Paediatric surgery ‘list orders’ – information for parents and carers

What is a surgery ‘list order’?

Each surgeon is allocated to an operating theatre for the day. Planned operations commence at 08:15 and finish at 18:00. The term ‘list order’ is used to describe the list of children planned to have their operation in a specific theatre by a surgical team on a specific date and the order in which the different children will be operated on.

Who decides the list order?

The order in which children will have their operations is decided upon by the consultant surgeon during the working day before the theatre list takes place.

How is the list order decided?

There are many factors taken into consideration when a list order is compiled. Some factors relate to the patient and others do not:

Patient related factors

• Age; where possible the youngest child is operated on first whilst older children are scheduled for later on the list.
• Underlying condition; some children have underlying conditions which necessitate the position they have on a theatre list. For example, children with diabetes need to be prioritised to have their operations early in the morning.
• Type of operation needed; for example, there may be a need to get a biopsy to the laboratory for analysis before a certain time.
• Allergies to anaesthetic medications; it is very rare for children to be allergic to anaesthetic medications but those that are have to be operated on first.
• Presence of Methicillin-Resistant Staphylococcus aureus (MRSA). MRSA is a particular type of Staphylococcus aureus, a common bacteria which 3 in 10 of us carry naturally, that has developed resistance to a type of penicillin, as well as other types of antibiotics. 'Resistance' means that it is not killed by the antibiotic. Most of the time MRSA just sits on the skin without causing a problem but if it enters the body through a wound it may cause an infection. Specific precautions are required when a child with MRSA undergoes surgery and this can include the need to be last in the list order. A specific information leaflet is available with regards to MRSA; please ask if you would like a copy.

Non-patient related factors

• Equipment – Sometimes there are children on a theatre list who will require the same equipment and therefore we need to allow time for the equipment to be re-sterilised between different patients. Children who will require the same piece of equipment therefore need to be at staggered times on the list order to allow for sterilisation time.
• Equipment – Shared with other teams – occasionally the equipment we need for one child’s operation is also needed by another surgeon in another operating theatre and so we need to schedule the children at times to ensure all required equipment is available
• Post-operative care requirements and recovery time– some children have to fulfil specific criteria before they can be discharged home and will need time to fulfil such criteria (for example; passing urine, parental teaching etc) and so need to be operated on earlier in the day to allow sufficient recovery time.
• Combined procedures with other specialists –sometimes children are undergoing combined procedures with other specialists. The time of the operation needs to be set for a time when all specialists can be available at the same time.

Why might the list order change?

There are various reasons why a list order may change. Some factors relate to the patient and others do not.

Patient related factors:

• If a child attends hospital but is then found to be unwell, their operation cannot proceed, other children’s operations will be moved forward on the list order.
• Occasionally, despite careful planning, it is identified after a child’s admission that repeat tests or investigations are required before their operation can proceed. Completion of such tests takes time and as such the child requiring repeat tests may need a later operating time on the same day (or very occasionally their operation may need to be deferred to a different day). Meanwhile other children will be moved up the list order and so have their operation earlier.
• Length of an operation – Although our surgical team are experienced in estimating the average length of each type of operation, how long each individual operation actually takes cannot be guaranteed in advance. Operations may take more or less time than anticipated for a wide range of reasons and as a result an operating list may run earlier or later than predicted.

Non-patient related factors

• Each operation requires specific equipment to be available. Occasionally the equipment required is not available at the time that we anticipated it would be needed for and so the list order will change in order to ensure that all equipment is available at the time of the operation taking place.
• Some children will require a bed on one of our children’s wards after surgery and some will require a bed in our children’s high dependency or intensive care unit. To maintain the child’s safety it is imperative that children are only operated on when we know that a bed in an appropriate clinical area is available for them following surgery. Where a bed, for example, in intensive care, is not available until later in the day, the child will need to move back on the list order so that their operation takes place later and meanwhile other children will have their operation performed earlier. Sometimes, despite pre booking appropriate beds for post-operative care, emergency admissions result in appropriate beds not being available at all on the day of the child’s scheduled surgery and in such cases, unfortunately, it is necessary to re-schedule the operation for a different day. You will be kept updated in such situations by the nurses and doctors caring for your child
• Unfortunately, sometimes emergency operations need to take place as a priority and as a result the planned list order changes to accommodate such emergency patients. As a result of such emergencies, sometimes, despite our best efforts, some children’s operations will be cancelled and require re-booking for a different day.

What does this mean for my child?

• Your child may be moved to a different position on the operating list and this may result in their operation being earlier or later than originally planned.
• Overall, being able to change the list order prevents cancellations but some children will, as a result of changing the list order, need to wait longer than originally anticipated and despite our best efforts, a few children may need to be re-scheduled for their operation on a different day.
• Your child’sfasting times will have been based on information at the time the list order was made. If your child’s position within the list order moves back your child will be given additional drink where appropriate. You will be kept up to date regarding this.

We appreciate that waiting for your child to have their operation is an anxious time and changes to list orders can add to this anxiety. We assure you that we will do our best to ensure minimal changes are made to our list orders and meanwhile we appreciate your patience and understanding.

If you have any further questions please feel free to ask to speak to the nurse in charge or a member of the surgical team.

For information or questions before or after admission please call:

Clinical nurse specialists……………………………………………….

Ward………………………………………………………………………………