8. Operating List management

• Close communication and co-ordination between the pre-operative area and theatre using agreed procedures is essential.


• A receptionist and/or theatre manager should liase closely with ward and transport staff. Electronic links sending for and identifying patients may be used.


• Up-to-date information about operating lists must be available and all personnel informed of any changes as soon as they are decided.


• In theatre, a suitably staffed and equipped holding area for patients will assist with the smooth running of the lists.


• Patients must be ready for theatre when they are sent for and theatres should liase closely with the ward and bed manager at all times, particularly if the order of the operating list has been changed.


• The incidence and reason for all cancellations, delays and overruns should be logged and reviewed by the theatre management team. A 'Cancelled Operations Toolkit' is available from the Modernisation Agency Theatre Programme.


• Policies on, for example, fasting, anticoagulation, shaving, dentures, jewellery, appropriate underwear and removal of make-up should be developed, applied and audited.


• Unsedated patients can walk to theatre with a patient escort. Otherwise patients need to be transported on a bed, trolley or wheelchair.


• Units should develop policies to decide what level of training is appropriate for patient escorts


• It is important that sufficient transfer staff are available during all operating times and that they are based in theatre with no other conflicting duties. Consideration should be given to a flexible system in which staff from other areas of theatre provide transfer assistance when possible.


• All personnel involved in transfer of patients, including medical staff, should receive instruction in moving and handling.


• There must be a documented system of identification and handover of the patient.


• Multiple checks can increase patient anxiety and cause confusion and should be reduced to a safe minimum.


• As well as wristband identification, it is important that, where possible, patients identify themselves actively e.g. state their name and date of birth. This also applies to confirmation of ‘side’ of operation.
• There is little evidence to show that inside and outside trolleys reduce infection or that taking beds into theatre increases it, providing the bed linen is changed prior to transfer. Providing the bed or transfer trolley can tip and is of adjustable height, patients can be transferred directly to the anaesthetic room.


• The recovery unit must be suitably staffed and equipped, be of sufficient capacity and remain open during all periods of activity. Shift patterns should pay attention to the peaks of activity occurring mid morning and afternoon and the later start and finish to the normal working day compared to theatres.


• High dependency and intensive care units should have agreed admission and discharge policies to prevent blockage of beds. A lead clinician in Critical Care, using established guidelines and ensuring proper communication between staff groups, can provide a vital role . A system of booking elective admissions should be in place although a check of bed availability must be made before proceeding with anaesthesia for elective surgery