Improving teamwork and communication in the operating room by introducing the theatre cap challenge

Objective One of the steps of the Surgical Safety Checklist is for the team members to introduce themselves. The objective of this study was to implement a tool to help remember and use each other’s names and roles in the operating theatre. Methods This study was part of a pilot study in which a video and medical data recorder was implemented in one operating theatre and used as a tool for postoperative multidisciplinary debriefings. During these debriefings, name recall was evaluated. Following the implementation of the medical data recorder, this study was started by introducing the theatre cap challenge, meaning the use of name (including role) stickers on the surgical cap in the operating theatre. Findings In total, 41% (n = 40 out of 98) of the operating theatre members were able to recall all the names of their team at the team briefings. On average 44.8% (n = 103) was wearing the name sticker. Conclusions The time-out stage of the Surgical Safety Checklist might be inadequate for correctly remembering and using your operating theatre team members’ names. For this, the theatre cap challenge may help.

P-B04 Restarting bariatric surgery after the Covid-19 pandemic: a template for safe practice

Background Bariatric surgery virtually ceased with the advent of the Covid-19 pandemic and has been amongst the last sector of operative practice to restart. There have been understandable concerns about restarting bariatric surgery including the risks to patients of contracting Covid infection in the peri-operative period, potential de-skilling of surgeons and theatre teams and the appropriateness of directing scarce and limited resources to bariatric surgery when every surgical specialty is experiencing rapidly rising waiting times and ever lengthening waiting lists. This study describes the restart programme at our NHS bariatric unit and offers a template for safe commencement of complex benign surgeries in the current era. Methods In the months after the pandemic started, our Bariatric MDT reviewed every case on the waiting list and contacted each patient to explain the current waiting times and the importance of not gaining weight to be eligible for surgery when surgical practice resumed. Group education and Support Group sessions were moved from face-to-face appointments to online classrooms and regular input was sought from specialist dieticians, nurses and psychologists. The expected waiting times for patients was pro-actively submitted to the Executive Board of the Trust with details about >104-week waiting patients being clearly articulated. Once approval was given to restart bariatric surgery, every patient was assessed and prioritised in terms of waiting time and clinical need. A bariatric theatre team was brought together and engaged in pre-operative training and a local refresher course on equipment and the planned surgeries. There was engagement with industry to provide on-the-ground support for the first lists to ensure proper and safe use of energy and stapling devices. Each list had two consultant surgeons assigned to it and just two cases per day were planned and patients were managed on an entirely green pathway within the NHS hospital . Results The bariatric restart programme commenced in May 2021; between May 2021 and August 2021, there have been 27 operations carried out (25 Roux-en-Y gastric bypass, 2 sleeve gastrectomy) and two cancellations on the day (both due to patient choice). Each operating list finished between two and three hours before the planned finish time. Formal debrief sessions after each list identified no problems with the operations of the equipment and none of the patients had any post-operative complications. Length of stay was between 1 to 2 days for the entire cohort. Since the restart programme commenced, the requirement for dual consultant operating has ceased and the last 5 cases have been entirely training cases for the operating registrar, again without complication. Each list is now planned to increase to pre-pandemic levels of activity with four cases per list. Conclusions Restarting complex benign surgical practice is complicated and requires engagement with management, theatre and nursing colleagues to ensure that cases are not ‘left behind'. It is important to reduce the risk of complications and of peri-operative covid-19 infection in bariatric patients and development of a pathway that all members of the theatre team have input in to meant that there were few problems or issues with either the planning of the lists or the running of the lists. Such an approach could be considered for restarting any high volume, complex benign surgical practice.

EP.WE.858Risk of Post-Operative COVID-19 Infection Following Breast Surgery

Aims To study the risk of post-operative COVID-19 infection in patients undergoing breast surgery during the height of the pandemic in 2020. Methods We continued to perform surgery for breast cancers and other urgent breast conditions during the pandemic in a dedicated “Green” operating theatre in a COVID-19-free hospital. NHS guidance regarding staff and patient COVID-19 screening and patient self-isolation period changed frequently during the study period, and recommended guidance was followed. PPE was worn by theatre team. Patient records were subsequently reviewed for a positive COVID-19 swab or a COVID-19-related hospital admission within 8 weeks of surgery. Results 96 consecutive operations were performed by 4 consultants between April and August 2020. All but 14 were for breast carcinoma. Median age 56 (21-89). Median ASA grade 2 (1-3). 64 patients had negative preoperative COVID-19 swabs, others in the early stages were screened with chest X-ray or CT. 83% (n = 80) were done as day cases. Among breast cancer operations there were 17 mastectomies, bilateral in 2 cases. There was no cases of COVID-19 positivity or COVID-19-related hospital admission post-operatively. Conclusions Breast surgery, done mainly as day case, did not predispose patients to COVID-19 infection in the postoperative period when guidelines were followed. Concern about postoperative COVID-19 infection should not be a cause of surgical delay in any future waves, which can be potentially harmful to breast cancer patients.

SP10.2.13 Theatre-team meeting start times during the COVID-19 pandemic: An audit of elective orthopaedic theatre practices at a high volume elective orthopaedic centre during the COVID-19 pandemic

Aims The estimated cost of running an NHS theatre is 20 pounds per minute therefore it is essential that theatres runs as efficiently as possible to reduce waste. After elective services were restarted a disproportionate increase in late theatre start times was observed. An audit was carried out to evaluate whether team meetings were beginning on time (08:00) and if not; the length of and reason for the delay. These findings were presented at Clinical Governance and a re-audit was done to see if there had been any improvement. Method Data was recorded on an audit proforma in each theatre before the first case. This was done for 2 weeks over 12 days of theatre sessions and subsequently analysed to evaluate if practice was compliant with local theatre protocols. Results First cycle – average team brief start time of 08:05 with 17/18 (94%) of late starts due to surgeon/anaesthetist lateness. Second cycle - average team brief start time of 08:08 with 10/22 (45%) of late starts due to surgeon/anaesthetist lateness. Conclusions Late starts led to further delays to the patient being sent for and arriving in theatre; late starts were usually caused by doctors/surgeons. The proportion of late starts due to the surgeon/anaesthetist (45%) decreased compared to the first cycle (94%) suggesting that theatre team members successfully adapted their practices following changes to local protocols during the COVID-19 pandemic. A number of extraneous factors were also attributed to the later average start times in the second cycle.

TP10.1.7New Minor Surgical Set as a way to improve surgical efficiency during COVID-19 pandemic

Aims Large number of paediatric plastic surgical procedures were identified in Evelina Hospital during COVID-19 pandemic as not requiring large conventional surgical operative sets that can contain at average 35 instruments. Large sets are more expensive, take longer preparation time due to instrument counting and as a consequence take more total operating time. Furthermore, more instruments need to be unnecessarily purchased, stored and cleaned post procedure. Simple paediatric plastic surgery procedures including nailbed repair or laceration repair require limited and largely replicating operative instrument set. We have therefore introduced Small Minor Plastic Surgical set (MS) containing only 10 instruments. We audited its effectiveness and introduced a revised version of the set as per feedback, permanently arranged into theatre operative set collection. Methods MS set was introduced and used at senior surgeons discursion for paediatric plastic surgical procedures. Feedback was gathered from the surgeon and scrub nurse via specially designed questionnaire at post operation and theatre team debrief. Suggested alterations were implemented and New Minor Surgical (NMS) set was introduced and re-audited using revised questionnaire. Results 61% of surgeons and 89% of scrub personnel thought MS set contained everything that was needed for the case. Following revision 91% of surgeons and 95% of scrub nurses thought NMS set contained all necessary equipment for the operation. Conclusions NMS set introduced into daily surgical practice in Evelina Hospital theatres improved overall staff satisfaction when considering both surgeon and nursing staff. It provided cost- and time-effective operative set now vastly used across surgical specialities.

789 New Minor Surgical Set as A Way to Improve Surgical Efficiency During COVID-19 Pandemic

Introduction Large number of paediatric plastic surgical procedures were identified in Evelina Hospital during COVID-19 pandemic as not requiring large conventional surgical operative sets that can contain at average 35 instruments. Large sets are more expensive, take longer preparation time due to instrument counting and as a consequence take more total operating time. Furthermore, more instruments need to be unnecessarily purchased, stored and cleaned post procedure. Simple paediatric plastic surgery procedures including nailbed repair or laceration repair require limited and largely replicating operative instrument set. We have therefore introduced Small Minor Plastic Surgical set (MS) containing only 10 instruments. We audited its effectiveness and introduced a revised version of the set as per feedback, permanently arranged into theatre operative set collection. Method MS set was introduced to Evelina Theatres and used at senior surgeons’ discursion for paediatric plastic surgical procedures. Feedback was gathered from the surgeon and scrub nurse via specially designed questionnaire at post operation and theatre team debrief. Suggested alterations were implemented and New Minor Surgical (NMS) set was introduced and re-audited using revised questionnaire. Results 61% of surgeons and 89% of scrub personnel thought MS set contained everything that was needed for the case. Following revision 91% of surgeons and 95% of scrub nurses thought NMS set contained all necessary equipment for the operation. Conclusions NMS set introduced into daily surgical practice in Evelina Hospital theatres improved overall staff satisfaction when considering both surgeon and nursing staff. It provided cost- and time-effective operative set now vastly used across surgical specialities.

1496 Building Inclusivity and Diversity from our Foundations: A Cross-Sectional Study Identifying Barriers to Theatre Based Training for Foundation Doctors

Aim Theatre experience is a powerful factor enabling trainees to determine whether they possess the enthusiasm and aptitude to undertake a surgical career. Removing barriers to theatre learning should allow a more meritorious and diverse cohort of surgical trainees. Method An 18 -point open and closed question Likert scale survey was distributed to Foundation Doctors in three hospitals within the Northern Deanery. The survey was designed via focus group and literature review, ascertaining perceived levels of preparedness, acceptance, enjoyment, and barriers to theatre access. Results The survey dichotomized respondents (n = 54) into those who attended theatre (n = 40) and those who did not (n = 14). Of those attending 38% (n = 15) reported intimidation and 15% (n = 6) cited a cultural barrier to attendance. Of those who did not attend 79% (n = 11) were interested in surgery. These respondents predominantly reported concerns around prohibitive ward workload and unfamiliarity with protocols. Covid restricted surgical rotations for some. There was a statistically significant difference (p fishers exact test = 0.001) between 83% of respondents who felt welcomed by the surgeons compared to just 45% made to feel welcome by the wider theatre team. Only 20% (n = 11) of respondents felt prepared for theatre by medical school. 50% (n = 27) were confident with theatre protocols. Conclusions The study raises concerns around apprehension surrounding the theatre environment and ward workload which appear to impede access to theatre. Adequate undergraduate surgical teaching, appropriate induction and allocation of theatre time are crucial to improve safety, diversity of applicants, confidence for trainees and compliance within the team.

Writing’s on the wall: improving the WHO Surgical Safety Checklist

Background and problemThe WHO Surgical Safety Checklist has been shown to improve patient safety as well as improving teamwork and communication in theatres. In 2009, it was made a mandatory requirement for all NHS hospitals in England and Wales. The WHO checklist is intended to be adapted to suit local settings and was modified for use in Gloucestershire Hospitals NHS Foundation Trust. In 2018, it was decided to review the use of the adapted WHO checklist and determine whether improvements in compliance and engagement could be achieved.AimThe aim was to achieve 90% compliance and engagement with the WHO Surgical Safety Checklist by April 2019.MethodsIn April 2018, a prospective observational audit and online survey took place. The results showed compliance for the ‘Sign In’ section of the checklist was 55% and for the ‘Time Out’ section was 91%. Engagement by the entire theatre team was measured at 58%. It was proposed to move from a paper checklist to a wall-mounted checklist, to review and refine the items in the checklist and to change the timing of ‘Time Out’ to ensure it was done immediately prior to knife-to-skin.ResultsFollowing its introduction in September 2018, the new wall-mounted checklist was reaudited. Compliance improved to 91% for ‘Sign In’ and to 94% for ‘Time Out’. Engagement by the entire theatre team was achieved 100% of the time. Feedback was collected, adjustments made and the new checklist was rolled out in stages across all theatres. A reaudit in December 2018 showed compliance improved further, to 99% with ‘Sign In’ and to 100% with ‘Time Out’. Engagement was maintained at 100%.ConclusionsThe aim of the project was met and exceeded. Since April 2019, the new checklist is being used across all theatres in the Trust.

Minimising aerosol spread during endoscopic sinus and skull base surgery. Experimental model evaluation of the efficacy of the microscope drape method

BackgroundEndoscopic sinus and anterior skull base surgery is considered particularly high risk for severe acute respiratory syndrome coronavirus-2 transmission in the operating theatre setting. In this context, the use of a microscope drape method is proposed, to minimise aerosol spread in the wider operating theatre environment.MethodsThe efficacy of the method is assessed with a simulation model, using a CMI Concept Air Trace MK2 smoke generator for aerosol generation and a Fluke 985 air particle counter to measure air particles sized 0.3–10 μm in the operating theatre environment.ResultsAerosol spread was contained almost to baseline levels with the application of the drape barrier and the negative pressure created using suction within the drape.ConclusionThe method is an efficient adjunct that could reduce the risk of aerosol shedding and viral transmission to the operating theatre team. It potentially allows faster operating theatre turnover and more liberal use of powered instruments during endonasal surgery.