Configuration of Surgery

We'll look at

Surgery Workflow 1.	Create operating room(s) 2.	Track patients on a waiting list 3.	Track operation requests 4.	Scheduling operations 5.	Tracking operation 6.	Anesthesia 7.	Perioperative Occurrences 8.	Non-O.R. Procedures 9.	Comments 10.	Incorporating and using Coding Standards 11.	Activating the surgery tab 12.	Surgery Reports 13.	Lab interim Report 14.	Chief of Surgery reports 15.	Surgery risk assessment 16.	Verification of surgery reports

Overview 

The Surgery package is designed to be used by Surgeons, Surgical Residents, Anesthetists, Operating Room Nurses and other surgical staff. This package integrates booking, clinical, and patient data to provide a variety of administrative and clinical reports Surgery Workflow 1)Before the surgery a)	Waiting list b)	Request operation and Scheduling 2)During the Surgery a)	Operation b)	Anesthesia 3)After the Surgery a)	Reports – Operation Report, Nurse’s Interoperative report, Anesthesia report. i)	Doctor dictates on hospital dictation system, or on a tape. ii)	 Voice file/recording is assigned to a transcriptionist. iii)	Transcriptionist creates report by typing into CPRS, or by creating a report on a word processor. iv)	If word processor is used, then resulting file is uploaded into VistA, and filer program puts the text into a TIU DOCUMENT Record.

Site specific Setup 1.	Create operating room(s) The operating rooms must be added to the VA FileMan HOSPITAL LOCATION file (#44) and the OPERATING ROOM file (#131.7) before they can be used in any of the Surgery package applications.All locations for non-O.R. procedures must be defined in the HOSPITAL LOCATION file (#44).

HOSPITAL LOCATION file (#44) The following is an example of how to set up an operating room in the HOSPITAL LOCATION file (#44). Please coordinate entries with the Medical Administration Service (MAS) package coordinator. Select VA FileMan Option: Enter or Edit File Entries INPUT TO WHAT FILE: HOSPITAL LOCATION EDIT WHICH FIELD: ALL//  Select HOSPITAL LOCATION NAME: OR1 ARE YOU ADDING 'OR1' AS A NEW HOSPITAL LOCATION (THE 24TH)? Y (YES) HOSPITAL LOCATION TYPE: OR OPERATING ROOM HOSPITAL LOCATION TYPE EXTENSION: OPERATING ROOM//  ABBREVIATION: OR1 TYPE: OPERATING ROOM//  TYPE EXTENSION: OPERATING ROOM//  INSTITUTION: BIRMINGHAM, AL. [Very important at multi-division medical centers.] DIVISION: ^ [It is unnecessary to enter any other fields in this file. Enter an up arrow (^) to exit.]

OPERATING ROOM file (#131.7) Following is an example of how to set up an operating room in the OPERATING ROOM file (#131.7). The Surgery Utilization Menu [SR OR UTIL] option in the Surgery Package Management Menu [SRO PACKAGE MANAGEMENT] option has a sub-option called the Normal Daily Hours (Enter/Edit) [SR NORMAL HOURS] option - for editing operating room normal daily hours. The Operating Room Information (Enter/Edit) [SRO-ROOM] option in the Surgery Package Management Menu [SRO PACKAGE MANAGEMENT] option can be used to edit other information in this file.

Example: Setting Up an Operating Room in the OPERATING ROOM File (#131.7) Select VA FileMan Option: Enter or Edit File Entries INPUT TO WHAT FILE: OPERATING ROOM EDIT WHICH FIELD: ALL//  Select OPERATING ROOM NAME: OR1 ARE YOU ADDING 'OR1' AS A NEW OPERATING ROOM (THE 1ST)? Y (YES) LOCATION: FIRST FLOOR UNIT I PERSON RESP.: JACK,JUFF TELEPHONE: REMARKS:  TYPE: ? ANSWER WITH OPERATING ROOM TYPE NAME DO YOU WANT THE ENTIRE 13-ENTRY OPERATING ROOM TYPE LIST? Y (YES) CHOOSE FROM: AMBULATORY OPERATING ROOM CARDIAC OPERATING ROOM CARDIAC/NEURO OPERATING ROOM CLINIC CYSTOSCOPY ROOM DEDICATED ROOM ENDOSCOPY ROOM GENERAL PURPOSE OPERATING ROOM INTENSIVE CARE UNIT NEUROSURGERY OPERATING ROOM ORTHOPEDIC OPERATING ROOM OTHER LOCATION WARD TYPE: GENERAL PURPOSE OPERATING ROOM CLEANING TIME: 30 Select DAY OF THE WEEK: SUNDAY ARE YOU ADDING 'SUNDAY' AS A NEW DAY OF THE WEEK (THE 1ST FOR THIS OPERATING ROOM)? Y (YES) NORMAL START TIME:  NORMAL END TIME:  INACTIVE (Y/N): YES Select DAY OF THE WEEK: MONDAY ARE YOU ADDING 'MONDAY' AS A NEW DAY OF THE WEEK (THE 2ND FOR THIS OPERATING ROOM)? Y (YES) NORMAL START TIME: 07:00 NORMAL END TIME: 15:30 INACTIVE (Y/N):  Select DAY OF THE WEEK: TUESDAY ARE YOU ADDING 'TUESDAY' AS A NEW DAY OF THE WEEK (THE 3RD FOR THIS OPERATING ROOM)? Y (YES) NORMAL START TIME: 07:00 NORMAL END TIME: 15:30 INACTIVE (Y/N):  Select DAY OF THE WEEK: WEDNESDAY ARE YOU ADDING 'WEDNESDAY' AS A NEW DAY OF THE WEEK (THE 4TH FOR THIS OPERATING ROOM)? Y (YES) NORMAL START TIME: 07:00 NORMAL END TIME: 15:30 INACTIVE (Y/N):  Select DAY OF THE WEEK: THURSDAY ARE YOU ADDING 'THURSDAY' AS A NEW DAY OF THE WEEK (THE 5TH FOR THIS OPERATING ROOM)? Y (YES) NORMAL START TIME: 07:00 NORMAL END TIME: 15:30 INACTIVE (Y/N):  Select DAY OF THE WEEK: FRIDAY ARE YOU ADDING 'FRIDAY' AS A NEW DAY OF THE WEEK (THE 6TH FOR THIS OPERATING ROOM)? Y (YES) NORMAL START TIME: 07:00 NORMAL END TIME: 15:30 INACTIVE (Y/N):  ARE YOU ADDING 'SATURDAY' AS A NEW DAY OF THE WEEK (THE 7TH FOR THIS OPERATING ROOM)? Y (YES) NORMAL START TIME:  NORMAL END TIME:  INACTIVE (Y/N): YES INACTIVE?: 

2.Track patients on a waiting list Use the Maintain Surgery Waiting List menu to Print, Enter, Edit and Delete a patient on the Waiting List

3.Track operation requests a.	The Request Operations menu may be used to Display Availability Scheduled operations display on the graph as an equal sign (=) followed by the letter X. The equal sign before the X indicates the beginning of a scheduled operation. Surgical specialty blockouts are indicated by an abbreviation for the service (for more information on service blockouts, a function of the Scheduling menu, see the Create Service Blockouts option). After entering this option, the user has a choice of viewing the room availability on the blockout graph in two ways. The user can either view all rooms for a particular date (as in Example 1) or view a particular operating room for a range of dates (Example 2). Notice, in the first example, that the user can also list requests, if any have been made.

Example 1: All O.R.S For One Day Select Request Operations Option: A Display Availability Do you want to view all Operating Rooms on one day ? YES // <Enter> Do you want to list requests also ? NO// <Enter> Display Operating Room Availability for which Date ? T (DEC 10, 2003) Display of Available Operating Room Time 1. Display Availability (12:00 AM - 12:00 PM) 2. Display Availability (06:00 AM - 08:00 PM) 3. Display Availability (12:00 PM - 12:00 AM) 4. Do Not Display Availability Select Number: 2// <Enter> ROOM 6AM 7 8 9 10 11 12 13 14 15 16 17 18 19 20 OR1 |=XXX|XXXX|XXXX|gen.|gen.|gen.|____|____|____|____|____|____|____|____| OR2 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| OR3 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| OR4 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| OR5 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| OR6 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| Press RETURN to continue

Example 2: One O.R. for a Date Range Select Request Operations Option: A Display Availability Do you want to view all Operating Rooms on one day ? YES // N Begin Display on which Date ? T (APR 14, 2003) Select OPERATING ROOM NAME: OR1 Display of Available Operating Room Time 1. Display Availability (12:00 AM - 12:00 PM) 2. Display Availability (06:00 AM - 08:00 PM) 3. Display Availability (12:00 PM - 12:00 AM) Select Number: 2// <Enter> Operating Room: OR1 (6:00 AM - 8:00 PM) DATE 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 04-14-03 |____|____|____|____|____|eye.|eye.|____|____|____|____|____|____|____| 04-15-03 |____|eye.|eye.|eye.|eye.|eye.|____|____|____|____|____|____|____|____| 04-16-03 |____|gen.|gen.|gen.|gen.|gen.|____|____|____|____|____|____|____|____| 04-17-03 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| 04-18-03 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| 04-19-03 |____|____|____|____|____|eye.|eye.|eye.|eye.|____|____|____|____|____| 04-20-03 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| 04-21-03 |____|____|____|____|____|eye.|eye.|____|____|____|____|____|____|____| 04-22-03 |____|eye.|eye.|eye.|eye.|eye.|____|____|____|____|____|____|____|____| 04-23-03 |=XXX|XXXX|XXXX|gen.|gen.|gen.|____|____|____|____|____|____|____|____| 04-24-03 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| 04-25-03 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| 04-26-03 |____|____|____|____|____|eye.|eye.|eye.|eye.|____|____|____|____|____| 04-27-03 |____|____|____|____|____|____|____|____|____|____|____|____|____|____| 04-28-03 |____|____|____|____|____|eye.|eye.|____|____|____|____|____|____|____| Press RETURN to continue

The Request Operations menu is also used to Make Operation Requests, Delete or Update Operation Requests, Make a Request from the Waiting List, Make a Request for Concurrent Cases, Review Request Information, Operation Requests for a Day, Requests by Ward

4.Scheduling operations The Schedule Operations menu is used to Display Availability, Schedule Requested Operations, Schedule Unrequested Operations, Schedule Unrequested Concurrent Cases, Reschedule or Update Scheduled Operations, Cancel Scheduled Operation, Update Cancellation Reason, Schedule Anesthesia Personnel, Create Service Blockout, Delete Service Blockout, Schedule of Operations

5.Tracking operation Operation Menu is used to enter a new surgical case or enter information for an existing case, review the information already entered, or delete the case.

6.Anesthesia Anesthesia Menu is used to Enter/Edit Anesthesia Information, Enter/Edit Anesthesia Technique, Enter/Edit Medications, Anesthesia Report, Schedule Anesthesia Personnel

7.Perioperative Occurrences The Perioperative Occurrences Menu can Enter/Edit Intraoperative Occurrences, Enter/Edit Postoperative Occurrences, Enter/Edit Non-Operative Occurrences, Update Status of Returns Within 30 Days and display the Morbidity & Mortality Reports

8.Non-O.R. Procedures Non-O.R. Procedures option,is used to Enter/Edit Non-O.R.. Procedures, display Annual Report of Non-O.R.. Procedures and Report of Non-O.R. Procedures

9.Comments Surgeons use the Comments option to respond to the GENERAL COMMENTS field for a surgical case or non-O.R. procedure. This option is designed to give surgeons an opportunity to directly add general comments after a case has been booked. The GENERAL COMMENTS field may already contain information added by the person booking the operation.

10.Incorporating and using Coding Standards The CPT/ICD9 Update/Verify Menu allows Updation/ of Procedure/Diagnosis Code and displays a Report of CPT Coding Accuracy. The List Completed Cases Missing CPT Codes option gives a report of all the cases that do not have a code associated with it.

11.Activating the surgery tab The Surgery tab will be activated at the System Level when SR*3*100 is installed. The GeneralParameter Tools option can be used to control the display of the Surgery tab following installation. Example: Utilizing the General Parameter Tools option Select OPTION NAME: XPAR MENU TOOLS General Parameter Tools menu LV List Values for a Selected Parameter LE List Values for a Selected Entity LP List Values for a Selected Package LT List Values for a Selected Template EP Edit Parameter Values ET Edit Parameter Values with Template Select General Parameter Tools Option: EP Edit Parameter Values --- Edit Parameter Values --- Select PARAMETER DEFINITION NAME: ORWOR SHOW SURGERY TAB Show Surgery Tab in GUI ORWOR SHOW SURGERY TAB may be set for the following: 1 User USR [choose from NEW PERSON] 2 Service SRV [choose from SERVICE/SECTION] 3 Division DIV [REGION 5] 5 System SYS [ROX-REV.ISC-SLC.VA.GOV] 7 Package PKG [ORDER ENTRY/RESULTS REPORTING] Enter selection: 5 System ROX-REV.ISC-SLC.VA.GOV - Setting ORWOR SHOW SURGERY TAB for System: ROX-REV.ISC-SLC.VA.GOV - SHOW SURGERY TAB: YES ORWOR SHOW SURGERY TAB may be set for the following: 1 User USR [choose from NEW PERSON] 2 Service SRV [choose from SERVICE/SECTION] 3 Division DIV [REGION 5] 5 System SYS [ROX-REV.ISC-SLC.VA.GOV] 7 Package PKG [ORDER ENTRY/RESULTS REPORTING] Enter selection:

12.	Surgery Reports a.Management Reports – (a)	Schedule of Operations (b)	Annual Report of Surgical Procedures (c)	List of Operations (d)	List of Operations (by Postoperative Disposition) (e)	List of Operations (by Surgical Specialty) (f)	List of Operations (by Surgical Priority) (g)	Report of Surgical Priorities (h)	List of Undictated Operations (i)	Report of Daily Operating Room Activity (j)	Monthly surgical workload report b.Surgery Staffing Reports – (a)	Attending Surgeon Reports (b)	Surgeon Staffing Report (c)	Surgical Nurse Staffing Report (d)	Scrub Nurse Staffing Report (e)	Circulating Nurse Staffing Report c.Anesthesia Reports – (a)	Anesthesia AMIS (b)	List of Anesthetic Procedures (c)	Anesthesia Provider Report d.	CPT Code Reports – (a)	Cumulative Report of CPT Codes (b)	Report of CPT Coding Accuracy (c)	List Completed Cases Missing CPT Codes

13.Lab interim Report  The results of lab test of surgery patients from the Laboratory package.

14.Chief of Surgery reports The surgery chief has access to different reports and options like View Patient Perioperative Occurrences, Management Reports, Unlock a Case for Editing, Update Status of Returns Within 30 Days, Update Cancelled Case, Update Operations as Unrelated/Related to Death, Update/Verify Procedure/Diagnosis Codes, Report of Cancellations, Wound classification Report (User Manual Pg 363), Quarterly Report - Surgical Service, Deaths Within 30 Days of Surgery, Admissions Within 14 Days of Outpatient Surgery, List of Invasive Diagnostic Procedures, List of Operations Included on Quarterly Report, Report of Missing Quarterly Report Data

15.Surgery risk assessment a.Enter/Edit Non-Cardiac Assessment Information (Creation of a risk assessment for an Operation) b.Enter/Edit Cardiac Risk Assessment Information c.Print a Surgery Risk Assessment d.Update Assessment Completed/Transmitted in Error e.List of Surgery Risk Assessments f.Print 30 Day Follow-up Letters g.Enter/Edit Exclusion Criteria h.Monthly Surgical Case Workload Report i.Update Operations as Unrelated/Related to Death j.M&M Verification Report k.Update 1-Liner Case l.T Queue Assessment Transmissions m.Reports 1.	List of Incomplete Assessments 2.	List of Completed Assessments 3.	List of Transmitted Assessments 4.	List of Non-Assessed Major Surgical Cases 5.	List of All Major Surgical Cases 6.	List of All Surgical Cases 7.	List of Completed/Transmitted Assessments Missing Information

16.Verification of surgery reports To setup for allowing operative reports refer to “Surgery Electronic Signature for Operative Reports – Installation Guide” Surgery Reports can be signed/verified from CPRS or List Manager References: Surgery Manuals from vdl ETIPL Resources