Complete guide to Australian hospital surgical services — operating room management, ERAS (Enhanced Recovery After Surgery) pathways, surgical safety (WHO checklist), RACS standards, theatre efficiency, and surgical software.
RACS sets Australian surgical standards. WHO Surgical Safety Checklist is mandatory (NSQHS Standard 5). ERAS reduces LOS by 2-3 days. This guide covers Australian surgical services.
OR Management Components
| Component | Description | Target |
|---|---|---|
| OR utilisation | Percentage of available OR time used | 75-85% |
| On-time starts | First case on-time start rate | > 90% |
| Turnover time | Time between cases | < 25 minutes |
| Cancellation rate | Same-day cancellation rate | < 5% |
| Surgical safety checklist | WHO checklist compliance | 100% |
| Antibiotic prophylaxis | Antibiotic within 60 min of incision | > 95% |
| SSI rate | Surgical site infection rate | < 2% |
| Surgical mortality | 30-day mortality (ANZASM) | Within expected |
ERAS Pathway for Common Surgeries
| Surgery | Traditional LOS | ERAS LOS | Key ERAS Elements |
|---|---|---|---|
| Colorectal surgery | 7-10 days | 3-5 days | No bowel prep, early feeding, early mobilisation |
| Hip replacement | 5-7 days | 2-3 days | Regional anaesthesia, early mobilisation, multimodal analgesia |
| Knee replacement | 5-7 days | 2-3 days | Regional anaesthesia, early mobilisation, multimodal analgesia |
| CABG | 7-10 days | 4-6 days | Early extubation, early mobilisation, early feeding |
| Hysterectomy | 3-5 days | 1-2 days | Minimally invasive, early mobilisation, early feeding |
| Caesarean section | 3-4 days | 1-2 days | Early feeding, early mobilisation, early bonding |
Surgical Safety
- WHO Surgical Safety Checklist: Sign In, Time Out, Sign Out for every procedure
- Antibiotic prophylaxis: Within 60 minutes of incision, correct antibiotic and dose
- VTE prophylaxis: Risk assessment and appropriate prophylaxis
- Normothermia: Maintain normal body temperature during surgery
- Glucose control: Blood glucose management for diabetic patients
- Instrument count: Count instruments and swabs before and after surgery
- Specimen labelling: Correct labelling of all specimens
- Surgical audit: Participate in RACS surgical audit and peer review
- Mortality review: ANZASM review of surgical mortality
Frequently Asked Questions
- What is RACS?
- RACS (Royal Australasian College of Surgeons) is the professional body for surgeons in Australia and New Zealand. RACS: 1) Sets surgical training and examination standards, 2. Maintains surgical competence standards, 3. Publishes surgical guidelines, 4. Runs the Surgical Audit and Peer Review programme, 5. Manages the Australian and New Zealand Audit of Surgical Mortality (ANZASM).
- What is the WHO Surgical Safety Checklist?
- The WHO Surgical Safety Checklist is mandatory in Australian hospitals (NSQHS Standard 5). It has 3 phases: 1) Sign In (before anaesthesia — patient identity, procedure, consent, allergies), 2. Time Out (before incision — team introduction, antibiotic prophylaxis, imaging), 3. Sign Out (before patient leaves OR — instrument count, specimen labelling, post-op plan). Checklist compliance is audited.
- What is ERAS and is it used in Australia?
- ERAS (Enhanced Recovery After Surgery) is widely used in Australian hospitals. ERAS pathways: 1) Pre-op education and optimisation, 2. No prolonged fasting, 3. Carbohydrate drink, 4. Regional anaesthesia, 5. Minimally invasive surgery, 6. Early mobilisation, 7. Early nutrition, 8. Multimodal analgesia. ERAS reduces LOS by 2-3 days and complications by 30%.