Sri Venkateshwara Multi-Speciality Hospital · Kukatpally, Hyderabad · 60 beds
AR
Operation Theatre
Two theatres · Saturday 18 July 2026 · 10:47 AM. Booking, safety checklist, sterilisation, implants, recovery and what the day cost.
Cases today
8 of 10 booked
▼ 2 cancelled
Theatre utilisation (projected)
51%
▲ month to date 48%
Theatre time lost today
₹68,774
137 min · late start + 2 cancellations
First case on time
1 of 2
OT-1 started 37 min late
Cost of the theatre standing still
Today, at this month's measured rate per theatre-minute
Owner view
₹68,774
137 minutes of staffed, booked theatre time that produced nothing today.
Late first case
₹18,574
37 min × ₹502 · OT-1, unmarked site at Sign In
Cancellations
₹50,200
100 booked min × ₹502 · 2 cases, reasons recorded below
Turnaround
₹0
13 min average today against your 20-min target — turnaround is not the problem today
Rate per theatre-minute
₹502
₹34.94 L of OT procedure revenue ÷ 6,960 in-theatre minutes, 1–17 Jul
Every figure here is division on numbers this hospital already has: your own billed procedure revenue and your own wheels-in / wheels-out times. HOS forecasts schedules, never outcomes.
Monday's first case is not ready
Registered in Reception 10:32 today · not yet on an OT list · 46 hours to 09:00 Monday
5 departments, nothing started
Mon 09:0020 Jul
OT-1 · first case
OT-1 · first case
D. Prakash · 51M
Right total knee replacement — right knee osteoarthritis, grade IV
Dr. P. Anil Kumar · Orthopedics · MRN SVH-2024-03118 · Star Health cashless, package TKR-SEMI-3N
A first case is the one slot where being unready costs the most: OT-1's first case this morning
started 37 minutes late for a single unmarked site, and that alone was ₹18,574. The same five
things have to be true before 09:00 Monday, and they belong to five different people.
HOS can draft each one and route it — it cannot sign any of them.
Theatre:
OT-1 · Major
Laminar flow · staffed 08:00–16:00 · 315 of 480 min projected · 66%
Case 1 in progress
08:37planned 08:00
→ 11:07 proj.
→ 11:07 proj.
K. Yadagiri · 58M
Total hip replacement, right — cementless
Dr. P. Anil Kumar · spinal, Dr. M. Yugandhar · scrub Sister Kavitha
Turnaround 15 min · clean-down and set-up, within your 20-min target
11:22planned 10:45
→ 12:52 proj.
→ 12:52 proj.
B. Sujatha · 41F
Laparoscopic hysterectomy
Dr. Sunitha Rao · GA, Dr. M. Yugandhar
Scheduled list break 12:52 – 13:37 · excluded from the turnaround average
13:37planned 13:00
→ 14:52 proj.
→ 14:52 proj.
M. Ravinder · 34M
ORIF tibia, plating
Dr. P. Anil Kumar · spinal, Dr. M. Yugandhar
15:0060 min booked
G. Satyavathi · 44F
Vaginal hysterectomy
Dr. Sunitha Rao · GA
Reason recorded: deferred by Dr. M. Yugandhar at 09:40 pending a cardiology opinion on the pre-operative ECG. Rebooking offered for 22 Jul, 15:00 — family to confirm.
OT-2 · Minor & day-care
Local anaesthesia list · staffed 08:00–16:00 · 170 of 480 min projected · 35%
Case 4 in progress
08:30on time
→ 09:01
→ 09:01
P. Saroja · 47F
Cervical polypectomy
Dr. Sunitha Rao · local anaesthesia
Turnaround 11 min
09:12planned 09:15
→ 09:48
→ 09:48
K. Suvarna · 33F
Marsupialisation, Bartholin's cyst
Dr. Sunitha Rao · local anaesthesia
Turnaround 12 min
10:00on time
→ 10:33
→ 10:33
D. Yesu Ratnam · 55M
Excision of sebaceous cyst, back
Dr. Sunitha Rao · local anaesthesia
Turnaround 11 min
10:44planned 10:45
→ 11:19 proj.
→ 11:19 proj.
T. Bhoomika · 26F
Cervical biopsy and polypectomy
Dr. Sunitha Rao · local anaesthesia
Turnaround 16 min
11:35planned
→ 12:10
→ 12:10
A. Naresh · 29M
Incision and drainage, forearm abscess
Dr. P. Anil Kumar · local anaesthesia
14:0040 min booked
M. Sailaja · 38F
Diagnostic laparoscopy
Dr. Sunitha Rao · GA
Reason recorded: no anaesthetist window. Dr. M. Yugandhar is committed to OT-1 until 14:52; this list needs general anaesthesia. Rebooked 21 Jul, 09:00.
Surgeon & anaesthetist availability
Committed blocks today, 08:00–17:00 · from the confirmed list, not a roster guess
1 anaesthetist covers both theatres
080910111213141516
Dr. P. Anil KumarOrthopedics
THR · OT-1
ORIF
Dr. Sunitha RaoGynecology
Hyst · OT-1
Dr. M. YugandharAnaesthesiology · visiting
Spinal
GA
Spinal
Dr. Yugandhar's free windows today: 11:07–11:22 (15 min) · 12:52–13:37 (45 min) · 14:52–16:00 (68 min).
He is committed for 315 of 480 staffed minutes — 66% — which is why every general-anaesthesia case has to be booked around him, and why M. Sailaja's 14:00 case could not run.
✦
Pre-anaesthetic check not booked — D. Prakash, TKR Monday 09:00
Draft — awaiting approval
Scheduling · GREEN tier
From Dr. Yugandhar's confirmed blocks today and Reception's admission record of 10:32.
Today is the last working day before Monday — 19 Jul is a Sunday and he does not visit.
His 12:52–13:37 window is the only free block long enough today, and it is already
inside the scheduled list break, so using it costs no theatre time.
Why this one matters: 4 of this month's 11 cancellations were recorded as no anaesthetist window — a rostering pattern, not bad luck. One anaesthetist covers both theatres, and Monday's 09:00 start cannot be assessed on the morning of surgery without risking the same outcome. Booking the slot is operational. The assessment itself, and any conclusion about fitness for anaesthesia, is Dr. Yugandhar's to make and sign — HOS states neither.
Why this one matters: 4 of this month's 11 cancellations were recorded as no anaesthetist window — a rostering pattern, not bad luck. One anaesthetist covers both theatres, and Monday's 09:00 start cannot be assessed on the morning of surgery without risking the same outcome. Booking the slot is operational. The assessment itself, and any conclusion about fitness for anaesthesia, is Dr. Yugandhar's to make and sign — HOS states neither.
✦
Scheduling fit for the rest of today
Draft — awaiting approval
Operational forecast · GREEN tier
Two clashes are already in today's list, and both come from recorded times rather than an opinion.
1 · Dr. Sunitha Rao is double-booked at 11:19. She is operating in OT-2 until 11:19 (projected) and is listed in OT-1 at 11:22. Her recorded median interval between finishing one case and knife-to-skin in another theatre is 14 minutes across 76 cases this month. OT-1 would start at 11:33, not 11:22 — pushing M. Ravinder's 13:37 case to 13:48 and Dr. Yugandhar's day to 15:03.
2 · The 14:52–16:00 anaesthetist window is empty. M. Sailaja's cancelled 40-minute laparoscopy fits inside it with 28 minutes spare, and OT-2 is free from 12:10.
Proposed plan: move A. Naresh's local-anaesthesia I&D from 11:35 to 12:10 in OT-2 so Dr. Anil Kumar covers the gap, hold B. Sujatha's OT-1 start at 11:33 as calculated rather than as hoped, and offer M. Sailaja today 15:00 in OT-2 instead of 21 Jul. Net effect on today: +40 in-theatre minutes, utilisation 51% → 55%, one cancellation recovered.
1 · Dr. Sunitha Rao is double-booked at 11:19. She is operating in OT-2 until 11:19 (projected) and is listed in OT-1 at 11:22. Her recorded median interval between finishing one case and knife-to-skin in another theatre is 14 minutes across 76 cases this month. OT-1 would start at 11:33, not 11:22 — pushing M. Ravinder's 13:37 case to 13:48 and Dr. Yugandhar's day to 15:03.
2 · The 14:52–16:00 anaesthetist window is empty. M. Sailaja's cancelled 40-minute laparoscopy fits inside it with 28 minutes spare, and OT-2 is free from 12:10.
Proposed plan: move A. Naresh's local-anaesthesia I&D from 11:35 to 12:10 in OT-2 so Dr. Anil Kumar covers the gap, hold B. Sujatha's OT-1 start at 11:33 as calculated rather than as hoped, and offer M. Sailaja today 15:00 in OT-2 instead of 21 Jul. Net effect on today: +40 in-theatre minutes, utilisation 51% → 55%, one cancellation recovered.
Built from: 10 booked cases · wheels-in/wheels-out times for 128 cases since 01 Jul · Dr. Yugandhar's confirmed visiting hours. No clinical data was used and no clinical judgement is offered — this is arithmetic on a calendar.
Cancellations today
A cancellation without a recorded reason is a cancellation you will have again next week
2 · 100 booked minutes
| Booked | Patient | Procedure | Reason recorded | Recorded by | Minutes | Rebooked |
|---|---|---|---|---|---|---|
| 15:00 · OT-1 | G. Satyavathi 44F |
Vaginal hysterectomy | Anaesthetist deferred pending cardiology opinion on the pre-operative ECG A clinical decision, made and signed by a clinician |
Dr. M. Yugandhar 09:40 |
60 | 22 Jul offered |
| 14:00 · OT-2 | M. Sailaja 38F |
Diagnostic laparoscopy | No anaesthetist window — GA required, Dr. Yugandhar in OT-1 until 14:52 An avoidable, operational cancellation |
Sister Anasuya Rani 08:15 |
40 | 21 Jul 09:00 |
| Total booked-and-unused | 100 | ₹50,200 | ||||
K. Yadagiri · 58M · Total hip replacement, right
OT-1 · in progress · Dr. P. Anil Kumar · spinal, Dr. M. Yugandhar
2 of 3 stages signed
Stage 1 · before induction
Sign In ✓
All 7 items confirmed.
Signed 08:34 by Sister Anasuya Rani, Dr. M. Yugandhar and Dr. P. Anil Kumar.
Held from 08:00 to 08:31 — site not marked.
Signed 08:34 by Sister Anasuya Rani, Dr. M. Yugandhar and Dr. P. Anil Kumar.
Held from 08:00 to 08:31 — site not marked.
Stage 2 · before skin incision
Time Out ✓
Team introduced by name and role. Patient, site and procedure confirmed aloud by all three. Critical events reviewed. Cefuroxime 1.5 g IV given 08:44, 8 min before incision — inside the 60-minute window. Imaging displayed.
Signed 08:41.
Signed 08:41.
Stage 3 · before leaving theatre
Sign Out — open
Opens at wheels-out (projected 11:07). Instrument, sponge and needle counts, specimen labelling, equipment problems, recovery concerns.
Counts are performed by a human and typed by a human. HOS leaves those fields blank and will not pre-fill them.
Counts are performed by a human and typed by a human. HOS leaves those fields blank and will not pre-fill them.
B. Sujatha · 41F · Laparoscopic hysterectomy
OT-1 · listed 11:22 · Dr. Sunitha Rao · GA, Dr. M. Yugandhar
Sign In · 4 of 6
✓
Patient identity, site, procedure and consent confirmed with the patient
Sister Anasuya Rani · 10:31 · consent form scanned and on file
Site marked by the surgeon
Waiting on Dr. Sunitha Rao — operating in OT-2 until 11:19. Not signable by anyone else.
Anaesthesia machine, circuit and suction checked
Waiting on Dr. M. Yugandhar — in OT-1 until 11:07.
✓
Pulse oximeter on the patient and functioning
Sister Kavitha · 10:33
✓
Known allergy — asked and answered
None known. Recorded from the patient at 10:31 and matched against her record in Patient Records.
✓
Difficult airway or aspiration risk · risk of blood loss over 500 ml
Reviewed by Dr. M. Yugandhar at the pre-anaesthesia visit, 17 Jul 18:20. 2 units cross-matched and reserved by the blood bank.
Blocked: 2 Sign In items unsigned.
There is no override on this button. A coordinator, an owner and a surgeon all cannot move a case past an unsigned Sign In — the only way through is to sign it.
This gate was added on 12 May 2026 after an internal audit found 3 checklists in April had been signed retrospectively; those 3 are in the Quality & Safety workspace under Clinical Audit.
Checklist completeness
Quarter to date · an NABH objective element, captured as a by-product
100%
| Stage | Cases | Signed | Median signing time |
|---|---|---|---|
| Sign In before induction | 214 | 214 | 2 min 10 s |
| Time Out before skin incision | 214 | 214 | 1 min 05 s |
| Sign Out before leaving theatre | 214 | 214 | 1 min 40 s |
All three stages signed on 214 of 214 cases since 01 Apr. The number is 100% because the gate makes any other number impossible, not because the OT team is unusually diligent.
What the gate cost, and what it bought
Both halves, in the same place
Cost. OT-1's list started 37 minutes late this morning because Sign In could not be closed at 08:00 without a marked site. At ₹502 a theatre-minute that is ₹18,574, and every case behind it moved.
Bought. A right total hip replacement went to theatre with the side confirmed by the surgeon, in writing, before induction. Wrong-site surgery is a never-event; the checklist exists because it used to happen.
No AI in this section. A safety checklist is a named human's attestation that they looked. A machine cannot attest on their behalf, so HOS does not draft, pre-tick, suggest or summarise anything here. It timestamps, it locks, and it refuses.
Instrument sets in circulation
14
6 sterile · 3 in theatre · 2 in cycle · 2 soiled · 1 repair
Sterile & issuable now
6
▲ all with a passed biological indicator
Held pending indicator
2
Cycle CY-1807-04 releases 12:20
Cycles run today
4
3 released · 1 running
Sterilisation cycles today
Autoclave A and B · 134 °C pre-vacuum · rapid-readout biological indicator, 75 min
CY-1807-04 running
| Status | Cycle | Autoclave | Load sealed | Cycle ended | Chemical indicator | Biological indicator | Sets | Released by |
|---|---|---|---|---|---|---|---|---|
| Released | CY-1807-01 | A | 06:40 | 07:02 | Pass | Pass 08:20 | 4 | Sister Kavitha 08:22 |
| Released | CY-1807-02 | A | 07:35 | 07:57 | Pass | Pass 09:15 | 3 | Sister Kavitha 09:17 |
| Released | CY-1807-03 | B | 09:20 | 09:42 | Pass | Pass 10:44 | 3 | Sister Kavitha 10:46 |
| Held | CY-1807-04 | B | 10:30 | 11:14 proj. | Reads at 11:14 | Due 12:20 | 2 | Not releasable |
ORTHO-JOINT-02 and SF-TRAUMA-02 are in CY-1807-04 and cannot be issued before 12:20.
ORTHO-JOINT-02 is being re-processed because its pack seal failed the 18 Jul storage audit — the audit worked, so the set went back through the autoclave instead of into a patient.
No case today needs it: the next joint case is 21 Jul 08:00, and M. Ravinder's 13:37 ORIF needs SF-TRAUMA-01, which was released at 09:17.
Traceability — which set, which cycle, which patient
Recorded at the point of issue by barcode, not written into a register afterwards
Last 7 cases
| Indicator | Patient | Date | Procedure | Instrument set | Cycle | Issued at | Issued by |
|---|---|---|---|---|---|---|---|
| Pass 08:20 | K. Yadagiri 58M | 18 Jul | Total hip replacement | ORTHO-JOINT-01 | CY-1807-01 | 08:29 | Sister Kavitha |
| Pass 08:20 | P. Saroja 47F | 18 Jul | Cervical polypectomy | MINOR-01 | CY-1807-01 | 08:24 | Sister Kavitha |
| Pass 08:20 | K. Suvarna 33F | 18 Jul | Marsupialisation, Bartholin's cyst | MINOR-02 | CY-1807-01 | 09:06 | Sister Kavitha |
| Pass 08:20 | D. Yesu Ratnam 55M | 18 Jul | Excision of sebaceous cyst | MINOR-04 | CY-1807-01 | 09:54 | Sister Kavitha |
| Pass 09:15 | B. Sujatha 41F · listed 11:22 | 18 Jul | Laparoscopic hysterectomy | LAP-GEN-01 | CY-1807-02 | Reserved | Sister Kavitha |
| Pass | G. Vijaya Lakshmi 61F | 16 Jul | Laparoscopic cholecystectomy | LAP-GEN-01 | CY-1607-05 | 09:34 | Sister Kavitha |
| Pass | B. Srinu 67M | 15 Jul | Total knee replacement, right | ORTHO-JOINT-02 | CY-1507-02 | 08:09 | Sister Kavitha |
Reprocessing turnaround
Measured over the last 30 cycles — the number that tells you whether you own enough sets
| Step | Median |
|---|---|
| Soiled receipt → decontamination complete | 42 min |
| Inspection, assembly and packing | 28 min |
| Autoclave cycle | 22 min |
| Biological indicator hold | 75 min |
| Cooling and storage | 18 min |
| Soiled to issuable | 3 h 05 min |
You own 2 joint sets and have 3 joint cases booked in the next 7 days (18, 21 and 23 Jul). At a 3 h 05 min turnaround, two sets are enough — buying a third would be idle capital. This is a stock-and-demand forecast, GREEN under ADR #7.
✦
Joint set readiness for Monday 09:00 — D. Prakash, TKR
Draft — awaiting approval
Stock & demand · GREEN tier
From the set register, the last 30 autoclave cycles, and Reception's admission record.
No set has been moved or reserved — this is the arithmetic only.
Both joint sets are accounted for and both clear Monday 09:00 comfortably:
ORTHO-JOINT-01 is in theatre now, used on K. Yadagiri's hip at 08:29 from cycle CY-1807-01. It returns dirty today and needs one 3 h 05 m reprocessing pass.
ORTHO-JOINT-02 releases from CY-1807-04 at 12:20 today — it went back through the autoclave because its pack seal failed the 18 Jul storage audit, so the audit did its job.
What approving this changes: the forward count becomes 4 joint cases in 7 days (18, 20, 21 and 23 Jul) instead of 3. At a 3 h 05 m turnaround with two sets and at least 23 hours between every pair of those cases, that is still a timing gate, not a shortage — a third set would remain idle capital.
ORTHO-JOINT-01 is in theatre now, used on K. Yadagiri's hip at 08:29 from cycle CY-1807-01. It returns dirty today and needs one 3 h 05 m reprocessing pass.
ORTHO-JOINT-02 releases from CY-1807-04 at 12:20 today — it went back through the autoclave because its pack seal failed the 18 Jul storage audit, so the audit did its job.
What approving this changes: the forward count becomes 4 joint cases in 7 days (18, 20, 21 and 23 Jul) instead of 3. At a 3 h 05 m turnaround with two sets and at least 23 hours between every pair of those cases, that is still a timing gate, not a shortage — a third set would remain idle capital.
Set register
14 sets · where each one is right now
| State | Set | Contents | Last cycle |
|---|---|---|---|
| In theatre | ORTHO-JOINT-01 | Hip arthroplasty, 62 items | CY-1807-01 |
| In theatre | MINOR-04 | Minor procedure, 18 items | CY-1807-01 |
| In theatre | MINOR-05 | Minor procedure, 18 items | CY-1807-03 |
| Sterile | LAP-GEN-01 | Laparoscopy, 34 items | CY-1807-02 |
| Sterile | LAP-GEN-02 | Laparoscopy, 34 items | CY-1807-03 |
| Sterile | SF-TRAUMA-01 | Small fragment, 48 items | CY-1807-02 |
| Sterile | MINOR-03 | Minor procedure, 18 items | CY-1807-02 |
| Sterile | EXTRA-01 | Retractors and extras, 22 items | CY-1807-03 |
| Sterile | MINOR-06 | Minor procedure, 18 items | CY-1707-09 |
| Held | ORTHO-JOINT-02 | Knee arthroplasty, 58 items | CY-1807-04 |
| Held | SF-TRAUMA-02 | Small fragment, 48 items | CY-1807-04 |
| Soiled | MINOR-01 | Minor procedure, 18 items | CY-1807-01 |
| Soiled | MINOR-02 | Minor procedure, 18 items | CY-1807-01 |
| Repair | SCOPE-02 | 30° laparoscope — sent 14 Jul | CY-1407-06 |
Implant & consumable value used
₹6,84,300
1–17 Jul · 96 items scanned into cases
Scanned but not billed
₹18,400
▼ 6 items caught this month
Lot capture at point of use
100%
▲ 96 of 96 items
Expiring within 90 days
2
Use first or return to supplier
K. Yadagiri · Total hip replacement, right · today
Scanned at the instrument trolley as each item was opened · OT-1
3 items · all on the bill
| Bill | Item | Lot / batch | UDI | Expiry | Value | Scanned |
|---|---|---|---|---|---|---|
| Line created | Femoral stem, cementless, size 11 | FS11-3390B | (01)08901234500019(10)FS11-3390B | 06/2032 | ₹92,000 | 09:14 |
| Line created | Acetabular cup 52 mm + liner | AC52-7741 | (01)08901234500026(10)AC52-7741 | 02/2031 | ₹58,500 | 09:26 |
| Line created | Femoral head, ceramic 32 mm | FH32-2208 | (01)08901234500033(10)FH32-2208 | 09/2033 | ₹34,000 | 09:41 |
| Scanned into this case | ₹1,84,500 | Fully billed | ||||
✦
Implant reconciliation — B. Srinu, total knee replacement, 15 Jul
Draft — awaiting approval
Billing reconciliation · GREEN tier
4 items were scanned into this case. 3 appear on bill INV-2026-1187. 1 does not.
The bone cement with gentamicin (2 × 40 g, lot BC40-7712) was scanned at 09:52 on 15 Jul by Sister Kavitha and has no matching bill line. Scanned value ₹1,25,700; billed value ₹1,19,300; difference ₹6,400.
B. Srinu's discharge is planned for 19 Jul, so this is correctable before his final bill is raised rather than after.
The bone cement with gentamicin (2 × 40 g, lot BC40-7712) was scanned at 09:52 on 15 Jul by Sister Kavitha and has no matching bill line. Scanned value ₹1,25,700; billed value ₹1,19,300; difference ₹6,400.
B. Srinu's discharge is planned for 19 Jul, so this is correctable before his final bill is raised rather than after.
| Bill | Item | Lot / batch | Expiry | Value |
|---|---|---|---|---|
| On bill | Femoral component, CoCr, size 4, right | FC4R-2451A | 03/2031 | ₹68,000 |
| On bill | Tibial baseplate + insert, size 4 / 10 mm | TB4-8827C | 07/2030 | ₹41,500 |
| On bill | Patellar button, 32 mm | PB32-1109 | 11/2029 | ₹9,800 |
| Missing | Bone cement with gentamicin, 2 × 40 g | BC40-7712 | 05/2028 | ₹6,400 |
Sources: implant scan log for case OT-2026-0715-01 (4 records) · bill INV-2026-1187 in Billing (3 implant lines) · tariff master entry CONS-BC-40. Nothing was added to any bill.
Recall lookup
A recall notice names a lot. Only lot capture can turn that into a list of people.
Without this, answering "who has this batch in them?" means opening every OT register page since the batch arrived. Hospitals do not do that, so in practice the question goes unanswered.
Expiry watch
High-value implants nobody wants to write off
2 within 90 days
| Days left | Item | Lot | Expiry | Value |
|---|---|---|---|---|
| 41 | Tibial insert, size 3 / 12 mm | TI3-6620F | 28/08/2026 | ₹18,900 |
| 78 | Acetabular cup 48 mm | AC48-5512 | 04/10/2026 | ₹52,000 |
| 214 | Femoral head, ceramic 28 mm | FH28-9004 | 17/02/2027 | ₹31,500 |
₹70,900 of implant stock expires within 90 days. Both items are consignment stock and returnable to the supplier up to 30 days before expiry — the return window on TI3-6620F closes on 29 Jul.
Issued to theatre today
₹6,770
consumables · both theatres · 07:40
Consumed into cases
₹4,595
K. Yadagiri · OT-1
Returnable unopened
₹725
goes back to the main store
Opened, unused — waste
₹1,450
sterility broken · cannot be returned
K. Yadagiri · total hip replacement, right · OT-1
Consumables issued to theatre against what the case actually used
Issue note OT-ISS-2026-0718-01
| Item | Issued | Used | Back unopened | Opened, unused | Rate | Used value |
|---|---|---|---|---|---|---|
| Suture, polypropylene 1-0 | 6 | 4 | 2 | — | ₹210 | ₹840 |
| Suture, Vicryl 2-0 | 6 | 5 | 1 | — | ₹185 | ₹925 |
| Disposable drape pack Second pack opened when the first was contaminated at 09:08 | 2 | 1 | — | 1 | ₹1,450 | ₹1,450 |
| Diathermy pencil | 1 | 1 | — | — | ₹640 | ₹640 |
| Suction set | 1 | 1 | — | — | ₹380 | ₹380 |
| Irrigation saline 3 L | 4 | 3 | 1 | — | ₹120 | ₹360 |
| Totals | 20 | 15 | 4 | 1 | — | ₹4,595 |
Issued ₹6,770 − used ₹4,595 = ₹2,175 not consumed, of which ₹725 returns unopened and ₹1,450 is waste. The drape pack was opened, so it cannot go back regardless of never touching the patient — recording it as a return would overstate stock by ₹1,450 and understate the cost of this case by the same amount.
✦
Controlled-drug register — K. Yadagiri, OT-1 · wastage needs a witness
Draft — awaiting approval
Statutory · NDPS register
Ampoules drawn by Dr. M. Yugandhar reconcile exactly against what was administered and what remained in the syringe. Part-used ampoules cannot simply be discarded — the remainder is wastage, and wastage recorded by one person is not a control.
Sister Kavitha scrubbed on this case and can witness the discard.
Sister Kavitha scrubbed on this case and can witness the discard.
| Drug | Issued | Administered | Wasted | Balances |
|---|---|---|---|---|
| Inj. Fentanyl 100 mcg 2 ampoules · 200 mcg drawn | 200 mcg | 150 mcg | 50 mcg | 150 + 50 = 200 |
| Inj. Midazolam 5 mg 1 ampoule | 5 mg | 3 mg | 2 mg | 3 + 2 = 5 |
| Inj. Propofol 200 mg Not a controlled drug — shown for the case record | 400 mg | 340 mg | 60 mg | No witness required |
Sources: anaesthesia record for case OT-2026-0718-01 · theatre controlled-drug register · issue note OT-ISS-2026-0718-01. HOS did not compute a dose and did not alter the register — it laid the three columns beside each other and checked they add up.
Stranded by today's 2 cancellations
Issued at 07:40 for cases that never started
₹3,140 in OT-2
| Item | Qty | Rate | Value | State |
|---|---|---|---|---|
| Disposable drape pack | 2 | ₹1,450 | ₹2,900 | Unopened |
| Irrigation saline 3 L | 2 | ₹120 | ₹240 | Unopened |
| Returnable | 4 | — | ₹3,140 | All unopened |
✦
Return note drafted — ₹3,140 back to the main store
Draft — awaiting approval
Both cancelled cases had their packs issued before the list started. Nothing was opened, so all four items are returnable. Left in theatre they are counted as consumed by this month's ₹6,84,300 — a cancellation would quietly cost the hospital the stock as well as the ₹502 per theatre-minute of idle time it already cost.
Sources: issue note OT-ISS-2026-0718-01 · today's schedule (2 cancelled of 10 booked) · theatre store count at 10:40. No stock was moved.
Theatre store reconciliation · today
Opening + issued − consumed − returned = closing
Balances
| Movement | Value | Note |
|---|---|---|
| Opening balance, 07:00 | ₹12,480 | carried from 17 Jul |
| Issued in from main store, 07:40 | +₹6,770 | OT-ISS-2026-0718-01 |
| Consumed into K. Yadagiri's case | −₹4,595 | 15 of 20 items |
| Waste — opened, unused | −₹1,450 | contaminated drape pack |
| Returned unopened | −₹725 | received by Pharmacy |
| Awaiting return — stranded by cancellations | ₹3,140 | still counted as theatre stock |
| Closing balance, 10:40 | ₹12,480 | counted, and it ties |
₹12,480 + ₹6,770 − ₹4,595 − ₹1,450 − ₹725 = ₹12,480. The ₹3,140 stranded in OT-2 is inside that closing figure, which is precisely why it has to be returned rather than forgotten — the store balances today and would still balance tomorrow while the stock quietly sat in a theatre.
Batches, valuation and vendor credit stay in Pharmacy → Stock & Batches. This panel records movement in and out of theatre; it does not keep a second set of prices.
In PACU now
2
of 4 bays · 1 more expected at 11:07
Discharged from PACU today
1
P. Saroja · 42 min
Longest wait for a discharge signature
22 min
K. Suvarna · criteria met at 10:25
Median PACU stay
48 min
1–17 Jul · 128 cases
PACU-1 · K. Suvarna · 33F
Marsupialisation · local anaesthesia · OT-2 09:12–09:48
Awaiting signature
In PACU
54 min
Criteria met at
10:25
Waiting since
22 min
Modified Aldrete score · recorded 10:25 by Sister Kavitha
Activity
2
Resp.
2
Circ.
2
Consc.
2
SpO₂
2
Total 10 of 10. Your discharge threshold is 9. The score is arithmetic on five recorded observations against a published scale — it is not a recommendation.
✓ Aldrete 10, threshold 9 · ✓ 30-minute minimum elapsed (54 min) · ✓ Pain 2 of 10 · ✓ No active bleeding · ✓ Escort present (husband) · ✗ Surgeon's discharge signature
PACU-2 · D. Yesu Ratnam · 55M
Sebaceous cyst excision · local anaesthesia · OT-2 10:00–10:33
Observing
In PACU
9 min
30-min minimum ends
11:08
Sign Out signed
10:35
Modified Aldrete score · recorded 10:44 by Sister Kavitha
Activity
2
Resp.
2
Circ.
2
Consc.
2
SpO₂
2
Total 10 of 10, but the mandatory 30 minutes has 21 minutes left. The clock is a policy your hospital set, and HOS will not shorten it.
✓ Aldrete 10 · ◷ 30-minute minimum — 21 min left · ✓ Pain 1 of 10 · ✓ Dressing dry · ✓ Escort present (son) · ◷ Surgeon's discharge signature
PACU-3 · expected 11:07
K. Yadagiri · 58M · total hip replacement · spinal
Inbound
Prepared for a spinal case: block regression must be documented before ward transfer — motor power in both legs, sensory level and first micturition, per your PACU policy for regional anaesthesia.
Critical care is not planned for this case, which matters today because the ICU is 8 of 8. A ward bed has been requested from the bed board in IPD. If the picture changes, the decision to escalate is the anaesthetist's and there is no bed here — the on-call number for your two recorded referral hospitals is on the Emergency workspace.
✦
Operation note drafting live — K. Yadagiri, total hip replacement
For Dr. P. Anil Kumar's signature
Drafted from the record · GREEN tier
The intra-op record for this case is open and being written to now — anaesthesia chart, theatre log, eMAR, trolley scanner and the event log. Draft the note and every field will name the source it came from.
Operation notes today
Nothing is filed in the patient record until the operating surgeon signs it
| Status | Patient | Procedure | Surgeon | Signed |
|---|---|---|---|---|
| Signed | P. Saroja | Cervical polypectomy | Dr. Sunitha Rao | 09:11 |
| Signed | K. Suvarna | Marsupialisation | Dr. Sunitha Rao | 09:58 |
| Drafted | D. Yesu Ratnam | Excision of sebaceous cyst | Dr. Sunitha Rao | Awaiting signature |
| Drafting | K. Yadagiri | Total hip replacement, right | Dr. P. Anil Kumar | Opens at wheels-out |
| Signed | B. Srinu 15 Jul | Total knee replacement, right | Dr. P. Anil Kumar | 15 Jul 11:20 |
What the drafting actually saved
Measured per note, not extrapolated into "hours a day"
Before
9 min 40 s
Median time to dictate or type a major-case note
Now
1 min 20 s
Median time to read the draft, correct it and sign
Median over the 34 major cases since 01 Jul, timed from note-open to signature. That is 86% of the writing time, inside the 70–90% the product claims — and it is a claim you can audit in the AI Quality register rather than a number from a slide.
What it did not save: the surgeon still reads every line, and 11 of the 34 drafts were edited before signing. Six of those edits were to the post-operative plan, which is the one field no record can supply because it is a decision, not an event.
What it did not save: the surgeon still reads every line, and 11 of the 34 drafts were edited before signing. Six of those edits were to the post-operative plan, which is the one field no record can supply because it is a decision, not an event.
Utilisation, 1–17 Jul
48%
6,960 in-theatre min of 14,400 staffed
First case on time
41%
▲ 12 of 29 lists · was 25% in week 1
Average turnaround
22 min
▼ against your 20-min target
Recoverable time lost
₹6.4 L
1,280 min with a recorded, fixable cause
Where 1,280 minutes went
1–17 Jul · only losses with a recorded cause are counted
₹6,42,560
| Cause | Events | Avg minutes | Minutes | At ₹502/min |
|---|---|---|---|---|
| Cancellations booked theatre time that produced nothing | 11 | 70 | 770 | ₹3,86,540 |
| Late first-case starts delay between the listed and actual first wheels-in | 17 | 26 | 442 | ₹2,21,884 |
| Turnaround over target 22-min average against your own 20-min target | 34 | 2 | 68 | ₹34,136 |
| Total | 62 | — | 1,280 | ₹6,42,560 |
What this number is not. Your theatres were idle for 7,440 of 14,400 staffed minutes in this period. Most of that is not recoverable — you do not have the surgeons, the referrals or the anaesthetist hours to fill it, and a target of 100% would be a target to cancel patients over.
These 1,280 minutes are the subset with a recorded cause you can act on. HOS does not claim the other 6,160.
Cancellation reasons
11 cancellations of 139 booked cases · 7.9%
| Reason | Cases | Avoidable? |
|---|---|---|
| No anaesthetist window | 4 | Scheduling |
| Pre-operative investigation missing or abnormal | 3 | Partly — 2 were missing, 1 abnormal |
| Patient not nil by mouth | 2 | Instruction not confirmed back |
| Patient did not report | 1 | No |
| Implant size not in stock | 1 | Stores |
| Total | 11 | 7 avoidable |
Four of eleven cancellations were one problem: a single visiting anaesthetist. Two extra sessions a week from Dr. Yugandhar would have carried all four — 280 booked minutes, ₹1.4 L. That is a rota decision, and it is yours.
First case on time, by week
Started within 15 minutes of the listed time · 29 lists
2 of 8 lists, then 4 of 10, then 6 of 11 — 12 of 29 overall, 41%. The improvement tracks the Sign In gate going live on 12 May: teams stopped discovering an unmarked site at 08:00 because the checklist now shows them at 07:30 what is unsigned.
Today OT-2 started on time and OT-1 did not, so today is 1 of 2.
Utilisation by theatre
In-theatre minutes ÷ staffed minutes · wheels-in to wheels-out
| Theatre | Today | 1–17 Jul | Minutes MTD |
|---|---|---|---|
| OT-1 · Major 315 of 480 min today | 66% | 58% | 4,180 |
| OT-2 · Minor & day-care 170 of 480 min today | 35% | 39% | 2,780 |
| Both 485 of 960 min today | 51% | 48% | 6,960 |
OT-2 is the cheap capacity — it needs no anaesthetist for a local-anaesthesia list, and it is running at 35%. Every day-care case moved out of OT-1 releases major-theatre time that only OT-1 can provide.
By surgeon
1–17 Jul · 128 cases operated of 139 booked
| Surgeon | Cases | Avg minutes | Theatre minutes | Cancelled |
|---|---|---|---|---|
| Dr. P. Anil Kumar Orthopedics | 52 | 71 | 3,692 | 4 |
| Dr. Sunitha Rao Gynecology | 76 | 43 | 3,268 | 7 |
| Total | 128 | 54 | 6,960 | 11 |
Average case length is a planning input, not a performance score. Dr. Anil Kumar's 71-minute average is arthroplasty and trauma; Dr. Sunitha Rao's 43 minutes is mostly day-care. Comparing the two would be arithmetic dressed up as judgement.
How ₹502 per theatre-minute was derived
Because a number this load-bearing should not be a black box
Your data only
OT procedure revenue, 1–17 Jul
₹34.94 L
Billed procedure and implant lines against OT encounters, from Billing
In-theatre minutes
6,960
Wheels-in to wheels-out, 128 cases
Revenue per theatre-minute
₹502
₹34,94,000 ÷ 6,960
What it is not
Not profit
Gross billed revenue, before consumables, payouts and the cost of keeping the room staffed
A recovered minute earns less than ₹502 net, and a lost minute costs less than ₹502 net. We use the gross figure because it is the one your billing system can prove, and we label it so nobody quotes it as margin. Your accountant can substitute a contribution rate in Administration → Tariff Master and every figure on this panel recalculates.