OT & Surgery Use Cases¶

Implementation Note: Operation Theatre (OT) management integrates with scheduling, bed management, inventory, and billing systems. Supports pre-operative assessments, intra-operative documentation, and post-operative care coordination.

UC-OT-001: Schedule Surgery¶

Purpose: Book operation theatre slot with surgeon, anesthesiologist, and resource allocation.

Property	Value
Actor	OT Coordinator / Surgeon
Trigger	Surgery request from doctor
Priority	P0

Main Success Scenario:

1. Receive surgery request:
   - Patient details
   - Procedure type (ICD-10-PCS / CPT)
   - Surgeon preference
   - Urgency (Elective/Urgent/Emergency)
2. Check OT availability:
   - Theatre rooms
   - Equipment requirements
   - Estimated duration
3. Check personnel availability:
   - Primary surgeon
   - Anesthesiologist
   - Nursing staff (scrub, circulating)
4. Validate pre-requisites:
   - Pre-operative investigations complete
   - Anesthesia fitness clearance
   - Consent obtained
   - Blood arranged (if required)
5. Allocate resources:
   - Assign OT room
   - Block equipment
   - Reserve PACU/ICU bed
6. Create surgery schedule entry
7. Notify all stakeholders:
   - Surgeon, Anesthesiologist
   - OT nursing staff
   - Ward nursing (patient prep)
   - CSSD (instrument sterility)

Acceptance Criteria: 1. [ ] Real-time OT calendar view 2. [ ] Conflict detection (double-booking) 3. [ ] Equipment availability check 4. [ ] Pre-requisite checklist enforcement 5. [ ] Multi-stakeholder notifications

India-Specific: - NABH OT scheduling compliance - MLC case flagging - Ayushman Bharat package rate display

UC-OT-002: Pre-Operative Assessment¶

Purpose: Document pre-operative evaluation and anesthesia fitness.

Property	Value
Actor	Anesthesiologist / Surgeon
Trigger	Surgery scheduled
Priority	P0

Main Success Scenario:

1. Review patient history:
   - Medical history, allergies
   - Previous surgeries/anesthesia
   - Current medications
2. Physical examination:
   - Airway assessment (Mallampati)
   - Cardiovascular status
   - Respiratory assessment
3. Review investigations:
   - Blood tests (CBC, coagulation, metabolic)
   - ECG, Chest X-ray
   - Specialty specific (Echo, PFT)
4. Calculate risk scores:
   - ASA classification
   - Cardiac risk index
   - STOP-BANG for sleep apnea
5. Determine anesthesia plan:
   - Type (GA, Regional, MAC)
   - Special considerations
   - Post-op care level
6. Document pre-op orders:
   - NPO instructions
   - Pre-medication
   - Prophylactic antibiotics
7. Obtain informed consent:
   - Procedure-specific risks
   - Anesthesia risks
   - Patient signature

Acceptance Criteria: 1. [ ] Pre-op checklist template 2. [ ] Auto-pull recent investigations 3. [ ] Risk score calculators 4. [ ] Digital consent capture 5. [ ] NPO time validation

UC-OT-003: OT Checklist (WHO Safe Surgery)¶

Purpose: Execute WHO Surgical Safety Checklist for patient safety.

Property	Value
Actor	OT Team
Trigger	Patient in OT
Priority	P0

Main Success Scenario:

1. SIGN IN (Before Anesthesia):
   - Patient identity confirmed
   - Site marked, consent verified
   - Pulse oximeter functioning
   - Known allergies documented
   - Airway risk assessed
   - Blood loss risk evaluated
2. TIME OUT (Before Incision):
   - Team introductions
   - Patient, procedure, site confirmed
   - Antibiotic prophylaxis given
   - Critical events anticipated
   - Imaging displayed
3. SIGN OUT (Before Patient Leaves OT):
   - Procedure recorded correctly
   - Instrument, sponge counts correct
   - Specimen labeled
   - Equipment issues documented
   - Key post-op concerns communicated
4. Document all checklist items:
   - Timestamp each phase
   - Capture team member confirmations
5. Flag any deviations:
   - Missing items
   - Count discrepancies
   - Immediate escalation

Acceptance Criteria: 1. [ ] WHO checklist mandatory enforcement 2. [ ] Digital sign-off per team member 3. [ ] Time-stamped documentation 4. [ ] Count discrepancy alert 5. [ ] Never-event prevention

UC-OT-004: Intra-Operative Documentation¶

Purpose: Record surgical procedure details, findings, and events in real-time.

Property	Value
Actor	Surgeon / OT Staff
Trigger	Surgery in progress
Priority	P1

Main Success Scenario:

1. Record procedure timeline:
   - Anesthesia start/end
   - Incision time
   - Procedure milestones
   - Closure time
2. Document surgical findings:
   - Anatomical observations
   - Pathology encountered
   - Deviations from plan
3. Record implants/devices:
   - Implant details (serial, lot, expiry)
   - Manufacturer information
   - Unique Device Identifier (UDI)
4. Document specimens:
   - Type and site
   - Labeled for pathology
   - Special handling (frozen section)
5. Anesthesia record:
   - Vitals (auto-capture if integrated)
   - Medications administered
   - Fluids, blood products
   - Events (intubation, extubation)
6. Generate operative note:
   - Structured template
   - Pre-op diagnosis
   - Post-op diagnosis
   - Procedure performed
   - Findings
   - Surgeon signature

Acceptance Criteria: 1. [ ] Real-time documentation 2. [ ] Implant tracking (UDI) 3. [ ] Auto-capture from monitors 4. [ ] Structured operative note 5. [ ] Specimen tracking

UC-OT-005: Post-Operative Care Orders¶

Purpose: Generate post-operative orders for PACU and ward care.

Property	Value
Actor	Surgeon / Anesthesiologist
Trigger	Surgery completed
Priority	P0

Main Success Scenario:

1. Define post-op monitoring:
   - Vital signs frequency
   - Neurological checks (if applicable)
   - Drain output monitoring
2. Pain management:
   - Analgesic regimen
   - PCA settings (if applicable)
   - Breakthrough orders
3. Activity orders:
   - Bed rest duration
   - Ambulation timeline
   - Physiotherapy
4. Diet progression:
   - NPO to clear liquids to regular
   - Special restrictions
5. Medications:
   - Antibiotics (prophylactic/therapeutic)
   - DVT prophylaxis
   - Stress ulcer prophylaxis
6. Wound care:
   - Dressing change schedule
   - Drain management
7. Complications to watch:
   - Warning signs to report
   - Escalation criteria
8. Disposition plan:
   - PACU → Ward
   - PACU → ICU
   - Expected discharge timeline

Acceptance Criteria: 1. [ ] Order set templates by surgery type 2. [ ] Pain protocol integration 3. [ ] DVT prophylaxis reminders 4. [ ] PACU discharge criteria 5. [ ] Handoff documentation

UC-OT-006: Surgical Instrument Tracking¶

Purpose: Track surgical instrument sets through sterilization and usage cycles.

Property	Value
Actor	CSSD / OT Staff
Trigger	Instrument set lifecycle
Priority	P1

Main Success Scenario:

1. Register instrument sets:
   - Set ID, Description
   - Items in set
   - Photo documentation
2. Track sterilization:
   - Wash → Pack → Autoclave
   - Sterilizer ID, Cycle number
   - Biological indicator results
3. Issue to OT:
   - Scan set barcode
   - Link to surgery/patient
   - Verify sterility expiry
4. Usage tracking:
   - Confirm set opened
   - Document any issues (damaged, missing)
5. Post-surgery processing:
   - Decontamination
   - Count verification
   - Return to CSSD
6. Maintenance tracking:
   - Sharpening, repair
   - Replacement of items
   - Full set lifecycle history

Acceptance Criteria: 1. [ ] Barcode/RFID tracking 2. [ ] Sterilization cycle logging 3. [ ] Sterility expiry enforcement 4. [ ] Instrument count reconciliation 5. [ ] Maintenance scheduling

UC-OT-007: Emergency Surgery Workflow¶

Purpose: Fast-track scheduling and preparation for emergency surgeries.

Property	Value
Actor	ED Physician / Surgeon
Trigger	Emergency surgery needed
Priority	P0

Main Success Scenario:

1. Emergency surgery request:
   - Patient ID, Diagnosis
   - Procedure required
   - Urgency level (Immediate/Urgent)
2. Immediate OT allocation:
   - Bump existing case if needed
   - Alert OT team
   - Mobilize on-call staff
3. Parallel preparation:
   - Blood bank: Emergency cross-match
   - Anesthesia: Rapid assessment
   - Consent: Emergency consent protocol
4. Expedited checklist:
   - Critical items only
   - Verbal confirmations acceptable
5. Document emergency protocol:
   - Time of request
   - Response times
   - Deviations from standard process
6. Post-case review:
   - Quality review of response
   - Learning documentation

Acceptance Criteria: 1. [ ] Emergency fast-track workflow 2. [ ] Parallel notification to all teams 3. [ ] Expedited consent process 4. [ ] Response time tracking 5. [ ] Post-event review trigger

UC-OT-008: Surgical Case Costing¶

Purpose: Calculate and track surgery costs for billing and analytics.

Property	Value
Actor	Billing System
Trigger	Surgery completed
Priority	P1

Main Success Scenario:

1. Capture cost components:
   - Surgeon fee
   - Anesthesiologist fee
   - OT charges (time-based)
   - Consumables used
   - Implants/devices
   - Blood products
2. Apply rate card:
   - OT hourly rate
   - Procedure-based packages
   - Insurance/TPA rates
3. Calculate total cost:
   - Itemized breakdown
   - Package vs. itemized comparison
4. Apply package rules:
   - PM-JAY/Ayushman rates
   - CGHS rates
   - Insurance package capping
5. Generate surgery bill:
   - Detailed cost breakdown
   - Package summary
6. Analytics:
   - Cost per procedure type
   - Surgeon productivity
   - OT utilization

Acceptance Criteria: 1. [ ] Real-time cost capture 2. [ ] Package rate application 3. [ ] Insurance capping rules 4. [ ] Surgeon-wise analytics 5. [ ] OT utilization dashboard

Document Owner: OT Manager / IT Lead
Last Updated: 2024-12-09
Related: Bed Management | Appointments | Billing