Wait Time Information System (WTIS) · OR Gen Surg OR Gen Surg Ped OR Oncology OR Ophth . Example...

User Guide Wait Time Information System

(WTIS)

Version: V1 | Date: November 15, 2013

Table of Contents Scheduling the Consultation Appointment ................................................................................... 1

Scheduling the Surgical Appointment .......................................................................................... 1

Example Doctors to be used for Demo in WTIS Training 2012 ........................................................ 1

*Primary Surgeon ..................................................................................................................................... 2 *Encounter Type ...................................................................................................................................... 2 *Waitlist Priority ...................................................................................................................................... 2 *WTIS Service Details Gen Surg ............................................................................................................... 2 *Date Decision to Treat ............................................................................................................................ 2 *Admitting/Pre Op Diagnostics ................................................................................................................ 3 *Dx_Planned Procedure (to send to PreAdmit) ....................................................................................... 3 Expected Length of Stay ........................................................................................................................... 3 PAC Note .................................................................................................................................................. 3 Special Considerations ............................................................................................................................. 4 *Anesthesia consult requested? .............................................................................................................. 4 Medical consult requested? ..................................................................................................................... 4 Interpreter required? ............................................................................................................................... 5 Accommodation Requested by patient .................................................................................................... 5 Responsibility for Payment ...................................................................................................................... 5 Anonymous Patient .................................................................................................................................. 5 Add On Case (Periop booking Use Only) .................................................................................................. 5 Referral Type-Surgery and Reasons ......................................................................................................... 6

Referral Types .................................................................................................................................................... 6 Date of Referral to Specialist .................................................................................................................... 6 Date of Consultation ................................................................................................................................ 7 DARCs and DARTs ..................................................................................................................................... 7

DARC ................................................................................................................................................................. 7 DART .................................................................................................................................................................. 8

Consult (Wait 1) and Surgery (Wait 2) System Delay Reasons ................................................................. 9 Wait 2 Delays .................................................................................................................................................... 9

Private Surgical Comments: ................................................................................................................... 10 Public Surgical Comments ...................................................................................................................... 10

Once all fields are filled in, click on Move to move the Appointment Details to the Work in Progress area ............................................................................................................................. 11

Procedure Duration ................................................................................................................................ 12 Click on Next to copy info for Pre-Admitting ............................................................................... 13

Change the appt. type to a PreAdmit appointment type. ............................................................. 14

Send PreAdmit to the Request List ............................................................................................. 14

Send the OR Appointment to the Request List............................................................................. 15

How to View the Request List .................................................................................................... 16

How to Adjust Columns +............................................................................................................... 17

How to Modify the Request details once sent to the Request Queue .......................................... 18

How to Modify the Appointment Details once sent to the Request Queue .................................. 20

How to Cancel a Request ............................................................................................................ 21 Version: V1| Date: 2013/11/15 Table of Contents

To view a request once it has been canceled .............................................................................. 23

How to Print a Surgical List ........................................................................................................ 25

Patient List by Resource Group ...................................................................................................... 26

Sched Resource Summary for Surgery Cases ................................................................................. 26

Version: V1| Date: 2013/11/15 Table of Contents

Wait Time Information System (WTIS)

SCHEDULING THE CONSULTATION APPOINTMENT Use GEN Surg New

SCHEDULING THE SURGICAL APPOINTMENT Search for the patient using the MRN or Proper Patient search

Reminder: Any field highlighted in yellow is a mandatory field and must be filled in before the request can be sent.

Select the patient to be scheduled for Surgery

Select the appropriate OR appointment type. The OR appointment type consists of the OR prefix, the service and the patient type.

Appt. Types OR Gen Surg

OR Gen Surg Ped OR Oncology OR Ophth

Example Doctors to be used for Demo in WTIS Training 2012 • OR ORTHO:

o Steven MacDonald |UH

• OR Dentistry:

o Henry Lapointe | UH

o Jerrold Armstrong | UH

• OR Gen Surg:

o Muriel Brackstone |

o Daryl Gray | VH

o Christopher Vinden

o Edward T Davies

• OR Oncology:

o Stephen Powers (Gyn + OBS)

Version: V1| Date: 2013/11/15 Page 1


*Primary Surgeon Enter the last name of the Surgeon who is requesting the OR time. If there is more than one with the same last name, then multiple matches will appear next to the name. Click on the binoculars to select the correct name from the list.

*Encounter Type You will now need to select the Encounter Type (One Day Stay, Inpatient or Same Day Admission) it will not default in. The field is required and will be highlighted in yellow.

*Waitlist Priority Select the appropriate priority from 1 being Most Urgent to 4 being Less Urgent.

*WTIS Service Details Gen Surg Select the appropriate Service Details from the list. This list is based on the appointment type selected for the OR booking.

*Date Decision to Treat The Date of Decision to Treat should accurately reflect the date when both the surgeon and the patient have mutually agreed to proceed with a service. Please be advised that this is not the operation date, but rather the date of the decision to proceed with a surgical procedure.



This is NOT the OR date. If this date is entered as a future date you will receive an error message

*Admitting/Pre Op Diagnostics Enter the Diagnosis at the time of Scheduling – this is a free text field

*Dx_Planned Procedure (to send to PreAdmit) Enter the name of the planned procedure – this is a free text field, unapproved abbreviations are not acceptable (see website link below)

LHSC: http://www.lhsc.on.ca/priv/periop/or/policies/abbrev.htm SJHC: http://intra.sjhc.london.on.ca/ptcare/docs/units/periop/docs/pdf/PGA-002.pdf

Expected Length of Stay Enter the expected length of stay for the patient in number of days. This field is mandatory for all inpatient and same day admits.

PAC Note Enter any notes relevant to the booking of the PreAdmit appointment. For example, Diagnostic test done off site; Patient prefers mornings; Patient requests telephone interview; Patient arriving via Voyageur etc.


http://www.lhsc.on.ca/priv/periop/or/policies/abbrev.htm

http://intra.sjhc.london.on.ca/ptcare/docs/units/periop/docs/pdf/PGA-002.pdf


Special Considerations Enter any special considerations for the patient. These may not be known at the time of scheduling and can be entered at a later date.

Users can select up to 7 special considerations by clicking on the yellow asterisk and then selecting another consideration. Repeat these steps until all considerations have been entered. (See example below)

The order of the considerations can be rearranged by highlighting the item and using the up and down arrows to reposition that particular consideration in the list.

*Anesthesia consult requested? Select ‘Yes’ or ‘No’ if an Anesthetic consult is required.

Medical consult requested? Select ‘Yes’ or ‘No’ if a Medical consult is required.



Interpreter required? Enter ‘Yes’ or ‘No’ for an Interpreter being required.

If the Interpreter required field is set to ‘Yes’ then a language MUST be selected.

Accommodation Requested by patient Enter patient’s requests, if any.

Responsibility for Payment Enter the method of payment. The field will default to Ontario Health Insurance Plan. If this is not the appropriate payment method then please make the change by selecting another option from the drop down menu.

Anonymous Patient If the patient wishes to be anonymous at the time of surgery, enter ‘Yes’. The default is set to ‘No’. This will mean that the patient’s name will not print on most of the OR lists.

Add On Case (Periop booking Use Only) This field will not be used by Secretarial staff



Referral Type-Surgery and Reasons

Referral Types

NEW Referral A referral for a patient who is seeing a clinician for the first time, or an existing patient with a new referral to the same clinician.

RE Referral A referral for a patient who has already seen a clinician or is seeking a second opinion which includes secondary referrals for complex/staged procedures.

No Referral/Follow up-Existing Patient (New Condition)

A patient who returns to see the clinician with a new condition, but has no new referral. This could include a patient who has an unexpected surgery without a referral for consultation or may include patients where the clinician identifies a new condition during follow-up visits for an existing condition.

No Referral/Follow up-Existing Patient (Recurring Condition)

A patient who returns for ongoing care for a recurring condition. This could include an existing patient.

No Referral/Follow up- No Referral

A patient who sees the clinician without a referral. This could include patients who self-refer for a consultation.

Date of Referral to Specialist Enter the date of Referral to your physician.

Note: While this field is not mandatory for general use in Cerner , it is mandatory for WTIS if the referral was a New Referral or Re-Referral.



Date of Consultation Enter the date of the first Consultation with your physician.

Note: While this field is not mandatory for general use in Cerner , it is mandatory for WTIS if the referral was a New Referral or Re-Referral.

DARCs and DARTs

DARC

DARC stands for Dates Affecting Readiness to Consult

Periods of time between the referral and consult date when the patient is unavailable for a first consultation due to patient-related reasons. The time will be subtracted from the overall Wait 1. The patient-related reasons do not include system-related delays such as surgeon unavailability, emergency closures or reduced clinic hours.

There are 3 fields available for PATIENT RELATED reasons for delaying Consult. Enter the start date, end date and reason for all delays, even if only for a single day, as this will affect Wait Time reporting.



DART

DART stands for Dates Affecting Readiness to Treat

Periods of time between the Decision To Treat (DTT) date or the Order Received date and the Actual Procedure date when the patient is unavailable for the procedure due to patient-related reasons. The period of time will be subtracted from the overall Wait 2. The patient-related reasons do not include system-related delays such as clinician technician unavailability, operating room closures, or scanner downtime.

There are 3 fields available for PATIENT RELATED reasons for delaying treatment. Enter the start date, end date and reason for all delays, even if only for a single day, as this will affect Wait Time reporting.

Note:

You must enter the start date, end date and reason fields if you do not fill in all the fields you will receive the following error message



Consult (Wait 1) and Surgery (Wait 2) System Delay Reasons These delay reasons are not subtracted from the wait time but provide valuable information to Leaders, Wait Time Office and Access to Care on long wait cases.

Select one or more reasons why there is a non-patient reason for a delay in conducting the:

• Consult: Wait 1

• Surgery: Wait 2

Wait 2 Delays

Emergency Closures Procedure delayed due to unforeseen unavailability of healthcare resources, i.e.: infectious outbreak, extreme weather

Lack of Hospital Resources

Procedure delayed due to the unavailability of non-surgeon staff, beds, operating room time.

Patient Preference Procedure delayed due to patient’s choice to remain on waitlist of a particular clinician or at a particular location despite being offered another option.

Prerequisites Not Completed

Procedure delayed due to missing or incomplete patient information. i.e.: incomplete labs or tests that are required.

Rescheduled Due to Higher Priority Case

The procedure is delayed to accommodate a higher priority patient.

Surgeon Unavailability Procedure delayed due to surgeon unavailability i.e.: vacation or illness.



Private Surgical Comments: This field will not be used by Secretarial staff.

Public Surgical Comments This field will not be used by Secretarial staff.



ONCE ALL FIELDS ARE FILLED IN, CLICK ON MOVE TO MOVE THE

APPOINTMENT DETAILS TO THE WORK IN PROGRESS AREA The Appointment Attributes window will open for you to fill in more details for the surgery being requested.

In the Order Search field, type in part of the procedure that will be performed and then press enter to see the list available.

Double click on the appropriate procedure in the Privileged Orders list to open up the fields in the right hand pane.

If there will be more than one surgical procedure performed at the same time, then repeat the steps above to select another surgery.



Once all of the procedures are listed in the center pane under the patient name, click on each procedure one at a time to fill in the procedure details on the right hand side as shown below.

There can only be one Primary procedure without overriding the system. Remember to change the other procedures to reflect that they are not the Primary procedure and enter if they will be concurrent or not.

Note: Contact OR booker if you need to book multiple surgeons.

Procedure Duration The procedure duration is entered under the Primary procedure. No times are entered under the other procedures.

Click on the Override radial button and enter the total time the physician will need for the procedure. There is no need to distinguish between setup and cleanup time.

Once the order information is complete, click on OK and the appointment will move to the work in progress.

If the patient is having more than one Primary procedure, then each surgeon will send a separate request for their procedure. Please indicate in the Procedure Free Text field the name of the other surgeon and procedure.



Click on OK and the appointment will move to the work in progress.

CLICK ON NEXT TO COPY INFO FOR PRE-ADMITTING For Adult patients only

Click on Next – if you do not click on next, you will over write the first appointment and will have to re-enter the information



Change the appt. type to a PreAdmit appointment type. Select the PreAdmit location.

Click on Move

The second appointment will appear in the work in progress.

Both appointments are ready to be sent to the Request list.

SEND PREADMIT TO THE REQUEST LIST The PreAdmit appointment will be highlighted, click on Request on the right hand side of the work in progress window.

The Request for Book window will appear.

Change the Appointment Date requested date range to reflect the surgery date, leave the end date blank.

The time should default to 0000 to 2359. Do not change.

If the surgery date is not known at the time of the request, enter 2100/01/01 as a default and then modify the request when the date is known.

Review the information in the selected request lists area to ensure that both the physician and the site specific PreAdmit appear in the list then click on OK.



This appointment is now on the PreAdmit request list.

SEND THE OR APPOINTMENT TO THE REQUEST LIST Click on the resource name in the Work in progress for the OR Appointment as shown below.

Click Request.

Change the Request date range and time to reflect the specific date and time of the surgery.



The Physician and site specific OR will appear in the selected request lists. (See print screen on next page)

Change the Appointment Date requested date range to reflect the surgery date, leave the end date blank.

Change the time to reflect the surgery date and time.

If the surgery date is not known at the time of the request, enter 2100/01/01 as a default and then modify the request when the date is known.

Review the information in the selected request lists area to ensure that both the physician and the site specific OR appear in the list then click on OK.

Click on OK to send the appointment to the request list.

Work in Progress should be empty and both appointments have been sent to the request list.

HOW TO VIEW THE REQUEST LIST

Click on the Request List Inquiry icon on the action bar in the scheduling book.

In the Inquiry field choose Surgical Request List Inquiry from the drop down menu.

In the Request List Queues, select the appropriate physician specific request list from the drop down menu.



Click Find

Note: the Request List Inquiry can be minimized for the day and refreshed by clicking on the Find button. This will save time in not having to reselect the Inquiry options.

How to Adjust Columns + To adjust the order of the columns you prefer to view

Right click on the column headers and select Preferences



Highlight the column you wish to move, then use the up and down arrows on the right to move the column.

If you wish to remove a column heading, highlight the column heading and choose Move

Click OK to save the changes

New Column Headings added as of June 2010

Mode of transportation

Waitlist Priority

HOW TO MODIFY THE REQUEST DETAILS ONCE SENT TO THE REQUEST

QUEUE

Click on the Request List Inquiry icon on the action bar in the scheduling book and follow the previous instructions for viewing the list of Requests.

Right click on the request to modify

Select Modify Request from the menu

Click on the Scheduling Criteria Tab

Change the requested date range and time to the date and time of surgery.



Click OK

Note: You can select both the PreAdmit and the OR request at the same time when you need to change the information for both requests.

To do so, select the first request for the patient by left clicking on that row to highlight the patient.

Hold the Ctrl key down and left click on the second request for the patient.

The Modify Request window will appear with both requests in the left hand pane as shown below.

Click on the first request; modify the date for the PreAdmit request to reflect the surgery date as the end date.

Now click on the OR request and modify both dates and the time to that of the surgery date and time.



HOW TO MODIFY THE APPOINTMENT DETAILS ONCE SENT TO THE

REQUEST QUEUE From the Surgical Request Inquiry, right click on the request and select modify from the menu. Similar to Modify request, you can select both the PreAdmit and the OR request at the same time in order to change the information in both requests.

Click on the details tab to modify any of the appointment details for this request

For example, you may have not known the exact length of stay of the patient or the special considerations at the time of the original request. Now that the information is known, you can modify the request.



If changes to the surgical procedures are required, click on the Orders tab to modify the original request.

HOW TO CANCEL A REQUEST From the Surgical Request List Inquiry, highlight both the PreAdmit and the OR request by holding down the Ctrl key and left click each request you wish to cancel.

Right click on the highlighted area and select Cancel Request from the menu.



Click on the first request on the left hand side of the Cancel window and select the appropriate reason from the drop down list by typing the letter “O” to bring all OR reasons to the top of the list

(Please see attached list for appropriate reasons)



TO VIEW A REQUEST ONCE IT HAS BEEN CANCELED In the inquiry choose “Canceled request by Queue”

Enter your physician

Time frame you wish to view in the Start Date and End Date

Choose find and your canceled request list will now be viewable

Note:

If a patient dies in one of our hospitals, (deceased date/time entered and deceased indicator = yes), then the surgical order is automatically canceled and the appointment request gets canceled. The action appears to be entered by a user called "System, System".

However, if the patient dies outside of the hospital, then the surgeon's secretary would have to manually go to the request queue and manually cancel.

Appointment requests stay on the queue until scheduled or canceled. There is no other auto-removal.

You must contact the OR for any changes once the request has been scheduled to the OR Grid and or Pre Admit Scheduling bookshelf, you cannot make changes yourself.

If they are canceled, there are scheduling inquiries to view cancellations by queue, appointment type or person.



SurgiNet Cancellation Reason Examples Those not used by secretaries

OR Anaesthesia unavailable Double booked, personal crisis, sick

OR Bed unavailable - ICU/CCTC

OR Bed unavailable - nursing unit

OR Blood unavailable

OR Bumped for urgent/emerg case Any case that takes medical priority over another case

OR Bumped for transplant (LHSC only)

Any donor/recipient procedure, excluding DCD

OR Cancelled by surgeon When no other explanation given, cancelled more than 24 hours in advance

OR Booking Clerks only

OR Data entry error Change patient type, incorrect name, pin procedure, duplicate request

OR Booking Clerks only

DCD patient exceeded time limit (LHSC only)

2 hour time limit exceeded Board Cases Only

OR Equipment/supply related (excluding litho at SJHC)

fleuro, instrumentation, loaner equipment, OSI table not available

OR Litho equipment down (SJHC only)

OR Nursing unavailable personal crisis, sick

OR Previous Case Overrun Previous case runs past allotted time

OR Organ not suitable for transplant (LHSC)

Enzymes off, time limit exceeded

OR Organ went elsewhere (LHSC only)

Taken to another hospital

OR Patient Cancelled Self Personal emerg, weather, cold feet

OR Patient condition Improved Patient got better

OR Patient condition Deteriorated Patient got worse

OR Patient deceased

OR Patient no show No notification from patient day of surgery

OR Patient not cleared medically Lab work unsuitable, no anaesthesia consult, sleep apnea

OR Patient not NPO Ate/drank before surgery

OR Patient went elsewhere Went to another hospital/clinic

OR Physical environment bomb threat, CJD, fire, humidity, flood, no heat, SARS

OR Rescheduled to earlier/later date Booking Clerks Only

OR Support staff unavailable Perfusion, imaging



SurgiNet Cancellation Reason Examples Those not used by secretaries

OR Surgeon unavailable Double booked, personal crisis, sick

System troubleshooting Not used by periop staff Information Management

OR Time Change only (booking clerk only)

Date remains the same but different time Booking Clerks Only

HOW TO PRINT A SURGICAL LIST

On the Appbar, click the Explorer Menu button to open the menu.

Under the Scheduling Reports there are two main reports that will provide you with the surgical information.

• Sched Resource Summary by Surgery Date

• Patient List by Resource Group (in the Outpatient clinic menu folder)

To enter the report criteria, double click on the report name and the right hand pane will be populated with the fields that are required to run the report.

If you would like to print the report rather than view it, enter the RP number in the printer name field.



Patient List by Resource Group

Sched Resource Summary for Surgery Cases


Wait Time Information System (WTIS) · OR Gen Surg OR Gen Surg Ped OR Oncology OR Ophth . Example...

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