia agents, antibiotics, analgesics, and other adjunctive medications. Approximately 15-30 minutes.

Surgical Team Notes

Include notes from the surgical team regarding the progression of the surgery, any challenges encountered, and decisions made during the procedure. Approximately 15-30 minutes.

Discharge Planning

Begin discharge planning by documenting the patient’s readiness for discharge, any ongoing care needs, and recommendations for follow-up care. Approximately 15-30 minutes.

Management and Operational Efficiency

Including the operating room management and compliance policies.

Activities and estimated duration #

Operating Room Management

Efficiently manage operating room resources to optimize workflow, enhance patient safety, and improve surgical outcomes. This involves coordinating scheduling procedures, allocating personnel and equipment, maintaining a sterile environment, and ensuring compliance with regulatory standards. Approximately 1 to 4 hours. 

Scheduling Procedures

Coordinate and schedule surgical procedures based on patient needs, surgeon availability, and operating room capacity. Approximately 30-60 minutes per procedure scheduled.

Equipment and Resource Allocation

Ensure that operating rooms are equipped with the necessary instruments, supplies, and technology required for each procedure. Approximately 15-30 minutes per room setup.

Staffing Management

Assign qualified personnel, including surgeons, nurses, anesthesiologists, and support staff, to each surgical team based on skill sets and experience. Approximately 30-60 minutes for staffing coordination per surgical team.

Room Turnover

Efficiently manage room turnover processes to minimize downtime between procedures and maximize operating room utilization. Approximately 15-30 minutes per room turnover.

Compliance Policies

Establish and enforce policies and procedures to ensure compliance with regulatory standards, accreditation requirements, and institutional policies within the operating room. This includes developing clear standards for operating room practices, promoting adherence through training and education, monitoring compliance through audits and inspections, and addressing non-compliance with appropriate corrective action. Approximately 1 to 4 hours. 

Policy Development

Develop and implement policies and procedures to ensure compliance with regulatory standards, safety protocols, and best practices in surgical care. Approximately 1-2 hours per policy development and implementation.

Staff Training

Provide ongoing training and education to operating room staff on compliance policies, infection control measures, and patient safety protocols. Approximately 30 minutes to 1 hour per training session.

Audits and Inspections

Conduct regular audits and inspections of operating room practices to assess compliance with established policies and identify areas for improvement. Approximately 1-2 hours per audit or inspection.

Documentation and Reporting

Maintain accurate records of compliance activities, including audit findings, corrective actions taken, and outcomes achieved. Approximately 30 minutes to 1 hour per documentation and reporting task.

Staff Roles and Responsibilities #

Including the sterile division and non-sterile division.

Activities and estimated duration #

Define Roles

Establish roles and responsibilities for operating room staff, both in the sterile and non-sterile divisions, to ensure effective teamwork, patient safety, and efficient workflow. Approximately 30 minutes to 1 hour for initial role assignment and periodic updates.

Sterile or Non-Sterile Decision

Determine whether a specific task or function requires sterile or non-sterile handling by operating room staff. Approximately from 15 minutes to 1 hour

Define Sterile Roles

Identify and define specific roles and responsibilities for staff involved in maintaining a sterile field and assisting in surgical procedures. Approximately 30 minutes to 1 hour for initial role definition and adjustments as needed.

Define Non-Sterile Roles

Establish roles and responsibilities for staff providing support to the surgical team but not directly involved in maintaining a sterile field or assisting in surgical procedures. Approximately 30 minutes to 1 hour for initial role assignment and periodic adjustments.

Training and Education

Provide training and education to operating room staff on sterile techniques, equipment handling, and other relevant aspects of their role. Approximately 1 to 2 hours per training session.

Ongoing Support

Provide continuous support and guidance to operating room staff to ensure optimal performance in their roles and responsibilities. Approximately 30 minutes to 2 hours per instance

Usual Loops #

Atributtes #

Staff #

Surgeons: Highly trained specialists in different areas of surgery.

Operating room nurses: Nursing professionals with experience in surgery and specialized knowledge in handling surgical instruments and sterilization.

Surgical technicians: Trained personnel in handling surgical equipment and providing direct assistance to the surgeon during procedures.

Anesthesiologists/Anesthetists: Specialists in anesthesia administration and patient care during surgery.

Support staff: Administrative, cleaning, and maintenance staff to ensure the smooth operation of the operating room.

Material #

Surgical instruments: Tools and devices necessary for performing surgical procedures, such as scalpels, forceps, scissors, etc.

Medical supplies: Wound dressings, dressings, sutures, and other supplies necessary for patient care.

Sterilization equipment: Autoclaves or other equipment for sterilizing instruments and supplies before use in surgery.

Medical devices: Specialized equipment such as surgical lasers, endoscopes, and vital signs monitors.

Method #

Surgical protocols: Standard procedures for performing different types of surgeries, including aseptic measures, patient preparation, and specific surgical techniques.

Safety protocols: Standards and procedures to ensure patient and staff safety during surgical procedures.

Emergency protocols: Action plans to address emergency situations during surgery, such as cardiac arrests or significant blood loss.

Machine #

Surgical equipment: Surgical tables, operating room lights, suction systems, and other equipment necessary for performing surgical procedures.

Anesthesia equipment: Machines and monitors for administering anesthesia and monitoring patient vital signs during surgery.

Imaging equipment: X-rays, ultrasounds, and other imaging diagnostic equipment that may be necessary during certain surgical procedures.

Downloads #

BPMN graphs #

Download the collapsed BPMN diagram.

Download the expanded BPMN diagram.

Download all the data.

Use Case #

In this use case, there are a different number of surgical (6,3,1) and nursing (12,6,2) staff, along with the anaesthetists(6,3,1). The number of operating rooms (3,2,1) also varyies depending oon the hospital (Hospital 1, Hospital 2, Hospital 3).

The displayed operations (Cataract surgery, Appendix surgery, Cancer Surgery, Heart surgery) may require (or not) the use of anaesthesia, along with an scheduled appointment (or not) depending on the level of urgency ( not urgent, urgent, emergency).

The recommended software is the Inverbis Healthcare platform. 

Download the use case data.

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