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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: [Moved to Appointments]

Note: Surgery scheduling is now handled under UC-APPT-010: Schedule Surgery to centralize all scheduling workflows.

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

UC-OT-009: OT Worklist Dashboard

Purpose: Provide a dynamic, real-time view of daily surgery schedule for OT teams.

Property Value
Actor OT Coordinator / Surgeon / Anesthesiologist
Trigger OT staff views daily schedule
Priority P1

Main Success Scenario: 

1. Display daily OT schedule:
   - All scheduled surgeries
   - OT room allocation
   - Surgeon and anesthesiologist assigned
   - Estimated start/end times
2. Real-time status tracking:
   - Waiting → In Progress → Completed
   - Delays and overruns highlighted
   - Patient ready status
3. Quick actions:
   - Swap OT rooms
   - Bump/reschedule cases
   - Mark case complete
4. Filter and view options:
   - By OT room
   - By surgeon
   - By surgery type (elective/emergency)
5. Notifications:
   - Next case alerts
   - Delay notifications to waiting patients
   - Turnaround reminders

Acceptance Criteria:

  1. [ ] Real-time schedule display
  2. [ ] Status updates visible to all stakeholders
  3. [ ] Room swap functionality
  4. [ ] Delay tracking and alerts
  5. [ ] Integration with scheduling system

UC-OT-010: Post-Operative Complication Tracking

Purpose: Document and grade post-operative complications using standardized classification (Clavien-Dindo).

Property Value
Actor Surgeon / Resident / QA Team
Trigger Post-op complication occurs
Priority P1

Main Success Scenario: 

1. Log complication:
   - Patient and surgery reference
   - Date of occurrence (POD - Post-Op Day)
   - Type of complication
2. Classify severity (Clavien-Dindo):
   - Grade I: Minor deviation, no intervention
   - Grade II: Pharmacological intervention
   - Grade IIIa: Intervention without GA
   - Grade IIIb: Intervention under GA
   - Grade IV: Life-threatening (ICU)
   - Grade V: Death
3. Document management:
   - Intervention performed
   - Outcome
   - Resolution date
4. Link to patient record:
   - Surgery details
   - Relevant imaging/labs
5. Generate reports:
   - Surgeon complication rates
   - Procedure-specific morbidity
   - Trend analysis

Acceptance Criteria:

  1. [ ] Clavien-Dindo classification system
  2. [ ] Link to original surgery
  3. [ ] POD (post-op day) tracking
  4. [ ] Complication rate analytics
  5. [ ] Quality dashboard integration

UC-OT-011: Surgical Diagram Upload

Purpose: Allow surgeons to upload or annotate diagrams documenting surgical findings and procedures.

Property Value
Actor Surgeon
Trigger Intra-op or post-op documentation
Priority P2

Main Success Scenario: 

1. Select diagram template:
   - Body region templates (abdomen, thorax, pelvis, etc.)
   - Organ-specific templates
   - Blank canvas option
2. Upload or annotate:
   - Camera/photo upload from device
   - Draw annotations on template
   - Mark incision sites, findings
   - Label anatomical landmarks
3. Document findings:
   - Text notes linked to markings
   - Tumor location/size
   - Lymph node involvement
   - Resection margins
4. Attach to operative note:
   - Link diagram to surgery record
   - Include in patient timeline
5. Export/share:
   - Include in tumor board packet
   - Print for patient education

Acceptance Criteria:

  1. [ ] Pre-built anatomical templates
  2. [ ] Image upload capability
  3. [ ] Drawing/annotation tools
  4. [ ] Integration with operative notes
  5. [ ] Export to PDF/image

UC-OT-012: Surgeon Case Log

Purpose: Maintain a case log for surgeons for training, credentialing, and audit purposes.

Property Value
Actor Surgeon / Resident / Credentialing Committee
Trigger Surgery completed
Priority P2

Main Success Scenario: 

1. Auto-populate from completed surgeries:
   - Date, Patient (anonymized if needed)
   - Procedure performed (CPT/ICD codes)
   - Role (primary surgeon, assistant, supervised)
   - Complexity level
2. Manual entry for external cases:
   - Surgeries at other facilities
   - Training/fellowship cases
3. Track by procedure type:
   - Oncological procedures by site
   - Minimally invasive vs. open
   - Emergency vs. elective
4. Generate reports:
   - Case volume by period
   - Procedure type breakdown
   - Supervision ratio (for residents)
5. Export for credentialing:
   - Certification applications
   - Privileging reviews
   - Board requirements

Acceptance Criteria:

  1. [ ] Automatic log from OT system
  2. [ ] Manual entry for external cases
  3. [ ] Role tracking (primary/assistant)
  4. [ ] Procedure categorization
  5. [ ] Export for credentialing

Document Owner: OT Manager / IT Lead
Last Updated: 2025-12-26
Related: Bed Management | Appointments | Billing