Safer Surgery part 48. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | This page has been left blank intentionally Chapter 27 Behaviour in the Operating Theatre A Clinical Perspective Nikki Maran and Simon Paterson-Brown As clinicians we have spent many thousands of hours working in operating theatres over the last 20 years. As a senior anaesthetist and surgeon we recognize that we have a great deal of influence on the atmosphere created in the operating theatre and that our behaviour influences those around us. However as trainees we experienced many different regimes in a variety of theatres in which we were trained. There has always been a steep hierarchy within any surgical team and there was no question but that the senior surgeon was the leader. The only time this might ever have been in doubt was where there was an equally formidable theatre sister or anaesthetist in post. Voices were raised instruments thrown brows mopped and tears shed. These were not environments in which one questioned decisionmaking or challenged leadership if one wished to set foot in the operating theatre again We tended to work in small clinical teams or firms with little turnover of staff so everyone knew each other fairly well and teams became well oiled in routine practice . Although few protocols as we recognize them today existed deviation from the team routine was seldom tolerated. Patients died usually because they had co-existing medical disease and occasionally due to some technical failure during surgery at least these were the only things we measured. Occasional emergency situations arose which resulted in a patient s death and these unfortunate events were often regarded as unavoidable complications of surgery. Occasionally a culprit was identified and usually publically vilified in departmental mortality meetings. As junior doctors we provided continuity of care by working over 100 hours per week and specialist training lasted eight to ten years. The major focus of training was in the development of good technical skills and these were .
