• This surgical list Debrief tool flags up issues for improvement to management and WILL receive a response with resolutions. Any member of the OT team can complete it during the end of list debrief, or a scribe can be nominated.

  • Document No.

  • Audit Title

  • Surgical List and Theatre

  • Conducted on

  • Scribe/Team member completing form

  • Location
  • Personnel

Debrief Follow Up for QI

1. Equipment and Instruments

  • Were there any equipment or supply issues today?

  • Please specify

  • Other
  • Give details

  • Add media

2. Staffing and Personnel

  • Were there any problems with staffing on the list today?

  • Please specify

  • Provide Details

3. Preparation and Planning

  • Were there any problems with preparation for the list today?

  • Please specify

4. Operating Room Environment

  • Were there any environment problems today?

  • Please select:

  • Take a photo

  • Provide details

5. Patient-related issues

  • Were there any DATIX incidents to report directly involving the patient ?

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