Theatre team roles and communication

Why teamwork and communication matter in theatre

• Theatre is high-risk: multiple tasks happen quickly, often in parallel (anaesthesia, surgery, equipment, positioning).
• Good communication reduces errors (wrong patient/site, drug errors, missing equipment, delays in recognising deterioration).
• You are responsible for your actions, but safety depends on the whole team sharing information early and clearly.
• If you are worried, say so early: it is always acceptable to pause for safety.

Core theatre roles (who’s who)

• Anaesthetist: assesses patient, delivers anaesthesia/sedation, manages airway/breathing/circulation, analgesia, fluids, temperature, and perioperative safety.
• Anaesthetic trainee/new starter: works under supervision; escalate early; confirm plans and expectations at the start of the list/case.
• Anaesthetic assistant/ODP (Operating Department Practitioner) or anaesthetic nurse: prepares anaesthetic room/theatre, supports airway management, monitoring, drugs/equipment checks, helps with transfers and emergency drills.
• Surgeon: leads the operation, confirms procedure/site/side, communicates surgical plan, expected blood loss, positioning needs, and critical steps.
• Surgical assistant/trainee: assists surgeon; may help with consent checks and positioning; should communicate anticipated events (tourniquet, clamp release, insufflation).
• Scrub practitioner (scrub nurse/ODP): maintains sterile field, prepares instruments, counts swabs/needles/instruments, anticipates surgical needs.
• Circulating practitioner (runner): non-sterile support, fetches equipment, helps with positioning, documentation, liaises with other departments.
• Theatre coordinator/charge nurse: oversees theatre flow, staffing, escalation, and prioritisation across lists.
• Recovery practitioner (PACU): receives handover, monitors airway/breathing/circulation/pain/nausea, manages immediate post-anaesthetic care and escalation.
• Porters: patient transfers; often key for timely movement and safe handling—brief them on lines, oxygen, and monitoring needs.

Before the case: introductions and shared plan

• Introduce yourself by name and role to the whole team (including scrub and recovery) at the start of the list and for each new team change.
• Agree the plan: anaesthetic technique, airway plan, analgesia plan, antibiotics, thromboprophylaxis, positioning, expected blood loss, and special equipment.
• Clarify “critical moments” where you want quiet or attention (induction, airway instrumentation, emergence, transfer).
• Confirm who to call for help and how (buzzer/phone number/bleep) and where emergency equipment is (difficult airway trolley, defib, blood fridge).

The WHO Surgical Safety Checklist (how to use it well)

• Sign In (before anaesthesia): confirm patient identity, procedure, site/side marking, consent, allergies, airway/aspiration risk, blood loss risk, equipment/monitoring readiness.
• Time Out (before incision): whole team pauses; confirm identity/procedure/site, antibiotics given, imaging available, anticipated critical steps, VTE prophylaxis, positioning, diathermy/implant needs.
• Sign Out (before leaving theatre): confirm procedure performed, instrument/swab/needle counts, specimens labelled, equipment issues, post-op plan (analgesia, fluids, destination, concerns).
• If something doesn’t match (name/procedure/side), stop and resolve it—do not proceed “to keep things moving”.

Closed-loop communication (simple and effective)

• Use names and direct requests: “Sam, please draw up 50 micrograms of fentanyl.”
• Receiver repeats back: “50 micrograms fentanyl drawn up.”
• Sender confirms: “Yes, thank you.”
• Use for: drug doses, blood requests, critical observations (BP 70 systolic), and emergency instructions.
• Avoid vague phrases like “give some” or “a bit more” when it matters—state drug, dose, route, and timing.

Speaking up and escalation (human factors basics)

• If you are concerned, say it early and clearly; you do not need to be certain to raise a concern.
• Use graded assertiveness if needed: “I’m concerned…”, “I’m uncomfortable…”, “Stop—this is unsafe.”
• Use a structured message for escalation (e.g., SBAR): Situation, Background, Assessment, Recommendation.
• If you are not being heard, escalate to the consultant anaesthetist, theatre coordinator, or call for emergency help as appropriate.
• It is acceptable to ask for a pause to re-check identity, drugs, equipment, or plan.

Common ‘first time’ scenarios and what to say

• You don’t know the surgeon/team: “Hi, I’m [name], anaesthetics. Can we run through the plan—expected blood loss, positioning, antibiotics, and any critical moments?”
• Unexpected change in plan (e.g., laparoscopic to open): “Can we pause—this changes analgesia/fluids/blood loss risk. I’ll update the plan and check blood availability.”
• Concern about positioning/pressure areas: “I’m worried about nerve/pressure injury here—can we adjust before we start?”
• Noise during induction/intubation: “Quiet please for airway—thank you. I’ll let you know when we’re ready.”
• You think antibiotics were missed: “Time out—have antibiotics been given? If not, we should give them now before incision.”
• Recovery handover: “This patient had a difficult airway/aspiration risk—please keep them head-up, monitor closely, and call me if any stridor/desaturation.”

Handover: what recovery and wards need from you

• Use a consistent structure: patient/procedure, anaesthetic type, airway, key events, analgesia plan, antiemetics, fluids/blood loss, lines/drains, antibiotics, VTE plan, and specific concerns.
• State what ‘good’ looks like: target BP/HR, oxygen requirement, pain/nausea plan, and when to escalate.
• Mention any intra-op complications or near-misses (e.g., laryngospasm, hypotension, difficult IV access, anaphylaxis concern).
• Confirm destination and level of care (ward, HDU/ICU) and any required monitoring (e.g., arterial line, epidural observations).

Documentation and professionalism

• Document clearly: key times, drugs/doses, airway details, complications, discussions, and post-op instructions.
• Be respectful and calm; avoid blame language—focus on facts and safety.
• If an incident occurs, ensure patient safety first, then inform seniors and follow local reporting processes.