OT QA

Here is the comprehensive Quality Assurance (QA) framework for Operation Theatres (OTs).

I have grouped 05. ED OT, 06. General OT, and 07. CVTS OT together because they share the same "Core OT Standards" (Sterility, Anesthesia Safety), but I have also detailed the specific unique indicators for each type.

Core QA Framework (Applicable to ALL OTs: 05, 06, 07)

These are the non-negotiable NABH 6th Edition & WHO Surgical Safety requirements.

A. Patient Safety & Process Indicators

1. WHO Surgical Safety Checklist Compliance:

   • Indicator: % of surgeries where the "Sign In" (Before Induction), "Time Out" (Before Incision), and "Sign Out" (Before shifting) were verbalized and documented.

   • Target: 100% (Zero tolerance for missing Time-Outs).

2. 
   

3. Surgical Site Infection (SSI) Rate:

   • Indicator: Infections occurring within 30 days of surgery (or 90 days for implants).

   • Formula: (Number of SSIs / Total Surgeries) x 100.

   • Benchmark: < 2% (varies by wound class: Clean vs. Contaminated).

4. 
   

5. Adverse Anesthesia Events:

   • Indicator: Rate of complications such as dental injury, difficult intubation (requiring unplanned fiberoptic), aspiration, or cardiac arrest during anesthesia.

6. 
   

7. Unplanned Return to OT:

   • Indicator: Patients taken back to OT within 24-48 hours for complications (Bleeding, leak, dehiscence).[1]

   • Significance: High rate indicates poor surgical technique or hemostasis.

8. 
   

9. OT Utilization Rate:

   • Indicator: (Actual hours cases were running / Staffed OT hours) x 100.

   • Target: > 85% (Low utilization = wasted resources; > 100% = burnout/overtime).

10. 
    

B. Infection Control & Environment[1][2][3][4][5]

1. Flash Sterilization Rate:

   • Indicator: % of trays sterilized using "Immediate Use" (Flash) cycles.

   • Target: Near 0% (Should only be used for dropped instruments, not for routine set turnover).

2. 
   

3. Prophylactic Antibiotic Compliance:

   • Indicator: % of patients receiving the correct antibiotic within 60 minutes prior to incision.

4. 
   

5. Bio-Burden / Sterility Audits:

   • Monthly: Settle plates (Air culture) and Swab cultures (OT light, O2 regulator, Floor).

   • Weekly: Spore testing (Biological Indicator) of Autoclaves.

6. 
   

7. Zoning Compliance:

   • Audit: Strict adherence to the 4 Zones (Protective, Clean, Aseptic, Disposal).[1] ensure no street shoes/clothes in the Aseptic zone.

8. 
   

05. ED OT (Emergency OT) Specific QA

Focus: Speed, Readiness, and "Damage Control".

1. Decision-to-Incision Time (Category 1 Emergencies):

   • Indicator: Time from the Surgeon's decision to the skin incision.

   • Benchmark:

     • Crash C-Section: < 30 minutes.[1][6][7]

     • Ruptured Ectopic / Trauma Laparotomy: < 45-60 minutes.[1]

   • 
     
2. 
   

3. Sterile Tray Stock-out Rate:

   • Indicator: Incidents where a specific emergency set (e.g., Craniotomy set) was not ready/sterile when needed.[1]

4. 
   

5. After-Hours Staffing Response:

   • Audit: Time taken for the "On-Call" OT Sister/Technician to reach the OT at night (if not resident 24x7).

6. 
   

7. Damage Control Surgery Survival:

   • Clinical Indicator: Survival rate of trauma patients undergoing "Damage Control" (packing) vs. definitive surgery in the first setting.

8. 
   

06. General OT Specific QA

Focus: Schedule Adherence, Laparoscopic Safety, and Turnover.

1. Case Start Time Accuracy (First Case On-Time Starts):

   • Indicator: % of first cases starting at the scheduled time (e.g., 8:00 AM).

   • Common Delays: Surgeon late, Patient not shifted, AC not cooling.

2. 
   

3. Turnover Time (TAT):

   • Indicator: Time from "Patient A Wheels Out" to "Patient B Wheels In".

   • Target: < 20-30 minutes (Includes cleaning and setting up new trolley).

4. 
   

5. Rescheduling / Cancellation Rate:

   • Indicator: Surgeries cancelled on the day of surgery.

   • Reasons: Patient ate food (NPO violation), BP high, Lack of OT time.

6. 
   

7. Laparoscopic Conversion Rate:

   • Clinical Indicator: % of Laparoscopic cases converted to Open surgery. (High rate might imply poor patient selection or resident training issues).

8. 
   

07. CVTS OT (Cardiothoracic) Specific QA

Focus: Perfusion Safety, Hemodynamics, and Blood Conservation.

1. Pump Run Time & Cross-Clamp Time:

   • Indicator: Monitoring duration of Cardiopulmonary Bypass (CPB).

   • Significance: Longer times correlate with higher post-op morbidity (renal failure, stroke).

2. 
   

3. Re-exploration for Bleeding:

   • Indicator: Return to OT for mediastinal bleeding/tamponade.

   • Benchmark: < 3-5%.[8]

4. 
   

5. Blood Product Utilization Index:

   • Indicator: Average units of PRBC/FFP/Platelets used per uncomplicated CABG.

   • Goal: Implementation of "Blood Conservation Strategies" (Cell saver usage).

6. 
   

7. Leg Wound Infection Rate (Harvest Site):

   • Specific SSI: Infection rate at the Saphenous vein harvest site (often overlooked compared to sternal wound).

8. 
   

9. STS Score (Society of Thoracic Surgeons) Benchmarking:

   • Advanced QA: Comparing observed mortality vs. expected mortality based on STS risk score.[1]

10. 
    

Academic & Medical College Specific QA for OTs

Since this is a training institute, these are mandatory.

1. Resident "Cut-to-Close" Rate:

   • Indicator: % of cases performed by Senior Residents under supervision.

2. 
   

3. Logbook Verification:

   • Audit: Cross-checking the OT Register with the Resident's e-Logbook (NMC requirement).

4. 
   

5. Surgical Safety Seminar:

   • Process: Monthly Morbidity & Mortality (M&M) meeting specifically discussing OT complications (anesthetic or surgical).

6. 
   

7. Specimen Labeling Audit:

   • Audit: Ensuring Pathology forms for biopsies are filled by the surgeon inside the OT, not delegated to untrained staff.

8. 
   

Implementation Checklist for OT Matron/Manager

Daily (Morning):

AHU Check: Temperature (18-22°C) and Humidity (40-60%) logs verified for all theaters.
Narcotic Check: Physical count of Fentanyl/Morphine ampoules (broken and full) with the Anesthetist.
Crash Cart Defibrillator: Test discharge (30J) to ensure paddles work.
Suction Pressure: Check vacuum pressure in all ports (essential for aspiration).

Between Cases:

Cleaning Protocol: "Wet mopping" with disinfectant performed?
Bio-waste Clearance: Yellow bins replaced?

Monthly:

Air Culture Reports: Review settle plate reports from Microbiology. (Any growth of Staph aureus or Aspergillus requires immediate OT shutdown and fumigation).
Lead Apron Check: (For C-Arm OTs) Visual inspection for cracks.[1]
Surgeon Hand Scrub Audit: Observe random staff doing surgical scrub (Time > 3 mins? Elbows kept high?).