Whether you are a veterinarian in a high-volume spay-and-neuter practice, a referral specialty practice performing complex procedures, or anywhere in between, efficiency during the perioperative period will make the day smoother and more enjoyable for all involved. A streamlined day of surgical procedures often starts well before the procedure itself, with preparation for the client, patient, and team. The layout of the surgical prep area, operating room, and recovery area can help maximize workflow efficiency. Patient preparation Before entering the operating room, the patient should be prepared for the procedure. Any preoperative diagnostics (blood work, radiographs, ultrasound, etc.) should be completed and reviewed by the team prior to formulating an anesthetic plan. Immediately prior to the procedure, the patient is prepared for the operating room. Patient preparation involves placing the intravenous catheter, confirming the procedure to be performed, inducing general anesthesia, shaving the surgical site, initial scrub, and regional or nerve blocks. (Methods of surgical scrubbing and nerve block technique are beyond the scope of this discussion.) The prep space should be well-stocked and organized with all the equipment needed to complete these tasks. Additionally, there needs to be sufficient space for anesthetic monitoring equipment and patient warming devices, while minimizing foot traffic through this part of the hospital. Having this space near radiology is helpful if preoperative radiographs are needed. Operating room Once the patient is prepared for surgery and ready to move into the operating room, the efficiency of the procedure improves with optimally placing the patient, anesthetist, and equipment. The patient table should be positioned so the anesthetist has room to manipulate monitoring equipment and attend to the patient. Overhead lights should be adjustable to illuminate the surgical field. If drop lines are present for oxygen and nitrogen, the hoses should be positioned away from the surgical field to minimize potential contamination and allow the surgeon to move within the surgical field as needed during the procedure. Ideally, multiple operating rooms should be available for different types of procedures. For example, having one operating room dedicated to soft tissue procedures and a second dedicated to orthopedic surgeries is helpful. If more operating space is available, a dedicated operating room for dirty procedures may help limit surgical site infections. Dedicated operating rooms also help with efficient equipment storage. An operating room dedicated to orthopedic surgeries can store implants and other appropriate equipment in the room or nearby, making it easy to locate the right tool when needed. When multiple operating rooms are not possible, the surgical suite can still be optimized with an efficient, clutter-free layout. Surfaces, including countertops, floors, and walls, should be easy to clean. The operating room should be free of clutter and unnecessary supplies. Storage of ancillary equipment in the operating room should be avoided when possible. This reduces opportunities for dust collection and enables thorough, efficient disinfection between procedures. A ceiling track system in the operating room is appropriate for hanging limb prep during orthopedic surgeries. Photo courtesy Dr. Kendra Freeman Patient The operating room should be spacious enough to accommodate a comprehensive range of patients and equipment. The door to the operating room should be wide enough to allow a gurney to maneuver into and out of the room. Once the patient is moved into the operating room, they will need to be placed on the surgery table. The table should be of adequate size for a variety of patient sizes and allow for easy height adjustments. The table should be positioned in the room to facilitate movement around the patient. Team members will need space to position the patient on the table, connect to the anesthesia machine, warming devices, fluids, and all monitoring equipment. For orthopedic surgeries, the limb(s) must be suspended to allow for appropriate preparation and draping. The exact positioning will depend on the procedure to be performed. A track system on the operating room ceiling is ideal for this type of preparation. Once the patient is prepared and draped, the room must have space for all appropriate equipment. Simple procedures may require only a small instrument table. Orthopedic procedures often require multiple sterilely draped tables to accommodate equipment. A computer with a large monitor is helpful for reviewing images during the procedure. Minimally invasive procedures require space for cameras, light sources, insufflation, and viewing screens. Clutter-free counters in the operating room. Drop lines for oxygen and nitrogen are secured away from the surgical field. Photo courtesy Dr. Kendra Freeman Personnel A minimum of two people are needed for a basic procedure, with additional personnel often being helpful. The surgeon should have room to maneuver around the patient. The anesthetist should be able to operate equipment as needed during the procedure. Depending on the procedure’s length and complexity, additional personnel may be helpful. This may include a surgical assistant (scrub technician) and a float–a person who is able to assist the anesthetist, open additional surgical equipment, and leave the operating room to obtain instruments, anesthesia medications, etc. The operating room should allow all necessary personnel to perform their duties without contaminating the sterile field. Anesthesia For appropriate patient monitoring, anesthesia equipment should be well organized and easily accessible for the anesthetist in both the prep area and the operating room. Any instrumentation the anesthetist will need during the procedure should be readily available and close by. Anticipated equipment may include syringes for blood draws, additional catheters, hypotensive treatment medications, materials for recording vital parameters (paper or electronic), and supplies that may be needed on short notice. The operating room should have space for the anesthetist to store additional doses of medications, reversal agents, and medications needed in the event of cardiopulmonary arrest. Equipment From suture material to patient drapes to instruments, surgical procedures can require a large variety of equipment. This equipment should be stored in an organized manner so it may be retrieved quickly. Prior to the start of the procedure, the table drapes, instruments, blades, and suture should be gathered and set aside so they may be opened efficiently. This is especially helpful if equipment is stored nearby, but outside of the operating room. For equipment stored in the operating room, it should be stored in closed cabinets to minimize duct collection and allow for easy cleaning. Clearly labeled bins that can be quickly reached during the procedure are helpful. Pass-through cabinets allow for transfer of smaller equipment in and out of the operating room during a procedure, minimizing foot traffic. Recovery Once the surgical procedure is complete, the patient should ideally travel a short distance for recovery. Patient status and the nature of the procedure will determine where recovery is best–an outpatient kennel close to the operating room for short-term monitoring prior to discharge, or the intensive care unit and hospital admission for further treatment. Although we may not be able to design the perfect preparation area and operating space for our clinic, we can maximize the space available to us by clearly defining areas for patient preparation and surgery and anticipating equipment needs. Ensuring these areas are well-stocked but free of clutter will improve efficiency during surgery. Kendra Freeman, DVM, MS, DACVS (Large Animal/Small Animal), is a graduate of Colorado State University and maintains dual certification with the American College of Veterinary Surgeons. Dr. Freeman is an associate surgeon in Albuquerque, N.Mex. Her caseload consists of orthopedics, general soft tissue, and sports medicine cases, with occasional returns to her roots in large-animal lameness and surgery.
