In this MRCS Part B scenario you are the surgical registrar. The anaesthetist for today’s list has some questions for you.
Principles of ordering a theatre list:
The main priority for list order is the clinical urgency of case. If an operation is needed to save a patient’s life it takes priority regardless of other issues.
Traditionally “dirty” cases and patients with MRSA are put last on the list to facilitate adequate cleaning of the operating theatre.
This is not always necessary provided the cleaning of relevant surfaces can be done adequately before the next patient. After the patient has left any surface the have come into contact with should be cleaned with an approved detergent and hot water. It should then be left to dry for at least 15 minutes
Diabetic patients should be placed early on the theatre list, to reduce the chance of hypoglycaemia.
Operative list order can vary from surgeon to surgeon, and in this station, it is not the actual order you place the patients in that scores marks, rather the fact you have shown understanding of how co-morbidities may impact on surgery.
You have limited information about the severity of the patient’s condition, which you should acknowledge. One method to answering this question is to list the patients in order from most major surgery to most minor, and then take into account the comorbidities, placing dirty cases and those with MRSA last – unless they happen to have a good reason to go first e.g. they are diabetic, or the surgery is more clinically urgent, those with diabetes first, and those with major comorbidities early.
This can be quite a quick-fire station, so make sure you give a clear answer before offering an explanation for your reasoning - if the examiner is happy with your answer they may want to just move on to the next question.