Surgery, Perioperative & Anesthesia — Synthetic Review

MaxArc Enterprise Operations Center · CAP-SPA-001 · GHI-1825

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Restricted access · Prototype / Synthetic Review Environment. This review surface is Enterprise-Owner-only by architecture and deny-by-default. It is unavailable to public, client, facility, CAP, SAP, or general administrative users. Production authentication and authorization are NOT implemented in this prototype. The route is not securely deployable; access restriction is architectural intent recorded under DEBT-19, not an enforced production control.
Private · Enterprise Owner only · Read-only · Synthetic
Prototype / Synthetic Review Environment

Surgery, Perioperative & Anesthesia — Synthetic Review Environment

A private, Enterprise-Owner-only, read-only, synthetic review surface for the MaxArc Enterprise Surgery, Perioperative & Anesthesia Platform (CAP-SPA-001). It reuses the Enterprise Operations Center, the MaxArc design system, the enterprise authorization model, and the synthetic-event and audit-tray presentation. Nothing here is production: no theatre-management, anesthesia, device/monitor, medication-administration, implant-tracking, or blood-product system is connected, no live patient data is present, and no production command can be executed.

Security posture: Read-only by default. A synthetic scenario executes only after explicit confirmation, and every confirmed run emits an attributable synthetic audit event. Viewing and acting are separate permissions; this surface cannot bypass module authorization; no production data is present.
Review areas23

Each shown with an honest maturity status.

Synthetic scenarios15

Preview → confirm → visible resulting state + audit event.

Production gateDEBT-19

Open & blocking; no production activation.

Status legend

  • Implemented — Present and working in this prototype surface.
  • Synthetic Prototype — Working against bounded synthetic data only; not production.
  • Monitor Only — Read-only visibility; no action can be taken from this surface.
  • Planned — Declared for extensibility; not implemented here and not shown as active.
  • Deferred — Explicitly deferred to a future directive.
  • Production Blocked — Blocked by the DEBT-19 production gate until implemented, tested, reviewed, and accepted.

Review areas

Surgery Operations Overview

Synthetic Prototype

Synthetic perioperative operations snapshot: pending case requests, scheduled cases, readiness blocks, cases in procedure, cases in recovery, open adverse events.

view spa.overview.view · act spa.overview.none

Surgical Case & Order Queue

Synthetic Prototype

Surgery orders as specializations of EnterpriseOrder (family COO-FAM-SPA-001); each shows lifecycle state; a case is never treated as ready, timed-out, or completed prematurely.

view spa.order.view · act spa.order.none

Surgery Schedule

Synthetic Prototype

Synthetic surgical case scheduling; a requested case is never treated as scheduled. No production scheduling.

view spa.schedule.view · act spa.schedule.none

Theatre Readiness & Allocation

Synthetic Prototype

Operating theatre allocation and readiness; a scheduled case is never treated as ready. No production theatre activation.

view spa.theatre.view · act spa.theatre.none

Pre-operative Assessment

Synthetic Prototype

Pre-operative assessment including pre-op laboratory, radiology, medication, and blood-product readiness references; assessment is not authorization to proceed.

view spa.preop.view · act spa.preop.none

Surgical Safety Checklist & Timeout

Synthetic Prototype

Surgical safety checklist and an explicit, attributable timeout are required before procedure start; a failed check fails closed.

view spa.checklist.view · act spa.checklist.none

Anesthesia Readiness

Synthetic Prototype

Anesthesia assessment and plan; the anesthetist is the final authority; an anesthesia hold fails closed. No live anesthesia integration.

view spa.anesthesia.view · act spa.anesthesia.none

Blood-product Readiness

Synthetic Prototype

Blood-product readiness references CAP-BBT-001; missing blood product is surfaced and not silently bypassed. No production blood-product issue.

view spa.blood.view · act spa.blood.none

Equipment and Implant Readiness

Synthetic Prototype

Equipment and implant readiness; missing equipment or implants is surfaced and not silently bypassed. No production implant tracking.

view spa.equipment.view · act spa.equipment.none

Sterile-field and Infection Prevention

Synthetic Prototype

Sterile-field and infection-prevention checks; a failed check enters an infection-control hold and fails closed.

view spa.sterile.view · act spa.sterile.none

Patient and Procedure Identity

Synthetic Prototype

Patient/site/procedure identity integrity; mismatch fails closed and routes to governed exception review. No silent site reattachment; two-person verification modelled.

view spa.identity.view · act spa.identity.none

Intraoperative Status

Synthetic Prototype

Intraoperative documentation with procedure start, pause, cancellation, postponement, and completion; estimated blood loss and specimen references preserved.

view spa.intraop.view · act spa.intraop.none

Specimen Handling

Synthetic Prototype

Surgical specimen handling and chain-of-custody references; specimen records preserve provenance.

view spa.specimen.view · act spa.specimen.none

Recovery / PACU

Synthetic Prototype

Recovery/PACU status; a completed procedure is never treated as recovered. Post-operative monitoring preserved.

view spa.recovery.view · act spa.recovery.none

Post-operative Orders and Handoff

Synthetic Prototype

Post-operative orders and structured handoff; a routed handoff is not treated as reviewed.

view spa.handoff.view · act spa.handoff.none

Cancellations and Postponements

Synthetic Prototype

Cancellation and postponement remain distinct governed states and are never conflated.

view spa.cancellation.view · act spa.cancellation.none

Adverse Events and Incidents

Synthetic Prototype

Adverse events require workup, escalation, and acknowledgment; notification is not acknowledgment; an adverse event is not closed until worked up, acknowledged, and followed up.

view spa.adverse.view · act spa.adverse.none

Surgery Audit Tray

Synthetic Prototype

Append-only synthetic audit tray with prior/new state, actor, role, reason, approvals, workflow, correlation/causation IDs, enterprise event, and provenance.

view spa.audit.view · act spa.audit.none

Enterprise Events

Monitor Only

Normalized Enterprise Operations Events (surgery families). Reuses the enterprise event architecture; no parallel event bus.

view spa.events.view · act spa.events.none

Exceptions and Overrides

Synthetic Prototype

Governed exceptions and emergency overrides require reason, authorization, audit, and later review.

view spa.exception.view · act spa.exception.none

Operations Center Health

Monitor Only

Read-only synthetic service-health signals for the surgery review surface. No live telemetry.

view spa.health.view · act spa.health.none

Deferred Production Integrations

Production Blocked

Production surgery scheduling, theatre activation, live anesthesia/device/monitor integration, production medication administration, production implant tracking, and production blood-product issue are blocked by DEBT-19 until implemented, tested, reviewed, and accepted.

view spa.deferred.view · act spa.deferred.none

Synthetic testing scenarios

Read-only by default. Preview plans a scenario without executing it; running requires explicit confirmation (confirm=confirm-synthetic-surgery) and emits an attributable synthetic audit event. No real patient data, no live theatre/anesthesia/monitor, no production command.

Surgery audit tray synthetic

Append-only synthetic audit tray. Corrections preserve the original record; nothing is silently overwritten.

EventChangedPrior → NewActor / roleReasonApprovalWorkflowCorrelation / eventProvenance
AUD-SPA-0001 Case state TheatreAllocated → TimeoutCompleted Synthetic Circulating Nurse
perioperative-nurse		 Explicit surgical timeout completed and attributed timeout-verifier-1
2nd: timeout-verifier-2		 CAP-CWE-001:spa-timeout cor COR-SPA-0001 · cau CAU-SPA-0001
surgery.timeout.completed		 synthetic
AUD-SPA-0002 Procedure start TimeoutCompleted → ProcedureStarted Dr. Synthetic Surgeon
surgeon		 Procedure started after completed timeout surgeon-authorization
2nd: anesthetist-confirmation		 CAP-CWE-001:spa-procedure cor COR-SPA-0002 · cau CAU-SPA-0002
surgery.procedure.started		 synthetic
AUD-SPA-0003 Recovery entry ProcedureCompleted → InRecovery Synthetic PACU Nurse
recovery-nurse		 Patient transferred to recovery/PACU recovery-handoff-1
2nd: recovery-handoff-2		 CAP-CWE-001:spa-recovery cor COR-SPA-0003 · cau CAU-SPA-0003
surgery.recovery.entered		 synthetic
AUD-SPA-0004 Intraoperative record correction ProcedureCompleted → Corrected Dr. Synthetic Surgeon
surgeon		 Correction added; original preserved surgeon-final-authority CAP-CWE-001:spa-intraoperative cor COR-SPA-0004 · cau CAU-SPA-0004
surgery.procedure.completed		 synthetic
AUD-SPA-0005 Identity check PendingVerification → ExceptionReview System (fail-closed)
system		 Patient/site/procedure identity mismatch — fail closed n/a CAP-CWE-001:spa-identity cor COR-SPA-0005 · cau CAU-SPA-0005
surgery.order.state.changed		 synthetic

Enterprise events

Surgery emits normalized Enterprise Operations Events; it reuses the enterprise event architecture and introduces no parallel event bus.

  • surgery.case — Surgical case request and scheduling transitions (specializes EnterpriseOrder).
  • surgery.preop — Pre-operative assessment completion (assessment ≠ authorization).
  • surgery.consent — Consent obtained events (no surgery without required consent).
  • surgery.readiness — Readiness confirmation (scheduled ≠ ready; missing readiness surfaced).
  • surgery.theatre — Theatre allocation events.
  • surgery.timeout — Explicit, attributable surgical timeout events (required before start).
  • surgery.procedure — Procedure start, pause, completion, and abort events.
  • surgery.recovery — Recovery/PACU entry events (completed ≠ recovered).
  • surgery.handoff — Structured handoff events (routed ≠ reviewed).
  • surgery.adverse — Adverse event escalation and acknowledgment.
  • surgery.override — Emergency override events (reason, authorization, audit, later review).

Operations Center health

Review surfaceSynthetic

Prototype / Synthetic Review Environment — fixture-backed.

info
Production integrationsBlocked

Theatre/anesthesia/device/medication/implant/blood-product blocked by DEBT-19.

high
Audit trayAppend-only

Prior/new state, actor, role, reason, approvals, provenance.

healthy

Deferred production integrations · DEBT-19

Production gate DEBT-19 is open and blocking. Until implemented, tested, reviewed, and accepted by the Enterprise Owner, the following remain blocked:

  • production surgery scheduling
  • production theatre activation
  • live anesthesia integration
  • device and monitor integration
  • production medication administration
  • production implant tracking
  • production blood-product issue
  • deployment