Q: What time does theatre start at? A: Er…

“What time does theatre start at?” was the first item on the agenda when we anaesthetists were invited to a meeting by the ‘lean team’ running our improved theatre efficiency, Kaizen-type project. The whole meeting was typified by the fact that we never got beyond this item. But why should this be a difficult question to answer? The theatre lists clearly state ‘0830hrs’. Job plans generally start at 0815 or 0830 in anaesthesia. Most of us naively assume that means we start anaesthetising the first patient at 0830hours. What else could it possibly mean?

Well, in this new, patient safe lean way of working it can mean many things, or can actually have no meaning at all. In days gone by we did indeed turn up early to check machines, draw up the drugs and start with the first patient at 0830. More recently things are less straightforward. On a typical list, for example, the anaesthetist turns up at 0815 to prepare. All the theatre staff are ‘having breakfast’ followed by cigarette as ‘they started work’ at 0800.

Nothing is prepared in theatre because they aren’t sure which case we’ll be doing first, they need to see the surgeon. The anaesthetist nips round to the day surgery unit which functions more and more each day as a same day admission lounge and sees the first two patients for the list who arrived at 0730. The others are due to arrive at 1100, then noon, and finally at 1300 to reduce the amount of time they are ‘kept waiting’ for their operation.

This means the list needs to stop while surgeon and anaesthetist return later in the day to mark the correct side, establish their various fasting states and deal with the unexpected problems. Back to theatre, 0845, “can we get the first patient round?” the anaesthetist asks. Of course not. “We’ve not seen the surgeon yet,” state the theatre staff. Fair enough. “I’ve seen him”, the anaesthetist ventures, ever hopeful of getting the list started, “he’s in the admission area consenting and marking the two patients who have arrived”.

Now we need to wait for him to come to theatre so we can have the ‘team huddle’. 0900, surgeon arrives and the huddle begins. Everyone introduces themselves and that goes smoothly as we all know each other having worked together on this list for the past five years. Then, onto the first patient, confirmed as being the first name on the list, having the operation described on the list, with the routine set of equipment available. I comment that he’ll take 20 seconds to be knocked off to sleep. I don’t feel the need to explain my decision making processes when formulating my anaesthetic plan. I have 15 years experience in weighing up the risks and benefits as they pertain to individual patients and feel that dealing with those problems is my job, my responsibility, with the anaesthetic nurse or ODP being informed and prepared on a need to know basis.

We continue by huddling the second patient and then abruptly stop. The following four patients have not yet arrived. The surgeon cannot confirm the correct side of the planned surgery. I hope the patients will have been to the pre-assessment clinic, found it in good working order and have no special considerations. But we don’t know. Shall we just get started then? Shall we re-huddle at regular intervals? Again in the afternoon? Not bother? No one is sure and several of the staff are on half days anyway so lose interest.

The box on the form gets ticked that we have indeed performed the huddle and the first patient is brought to the anaesthetic room. It is 0910hours. Is that our start time? Or is when eventually the knife gets to the skin? The latter of course only happening after the surgical pause, and that’s a whole other story.

It’s going to be a long day…

Tags: Anaesthesia, Surgery