• Document No.

  • Conducted on

  • Prepared by

  • Hosptial Wing

  • Theatre Complex

  • Which Theatre

  • Which theatre?

  • Which Lab?

  • Theatre Complex

  • Which theatre?

  • Which theatre?

  • Which theatre?

  • Which theatre?

  • Which Specialty is the operating list?

  • How would you describe this list

  • Who is the named Consultant for this List/Case?

Briefing, Team & Location

  • What time did the Theatre Briefing begin?

  • Where was the Theatre Briefing conducted? ie. anaesthetic room, corridor etc

Please select the staff/personnel present at briefing

  • Consultant Surgeon

  • Surgical Registrar

  • Consultant Anaesthetist

  • Anaesthetic Registrar

  • Anaesthetic Practitioner (ODP/Nurse)

  • Surgical Scrub Lead Practitioner (Nurse/ODP)

  • How many Scrub/Circulating staff are present (including Scrub Lead)?

  • Are there other personnel present?

  • Role:

  • Role

  • Role:

  • Add a photo of briefing, team and location

Theatre Briefing

  • Planned Surgical Procedure for all patients discussed?

  • Please Comment

  • Order of the list confirmed/discussed

  • What is the reason?

  • Have all patients been seen by the anaesthetist?

  • Please comment

  • Has equipment (including prosthesis & monitoring) been discussed and available

  • Have any issues been identified?

  • Have any post-operative requirements or special investigations been raised for any of the patients?

  • Please comment

  • If there has been any equipment, post-op, patient, staffing or environmental issues raised, a named team member should be allocated to follow up & escalate their concerns.

  • On a scale of 1 - 10 how would you rank the briefing on quality and effectiveness? (1 Low -10 High)

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