1. ALL consent forms (with the exception of emergency cases) must be signed prior to the patient being brought to the operating room. The consent should accompany the preoperative patient dossier. Informed consent must be provided by the surgeon and the patient must not be asked to sign a consent form that does not clearly indicate the operation(s) to be performed.
2. ALL surgeons are expected to have seen their first patient of the day no later than 7:30 a.m. Thereafter, the staff surgeon must be available in a timely fashion for all subsequent cases. The OR staff cannot spend time looking for a surgeon who should be in the OR to begin his/her next case.
3. ALL surgeons (or acceptable replacement according to the Surpass guidelines) must be in the OR to participate in the Time-Out/ Surpass. A case WILL NOT be permitted to proceed unless the Surpass has been completed. Compliance will be monitored.
4. It is incumbent upon the surgeon to work in partnership with the Preoperative Clinic to make sure that his/her patient understands the importance of following ALL pre-op instructions, and has received all necessary, required and appropriate pre-operative preparations (including, where relevant – showers, antibiotics, catheters, etc.) and/or instruction booklet prior to the patient being brought to the OR.
5. It is expected that the surgical attending or senior resident (or Fellow) will participate in the closure of the operative wound to facilitate the timely turnover of patients. The surgical attending must be in the operating room during all critical parts of the procedure.
6. At all times, proper behaviour and decorum must be maintained in the operating room. A zero tolerance policy will be enforced for verbal abuse and any other forms of harassment, as defined by the hospital’s policy of zero-tolerance for harassment. If such a situation arises, it is everybody’s responsibility to resolve the incident and if necessary an incident report is to be filed.
7. All scheduled surgical cases must be booked no later than 2 weeks prior to the planned operative intervention. These cases may be exchanged, based on the allocation of OR time and resources, up to 48 hours prior to surgery. The only permitted exceptions are trauma, cancer, flex and cardiac surgery cases.
8. It is the responsibility of the attending surgeon to ensure that the operative report is dictated within 24 hours of the operation.
9. The patient and/or family must be advised preoperatively of the expected length of stay. This may be included in the preoperative pamphlet.
10. Surgeons are encouraged to implement and follow clinical care pathways.
11. All patients admitted to the hospital must have a projected day of discharge written in the postoperative orders.
12. Patients must be seen at least once in the first 24-48 hours postoperatively, and preferably on a daily basis by their staff surgeon (or an alternate attending staff). A daily notation must be made in the patient’s chart to document (1) the patient’s condition (stable or otherwise) AND (2) anticipated date of discharge, or clinical milestones to be met in order for patient to be discharged.
13. The anticipated discharge date must be communicated to the unit manger (or delegate) at least the evening before it is to occur, recognizing that circumstances may delay or alter that plan.
14. All confirmed discharges must be communicated to the Unit Manager by 9:00 AM. Patient must leave their bed by 11 am.
15. Patient discharge should not be delayed for last minute tests or imaging. This should be planned at least 1 day in advance. The Patient Flow Coordinator should be contacted to help facilitate this.
16. The follow-up plans for the patient must be indicated in the patient’s chart and/or conveyed to the patient prior to discharge.
Regular audits will be carried out to document compliance of these rules. Compliance will be taken into consideration when future resources are allocated.