Perioperative Daily Add-On Case Triage Log

Tracks add-on case requests, clinical urgency classification, and operating room slot assignment by the perioperative coordinator.

Case Request Details

• Request Date
• Request Time
• Service Line
• Case Type
• Brief Case Summary
  Provide a concise clinical summary sufficient for triage. Avoid unnecessary PII.
• Requesting Provider
  Enter the provider name or role only if needed for local workflow.

Clinical Urgency Classification

• Urgency Level
• Triage Rationale
  Document the clinical factors supporting the urgency classification.
• Anesthesia Required
• Special Equipment Needed

Room Slot Assignment

• Triage Disposition
• Assigned Room
• Assigned Start Time
• Estimated Duration (minutes)
• Capacity Constraint

Escalation and Audit Trail

• Escalation Required?
• Escalation Contact
• Escalation Notes
• Perioperative Coordinator Name
  Record the person completing the triage entry for the audit trail.
• Final Review Status