Theatre team
The SWLEOC theatre team runs six theatres, six days per week, all day lists (two-session days). The Theatre team completes, on average, 144 procedures/operations per week, including all types of elective orthopaedic surgery, from minor to complex procedures, for the spine, shoulder, elbow, wrist and hand, hip, knee and foot and ankle.
The theatre team is made up of surgeons, anaesthetists, registered nurses, Operating Department Practitioners (ODP), nursing associates, Health Care Assistants (HCA), domestic staff, receptionists and a theatre technician. SWLEOC supports placements and rotations for medical students, nursing students and ODP students in the department.
Staff are allocated to teams; each being responsible for a group of surgeons.
Surgeons from five base hospitals work at SWLEOC as part of their job plan, together with SWLEOC Consultants who also lead the academic surgical team and Research Department.
Preoperative:
- The rota co-ordinator participates in a 6-4-2 process, with the Trust for the lists undertaken in Trust theatres and with the SWLEOC theatre matrons and scheduling lead for lists undertaken in SWLEOC theatres;
- theatre staff check the theatre list on Bluespier two weeks in advance to discuss the needs for every procedure listed;
- electronic Kardex is made for each surgeon and has a brief description of equipment required for different procedures by different surgeons;
- if equipment is not available on shelf: team lead loans equipment and implants;
- company sales representatives are booked to support the team if required. (There is a system in place for representatives to book themselves to visit or support the team). Representatives must book themselves via the Intellicentrics booking system. This avoids representatives arriving to show surgeons new products without prior arrangement and disturbing the flow of the day;
- the theatre technician provides a link between the sterilisation unit and theatres. They make sure equipment required is readily available, or they fast track sets that are required at short notice;
- scrub nurses check that implants are available for the following day. If not, a request is placed with the procurement company; Sometimes the nurses borrow from neighbouring hospitals;
- health care assistants have in-house training on implants and compatibility such that they are part of the circulating team; and
- band 4 Nursing Associate scrubs for minor cases.
Peri operative:
Theatre morning meetings at 7:45am are attended by stores team and theatre and anaesthetic nurses only, to discuss and plan the equipment and implants required for the lists that day as well as any additional information that the theatre teams need to know regarding specific patients. This is the opportunity to share and cascade information and problem solve together. This meeting is led by the theatre coordinator of the day. Their responsibility is to share the outcome of the team briefing with the MDT at the 8:15am safety huddle attended by all departments in the Centre.
Team briefing for each theatre occurs at 8am before the lists start, to discuss the specifics regarding the relevant list and patient specific details. This is attended by the surgeon, anaesthetist and the allocated theatre team. When each patient enters theatre; the WHO checklist is used.
- The service was set up in 2004 when the Centre started. There has been improvement on turnaround times due to theatre planning and morning briefings;
- SWLEOC has acquired newer and more state-of-the-art equipment;
- staff retention has improved due to improved skill mix, work satisfaction and collaboration between managers and staff for team members to have a better work life balance;
- use of agency staff has reduced such that currently there is no agency staff in the department because of improved recruitment and retention and substantive staff doing additional bank shifts;
- storage area has improved with installation of new shelving being taller than the previous ones. Thus, space has been gained in height vs the amount of kit and cases done;
- two matron posts were created due to the identified need to support over 20 x band 7 staff. Band 7 numbers were increased to improve staff experience and provide clinical and managerial support to the theatre team;
- band 4 Nursing Associate – the Nursing Associate course upskilled the band 3 HCA to a band 4 Nursing Associate that can scrub for minor cases and is now being further upskilled and training as an Operating Department Practitioner (ODP) – This is a brilliant way to build a resilient and multiskilled workforce;
- band 2 HCAs started out as apprentices. Completing a care certificate facilitated their promotion to band 3 with a higher skill set to support the theatre team;
- stores team have been trained to prepare consumables into small packs according to the E-Kardex which improves the organisation and efficiency of preparing for theatre the following day.
- Management team;
- radiology team;
- onsite procurement managed service including stores;
- in-patient clinical teams;
- neighbour hospital;
- base hospital;
- MDT, performance and operational teams; and
- external company representatives.
In the SWLEOC theatre suite of six theatres.
- Bluespier;
- clinical manager;
- patient manager;
- PACS;
- LifeBox;
- TraumaCad;
- H-trac (Implant usage and ordering); and
- Synergy (Instrument Tracking).
- Lack of equipment and implants due to national supply chain issues;
- infection prevention and control / COVID pathways; and
- delayed delivery of sterile kits due issues with sterilisation.
- Making sure orders are completed in a timely manner, and some items are bought in bulk and stored outside of theatres;
- purpose built external storage to improve stock levels;
- working with neighbouring hospitals NHS/private providers to borrow kit;
- dedicated band 4 to co-ordinate between theatre team and sterilisation unit; and
- fast track equipment requests albeit for a fee, to avoid non-clinical cancellations.
Manual handling issues for staff due to overcrowding in the storage area of theatres. This has been overcome by improving staffing levels, providing dedicated manual handling training, providing leg holders, and supporting patients to walk to theatre where possible instead of being transported.
- Availability of implants;
- availability of sterilised sets as we do not have onsite sterilising department;
- workforce challenges of all disciplines;
- over-running lists;
- late starts due to unforeseen circumstances; and
- late changes to the theatre list due to unforeseen circumstances.
- Promote teamwork with a sense of belonging;
- financial remuneration for over-runs and bank cover to recognise that a specialist team is required to run such a department, in turn this will reduce the number of cancellations and agency spend;
- commitment to continuous professional development and education for staff including protected monthly training/meeting of the whole team;
- kindness and respect of all clinicians irrespective of their level or profession;
- well-led – staff retention, staff feel supported, and a degree of flexibility within service need to accommodate a good work life balance;
- on-the-job training (e.g., from company representatives); and
- encouraged staff to do the anaesthetic course so that staff are skilled in both scrubbing and anaesthetics.
- Increasing band 7 staff WTE;
- in-house full time practice educator for ongoing training and development;
- scanning system for implants to determine usage and prompt ordering – control in place to monitor spend for financial sustainability;
- band 4 theatre and sterilisation unit co-ordinator – equipment required more reliable;
- getting sets ready a day before procedure;
- all staff are on WhatsApp Group for information on equipment and implants to be disseminated promptly;
- monthly staff meetings; and
- having the Band 7 and 6 dual roles of scrub and anaesthetics which makes the service more sustainable and reduces cancellations due to workforce availability.
- Having the sterilisation unit off-site created delays in sets turn around;
- instances of cancelled cases due to delayed sets.
- Theatre team-initiated recycling in theatre has inspired all teams in SWLEOC to make sustainability a priority. All teams are now implementing creative solutions to improve environmental and financial sustainability;
- weekly theatre planning meeting with schedulers, PACU, wards and pre-theatre to plan the following:
- Equipment required;
- order of theatre lists, ensuring patients are listed correctly e.g., day case or inpatients; procurement handled by managed service thus ensuring clinicians are not spending time away from clinical duties to perform this function;
- improved communications resulting from having the management team within the Centre; and
- staff access to clinical governance meetings.
Staff
Staff Member: Theatre Matron (Band 8a x 2 WTE) – across 6 days
Role:
- management of the operation and staffing of theatres daily (six days per week);
- attend departmental meetings including performance, TIG, Synergy, Medical council, and clinical governance;
- work very closely with the procurement firm to ensure constant supply of equipment and implants; and
- clinical support if required.
Staff Member: Senior Scrub Nurse (Band 7 x 25 WTE)
Role:
- checks the theatre lists in advance to ensure that all equipment and implants required are available and have regular communication with the Surgeons, company reps;
- liaise with stores to order or loan-in specific kit;
- allocated Roles e.g., Infection Control, WHO, Audit champions;
- co-ordinate the theatre day;
- dual role of scrubbing and anaesthetics; and
- theatre co-ordinator approves annual leave, rota planning, and staff allocation.
Staff member’s other roles in the centre
- Checking equipment;
- rota planning; and
- staff allocation.
Staff Member: Scrub Nurse (Band 6 x 7 WTE)
Role:
- Deputise for the band 7 in all duties;
- scrub and anaesthetic dual role; and
- check equipment.
Staff Member: Scrub Nurse (Band 5 x 3 WTE)
Role:
- scrub and circulating nurse who assists scrub nurse with delivering and opening implants and consumables and documentation;
- responsible for theatre set up in the morning and checking equipment.
Daily Staffing Model
The Theatre team is made up of:
- Surgeons x 1;
- surgeon’s assistant registrar/fellow x 1 or 2 if the case is more complex;
- Anaesthetists x 1;
- Registered nurses (band 7 x 1, band 6 x 1, band5 x 1);
- Operating department practitioners (ODP) x 1; and
- Nursing Associates or Health Care Assistants x 1.
For the Theatre Complex:
- Domestic staff x 2;
- receptionists x 1; and
- theatre co-ordinator x 1.
Staff Member: Theatre Technician (Band 4 x 1 WTE)
Role:
- support theatre set up and circulating nurses;
- check equipment.
Staff Member: Health Care Assistant (Band 3 x 1 WTE)
Role:
- circulate within their allocated theatre;
- prepare consumables for the following day using E-Kadex.
Daily Staffing Model
The Theatre team is made up of:
- Surgeons x 1;
- surgeon’s assistant registrar/fellow x 1 or 2 if the case is more complex;
- Anaesthetists x 1;
- Registered nurses (band 7 x 1, band 6 x 1, band5 x 1);
- Operating department practitioners (ODP) x 1;
- Nursing Associates or Health Care Assistants x 1.
For the Theatre Complex:
- Domestic staff x 2;
- receptionists x 1;
- theatre co-ordinator x 1.