A senior nurse manager working in an endoscopy clinic in the northern suburbs of Melbourne is contemplating issues that have surfaced with the purchase of a new endoscope (colonoscope) used to investigate intestinal problems. This valuable medical equipment now enables the clinic to process its patients more quickly through the operating theatre; however, there now appears to be bottlenecks elsewhere.

Typically, patients begin to arrive at the clinic at 7.30 am. The operating list commences at 8.00 am. There is one administration staff, one surgeon, one anaesthetist, one theatre nurse, one anaesthetic nurse, one recovery room nurse and one recovery lounge nurse. The surgical procedures undertaken are either gastroscopy or colonoscopy.

On a typical morning, the patient is first checked in by the administration personnel (15 minutes).

They are then required to change into a theatre gown before an anaesthetic nurse assessment to ensure they are prepared and physically ready for surgery (30 minutes). The surgeon and anaesthetist find time between procedures to check the patient has signed the operating consent form and understands the procedure about to be undertaken (2–5 minutes). The patient is taken to theatre from the waiting lounge area (by the anaesthetist and anaesthetic nurse). The preparation and administration of initial anaesthetic takes 10–15 minutes. The endoscopy procedure takes anywhere between 10 minutes and 40 minutes depending on the procedure (colonoscopy or gastroscopy) and the complexity of the patient’s condition (total average theatre time 20–55 minutes). The endoscopes are prepared by the theatre nurse for the surgeon. The theatre nurse also assists the surgeon during the procedure. Cleaning, sterilisation and preparation takes 40 minutes for either type of endoscope.

Once the procedure is complete, the patient is then taken to the recovery area by the anaesthetist and nurse where 30 minutes of recovery-room nursing observation is administered:

1:1 (patient:nurse) care is provided (5–10 minutes), and then 3:1 (patient:nurse) care is provided (20–25 minutes). The patient is then moved to the recovery lounge where they are observed by the recovery lounge nurse as they rest on a recliner and are provided with refreshments until they are ready to be dressed and discharged (approximately 60 minutes). The patient is generally discharged about 4.5 hours after arriving at the clinic. The surgeon and anaesthetist only operate morning or afternoon shifts (morning: 8.00 am to 12 midday; afternoon: 2.00 pm to 6.00 pm). Sometimes the lists run overtime, but by no more than one hour.

Required

The senior nurse manager needs to evaluate the maximum number of patient bookings for a typical day and the nursing staff requirements. How might the TOC help with this evaluation?