This year, for the first time in my life, I had an experience which I’d never had before. I had to have a minor procedure in hospital and opted for a GA (general anaesthetic). Apart from watching hospital programmes on TV, I had no idea of what an operating theatre was like or what to expect. Curiosity got the better of me and so I decided to delve into the actual happenings of a theatre to take out the mystery of what was to come.
I found out that there can be many health professionals present in an operating theatre and for many individuals who have been fortunate enough never to have seen one previously, anxiety can be through the roof - I know mine was! When the day of my procedure came, quite a few clinicians came to me asking questions, I didn’t have a clue who they were. I think it is quite understandable for us to have many thoughts, questions and concerns.
I didn’t know that the number of staff in a theatre will depend on the specialty but usually there will be 2 Scrub Nurses, 1 ODP, up to 2 Anaesthetists, up to 2 Theatre Support Workers and up to 3 surgeons. There could also be more staff such as Radiology, Clinical Photography, Students and even Reps!
As you can see just by reading this how many health professionals can be in theatre it might get a little confusing for everyone: For starters, who is leading the show? the main Surgeon? They're all wearing face masks and green throw-away scrub hats and all that is seen are eyes - but why do all these people need to be here? What do they all do?
Scrub Nurses x 2
Typically, there will be 2 Scrub Nurses: One will scrub for the procedure and work inside the sterile field while the other will circulate outside the sterile field. Both Nurses are expected to make sure Theatre is in full working order by checking correct trays and equipment are all hand ready for the list.
TSWs (theatre support workers)
I wondered what their responsibilities are and learned that they help to transport patients from wards to theatres and from theatre to recovery. They also manage the theatre by ensuring it is well stocked with sutures, syringes and swabs, assist in the clean-up and tidy theatre before and after procedures, they also complete swab checks with the Scrub Nurse.
ODPs (operating department practitioners)
I never really knew what an ODP is responsible for and found they check the anaesthetic machines, ventilators, vital signs monitor, intravenous equipment, airway equipment and ensure they’re in correct working order before the start of every list. They are also in charge of ordering and checking drugs. When you first arrive in the anaesthetic room the ODP checks you in, checks your wristband and checks the consent form so your op/procedure can go ahead with no problems. It is part of their job to reassure and keep you calm whilst in recovery.
At times in theatres, you can have up to 2 Anaesthetists, an Anaesthetist Registrar and a Consultant Anaesthetist. Anaesthetists provide anaesthesia and pain management before, during and post-surgery. They monitor your vital signs and administer drugs when needed.
Their other key responsibilities are getting you ready for the procedure, intensive medicine, resuscitation and stabilisation if you should need emergency care. A personalised formula of drugs is created to anesthetise you specifically, as all patients are unique.
Usually, there will always be 2 Surgeons on a list (a Consultant and a Registrar) sometimes even 3 in complex cases. It is normal for a Surgeon to speak to you and inform you of the procedure you will be having together with benefits and risks. They will also ensure your consent form is signed (this is essential before starting any procedure). The Surgeon is responsible for performing the procedure and maintaining a sterile field. Surgeons are also responsible for remaining calm and composed during the procedure and should things not go as expected then they must remain level-headed for any possible bleeds. Managing post-operative recovery and follow-up care is also part of their job description.
We need all these people working together and individually with their own roles to perform to optimum levels. Could there be improvements? Yes, there could! Many miscommunication errors have occurred in operating theatres i.e. certain staff being mistaken for another as identification badges cannot be worn in theatres and not knowing who is who. As a vulnerable and frightened patient, having lots of unknown people around you is a very daunting and highly anxious experience. Even after the clinician has introduced themselves, add in tension, lots of other people, masks and the same-coloured uniform scrubs where they all look the same, it is very difficult to remember that introduction and which member of staff it was.
From a patient’s perspective, I firmly believe we have the right to know exactly who is looking after us, human factors like names and roles play a big part in helping us to feel more at ease and less fearful and I feel that the theatre team would also work better together if they all know exactly who they are working with!
Joy Baker, Patient at Warwick Hospital in July 2023.