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Eye Surgery: 
After-Hours Scheduling 

Effective 1/01; rev. 7/04
Palman, Karen Dumond, J. Allyn

** This Section will be updated to reflect changes now that the Scarborough Surgery Center (SSC) is open**
**See also the Off-Campus Page for additional info on access to the SSC after-hours**

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WeekDAYS
Evenings & Weekends
Nights
Phone Numbers

WeekDAYS: 
     0700-1700 Monday - Friday)
Surgeon will call the BSC OR (879-8214) to schedule eye emergencies for off hours.
Emergencies have been defined by the Ophthamology Service as:

  -Angle closure glaucoma that cannot be treated with laser
  -Vitrectomy for enophthalmitis
  -Any open globe diagonal corneal or scleral laceration or perforation
  -"Macula on" retinal detachment with rapidly progressive loss of peripheral vision
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Evenings & Weekends: 
     M-F           1630-2300  
     Sa/Su/Hol. 0700-2300 

   A. Surgeon will call the Brighton on-call nurse, who will  tell the surgeon when s/he is available to do the case, and how much  time will be needed for patient activation, preop preparation and room setup time.

   B. Surgeon will then page the Anesthesia floor walker (610) at the Bramhall OR to discuss medical condition of the patient, determine anesthesia resource availability, and case start time, giving consideration to the patient and room preparation time mentioned above. They will agree on a case start time.

   C. Surgeon will notify patient of arrival time to BSC, and notify BSC OR about the agreed-upon start time.
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Nights:
     2300-0659 hrs.

Brighton Surgical Center (BSC) is not on call between  11 PM and 7 AM. Cases during that time generally are covered by the MMC Bramhall OR staff, as needed. Eyelid and corneal lacerations or enucleations should be able to be covered by the Bramhall OR using the eye microscope and other equipment that is onsite.

For cases that require Brighton staff's expertise (or equipment), and that truly can't wait until morning, BSC staff has expressed willingness to respond, as available. The surgeon should have the Brighton switchboard page the call the team who was on call until 11PM and solicit their willingness to come in to care for the patient.

Per John Allyn 5/19/04:
Surgeons expected  to do simple stuff at MMC after 11pm, otherwise start at 0600-0630 and "bump" the eye room rather than do the case at 0200.  
If a True "open globe emergency" - BMC staff will be called and asked to cover 11pm - 7am.  This is a very rare event. (only seven cases in 8 years).  
Surgeons may not book a case between 11pm - 7am before 10pm - i.e. the case either needs to be done immediately with BMC call team used, or added on at the back of the next day's schedule.

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Pediatric & Pedi Heart Call
Anesthesia Staff Call: (Kovarik, rev. Jan 06)

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Guidelines for Establishing Priorities on Urgent/Emergent OR Cases
  Brad Cushing, K. Dumond, 11/2009

download as pdf document 

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Appendix A

I. Emergent: Life, limb or important bodily functions immediately threatened. Examples include;

1. Ruptured aneurysm
2. Unstable cardiac cath lab crash
3. Major trauma
4. Acute arterial occlusions with threatened limbs
5. Acute head trauma with deteriorating neurological function
6. Surgical relief of compartment syndrome
7. Acute intracerebral or intraspinal processes with deteriorating neurological function
8. Uncontrolled hemorrhage: post op, intracavitary, external GI
9. Neck hematoma or abscess threatening airway
10. Any procedure to relieve threatened airway obstruction
11. Perforated viscus with peritonitis and hemodynamic instability
12. Optic nerve decompression

II. Medically Urgent

1. Ongoing hemorrhage requiring no more than one unit transfusion per two hours
2. Contained perforated viscus hemodynamically stable
3. Open facial fractures
4. Open extremity fractures
5. Intra-abdominal abscess
6. Small or large bowel obstruction
7. Possible appendicitis, cholecystitis or any acute abdomen that is without peritonitis and hemodynamic instability
8. Coronary bypass, valve or any other cardiac procedure in a patient who can only be stabilized by an aortic balloon pump or temporary coronary stenting
9. Kidney transplants
10. Traumatic hip dislocations (most of these will be done outside of the operating room, but may require general anesthesia. They rank high on the urgent priority list. Dislocation of an artificial hip prosthesis however is generally not an urgent case)
11. In house trauma and burn cases requiring delayed operation or re-operation

Ophthalmology:
1. Angle closure glaucoma that cannot be treated with laser
2. Vitrectomy for endophthalmitis
3. Any open globe diagonal corneal or scleral laceration or perforation
4. "Macula on" retinal detachment



III. Administratively Urgent:
Any case scheduled more than twelve hours prior to anticipated surgery would be considered in this category. These will primarily be patients in house with whose surgery required this admission.

1. Consideration should be given to adding this case to the next day's elective schedule, if feasible.
2. These cases will be done if there is sufficient OR and anesthesia staff and time.
3. These cases will be deferred until categories one and two cases are completed
4. Ophthalmology cases include impending corneal perforation intraocular foreign body, corneal foreign body and a child requiring general anesthesia, examination under anesthesia for ocular trauma and a child phacolytic glaucoma

IV. Others:
Operation could be postponed at least 24-48 hours. These patients may be operated on if there is sufficient time, space and personnel available. If it is felt that doing these cases would compromise the overall performance of the operating room, they will be differed to a later date. Examples include;

1. Cases scheduled more than 18 hours prior to anticipated surgery
2. Weekend/holiday same day admissions unless there is a clearly documented reason for greater urgency
3. Long cases i.e., longer than 5 hours that medically could wait 24 hours or more

Additional Points

1. Policy for "bumping" cases for emergency has been outlined and accompanies this document.
2. Cases that were scheduled the day before and were bumped for non medical reasons will be given some priority as long as it does not compromise the care of the more acutely ill patients.
3. Broadly speaking, the sequence of cases will be established on the basis of these categories. Within each category in general it will be first come, first served. However, modifications of the schedule within each category will be made at the discretion of the attending anesthesiologist of the day to meet medical priorities.
4. Surgeons are encouraged to speak directly with the anesthesiologist of the day to explain the relative urgency of their case.
5. If there is disagreement the attending anesthesiologist of the day will be the final arbitrator of the sequence of cases.