5. Theatre Design and Operational Layout.

• As surgical and anaesthetic procedures become more complex, operating theatres need to be larger and multi-purpose to accommodate specialist equipment such as imaging.


• The operational layout of theatres should be such that the flow of patients through the system is facilitated. Delays can happen at any point in the process and can be minimised with good communication and transport systems.


• There should be good internal communication and IT systems within the theatre complex to facilitate contact and appropriate supervis

• There should be a single Director of Theatre Services with full budgetary authority, adequate sessional allowance, accountability, information systems, and administrative and secretarial support.


• The director should be a senior member of staff [4], with a clear understanding and experience of working in operating theatres and ability to take a broad view across various specialties.


• Where budgets are devolved to specialist services or departments in the trust, robust mechanisms must be in place to ensure accountability and safe running of the theatres services as a whole.


• Day-to-day running of theatres should be in the hands of a Theatre Manager, a senior nurse or ODP who works within the theatre complex, has no conflict of duties and is directly accountable to the Director of Theatre Services.


• The theatre manager should be responsible for maintaining communication with staff groups, and ensuring competent staffing and suitable equipping of all theatres.


• There should be a system for planning theatre activity to allow the theatre manager to allocate staff efficiently, and to respond safely and flexibly to changes in routine. This will involve close co-operation with surgeons and anaesthetists.


• The theatre manager should develop local policies to ensure that planned surgical activity in printed or electronic form is clearly posted, well in advance and in all appropriate locations. It should include starting time, running order, the names of the operating surgeon and anaesthetist, and the consultant surgeon and anaesthetist in charge.


• Policies should be developed for dealing effectively with changes in published operating lists.


• Departments of Anaesthesia and Surgery should have an identified consultant, usually the 'rotamaker', who is responsible for ensuring that all operating lists are staffed with a suitably trained clinician and that, where possible, medical staff are reallocated to cover for absence.


• Where surgical activity is carried out in widespread locations within the hospital or trust, it is important that close co-operation, at medical, nursing, ancillary and managerial level, exists between all theatre areas.


• The theatre management team should regularly audit utilisation, cancellations, list overruns and late starts. (See sections 8, 11 and 12).


• Theatre User Groups provide an opportunity for communication between staff and management and can be useful both to promulgate new ideas, agree strategy and to report on the effectiveness of current policy.