By: Mariel Gonzales
"It seems like there are so many staff looking after me today." We get those comments quite often from our surgical patients as we're checking them in for an operation. Some patients undergoing surgery are in complete shock when they see the amount of healthcare workers looking after them. It can be daunting to some but a relief to many but no one in an Operating Theatre can work single-handedly. In order to operate a patient, a team with a wide variety of skills must work together for safe and high quality perioperative care.
Who are they and what role each of them play in a Theatre List? I will give you a general view for each role but bear in mind that there are lots of specialisation in a Theatre Complex. Some can be highly specialised that the staff have received further training beyond the perioperative practice such as Cardiothoracic, Neurosurgery, Organ Transplant, Robotics etc. Let’s meet the team and dive into their respective roles.
Floor Control/ Theatre Coordinator
Whether it’s a small or large Theatre Complex, there’s always a Floor Control or Theatre Coordinator who oversees the activity of the Theatre department as a whole. The job is usually allocated to a senior staff member on a Band 6 or a Band 7 level. They ensure that the lists start on time, provide advice on problems, ensure skill mix is appropriate, arrange breaks for staff if it hasn’t been sorted out by the team, plan ahead for any overrunning lists, and provide support to staff throughout the day. He/She is the go-to person by everyone and makes decisions using critical judgment to ensure that the department will run smoothly, rectify problems as they arise or escalate them to appropriate persons.
Surgeons are probably the heart of any procedure. Of course, they are the medical professionals who operate on the patient to treat a disease or injury. They have a robust training on the speciality that they’ve chosen and ensures a positive outcome for the procedure. They lead the team and ensure open communication to all so everyone can be at the same page. Prior to starting the list, the surgeon informs the whole team about the plan for each patient on the list, his/her requirements and any critical or unusual steps that the team needs to know about.
Surgical Registrars and Senior House Officer ( SHO)
Surgical Registrars and SHOs are the right hand of the surgeons. The consultant surgeon can delegate tasks to them such as seeing the patients in the ward prior to starting the list for preoperative assessment, for gaining written consent, and marking the operative site as applicable. They also assist during the operation with various tasks such as providing retraction, suturing and helping with haemostasis. They have vast amount of knowledge and skills that can either be a broad specialty (ie. General Surgery) or subspecialty (ie. Cardiac). Some senior registrars can have their own lists or operate independently in an Emergency Theatre with a consultant surgeon on site should they need further advice and support. They provide clinical leadership in the surgical ward by assessing, diagnosing, creating a plan, and evaluating the outcome of care and treatment to surgical patients.
Surgical First Assistant (SFA)
Surgical First Assistants (SFA) are usually perioperative practitioners who have undergone further training to assist during the surgery under direct supervision of the surgeon. Whilst they can perform certain tasks during the surgery, they’re not allowed to perform any surgical intervention. Their role encompasses assistance with positioning, skin preparation and draping, use of machines and equipment relevant to the surgery, manipulating and retraction of tissues and organs for exposure, aiding with haemostasis such as suctioning, indirect application of diathermy with surgeon’s direction, camera holding during laparoscopic surgeries, assistance on closing the incision site and cutting sutures. They are also expected to enhance the communication with the patient, theatre team, and other multidisciplinary teams involved in the care of the patient. To know more about this role, read Phillip’s story as a Surgical First Assistant.
Surgical Care Practitioner (SCP)
Surgical Care Practitioners have been coined to be “surgeons who are not doctors” because they aren’t medically qualified but can perform minor surgeries independently. Like the SFAs, they have also done further training but are more extensive and their scope of practice is much broader. They have to undergo a two years Master’s degree in an accredited university and clinical practice and have to pass the Royal College of Surgeons Exam for SCPs.
Apart from assisting the surgeon during the operation, they also perform preoperative checks on patients, join the ward rounds and support the surgical SHOs and registrars with documentation and ordering investigations. They can also have a nurse-led clinic where they can see patients and liaise with GPs and MDT for continuity of care. To know more about this role, read Russel’s story as a Cardiothoracic SCP and Uchi’s story as Advanced Clinical Practitioner -SCP for General Surgery and Hepatobiliary Team.
Anaesthetists are specialist doctors who administer anaesthesia to patients who will undergo surgery. Without them, surgery wouldn’t be possible because anaesthesia allows the patients to be pain-free either with local, regional or general anaesthesia depending on the extent and nature of the surgical procedure. They assess whether the patient is fit for surgery, mitigates the risks should the patient have underlying comorbidities and optimise the patient’s condition prior to surgery as necessary. They are also experts with airway and pain management. Hence, you won’t only see them in the Operating Theatre but also as the lead doctors in Intensive Therapy Unit (ITU), managing airways in Cardiac Arrest Calls and seeing patients with chronic pain in the Pain Clinic.
Operating Department Practitioner (ODP)
Operating Department Practitioners or ODPs are highly skilled health practitioners specialising in all areas of the Operating Theatre. They can do all the aspects of perioperative practice such as Scrub, Anaesthetics and Recovery. They are regulated by the Health and Care Professions Council and their main base is the Operating Theatre. However, with their specialisation with anaesthetic assistance, you can also see ODPs as Resuscitation Officers, attending to cardiac arrest calls or educating staff members with Basic or Intermediate Life Support.
Scrub and Circulating nurse
Scrub nurses are responsible for ensuring that all the equipment needed for a certain operation is available. They also ensure that sterility is maintained all throughout the procedure and accountable items are counted correctly. Part of their role is also to anticipate the surgeon’s needs as well as passing the instruments needed to ease the surgeon’s workflow during surgery. Circulating Nurses monitors the overall environment of the Operating Theatre whilst surgery is taking place. They act as an advocate to the patient ensuring their safety whilst under their care, attending to the needs of the scrub nurse and liaising with the Theatre coordinator, ward or other departments involved in the patient’s care. To know more about the scrub and circulating role, read Mariel’s story as a Theatre Practitioner.
Anaesthetic Nurses provide skilled assistance to the anaesthetists with anaesthesia provision and airway management. The role is traditionally done by the ODPs as they are trained to do all areas in Theatres. Even if you came here in the UK as a very experienced Operating Room Nurse overseas, you still need to take an extra qualification as an anaesthetic assistant to be able to assist in anaesthesia induction. Once you have completed the Anaesthetic Course, the scope of practice is quite similar with the ODPs where you can also assist the anaesthetist during cardiac arrest and airway emergency calls. To know more about this role, read Jenny’s story as an Anaesthetic Nurse.
Theatre Support Worker (TSW)
Theatre Support Workers are equivalent to Healthcare Assistants (HCA) in other departments. They also carry out the duties of circulating nurses or ODPs during the procedure such as opening sterile equipment, handling specimens, counting swabs, instruments and sharps with the scrub person and completing the theatre care plan to be checked by the scrub at the end of the case. Although they’re unqualified, I have worked with TSWs who are really skilful and knowledgeable with the years of experience they have acquired. They also make sure that the environment is clean before the start of the list, ensure that the theatres are well stocked up with the consumable items that we need regularly.
Porters as the name suggests are our colleagues who help us transport items and patients from wards to theatre. They are the bridge that connects the nurses from their departments to other parts of the hospital. They also give nurses a hand with herculean tasks. They’re always on the go and rarely you will see them stop moving. From helping transfer patients from point A to point B to transporting almost everything, they always achieve thousands of steps a day as they go around the hospital to get the job done.
Recovery nurses are the final persons that a patient encounters after an operation. Recovery is also known as Post Anaesthesia Care Unit (PACU). They monitor the patient closely following anaesthesia and surgery and ensure that the discharge criteria are met prior to sending the patients back to their respective wards. Their duties include but are not limited to ensuring cardiopulmonary and neurovascular functions are normal or back to the baseline, assessment of level of consciousness, management of pain, nausea and vomiting, ensuring fluid balance is maintained and wound is clean and dry and no obvious signs of bleeding. With the sharp assessment skills of Recovery Nurses, they rely on clinical judgment whether the patient needs further management or is ready to go back to the ward for continuity of care. To know more about this role read the story of Toto as a Recovery Nurse.
Every team member in the Operating Theatre Suite plays a valuable role for delivering safe and quality perioperative care to patients. No single member of the theatre team will meet the patient's holistic needs in the perioperative environment. Whilst each person carries out a certain task, the whole team must work collaboratively in order to achieve the goal of completing the surgery safely whilst accomplishing theatre productivity and efficiency. There is no doubt about this popular acronym about the word TEAM and can also be applied in the healthcare setting that “Together Everyone Achieves More.”