New Blog Post: Shadowing the Clinical Lead on Safety Culture at Derriford Hospital

We talk to Joanna Pendray, Improvement Lead – Patient Safety of the South West Patient Safety Collaborative, about her day of ‘shadowing’ the Clinical Lead on Safety Culture, Dr Matt Hill in theatres at Derriford Hospital.

“I was lucky enough to be given the opportunity to shadow the work of our clinical lead on safety culture, Dr Matt Hill, for a day at Derriford Hospital in June this year.  Matt works as a Consultant Anaesthetist so it was my privilege to be allowed into the theatres in Plymouth.  It was pouring with rain as I arrived at Derriford Hospital and I hoped that starting the day with wet feet was the only thing which would make me feel uncomfortable during the day….
The hours that followed were highly illuminating – I changed into ‘scrubs’ for the first time which in itself felt like I was joining an exclusive club!  The first theatre I visited was dealing with a number of bariatric operations all of which were undertaken through key hole surgery.  When I first arrived, a patient was mid-operation so all I could see of him was his stomach area; watching the surgeons skilfully manoeuvre their operating instruments and being able to see it on a screen first hand certainly brings home the responsibility that clinicians take every day for keeping their patients safe and ensuring that the patient has the best possible outcome.  I was somewhat bemused by the part of the operation which entailed getting a removed piece of a person out of their body by inserting a bag inside them, popping the unnecessary organ into the bag and then bringing it out through a key hole.  Once the operation was concluded, seeing the patient’s face was sobering; until that point, it felt very much as if the operation was on an inanimate object.
In the other operations I saw, I was lucky enough to meet the patients before they underwent their operations, which were variously – an appendix removal, a gall bladder removal, a gastric band fitted and a hip replacement (this latter operation was quite different to the key hole surgery, with drills, hammers etc being used, so gave me another view about the skills and temperament needed to be involved in this type of work).  I was impressed by the interactions with patients, reassuring them and giving information was consistent in every instance.  It was reassuring to see the whole team come together to check information –  the name of the patient, date of birth, NHS number and the operation to be undertaken was checked both with the patient and with other clinicians several times.  It was interesting to see other patient safety measures such as the ‘go to’ person in control of the theatre wearing a red hat (not necessarily the most senior person in the room), in contrast to everyone else, and nursing staff and operating department practitioners checking of the number and type of instruments and swabs used in the operation to ensure that no foreign bodies would be left in a patient.  The whole teamwork ethos was exemplified by the way the nursing staff and operating department practitioners worked together closely and smoothly to, amongst other many other things, prepare the theatre for each operation, providing reassurance to patients, anticipating needs during operations, clearing away methodically, and caring for patients as they emerged from the effects of the anaesthetic.  The transition to the nursing staff in recovery was undertaken using critical language about the operation, the status of the patient and the medication they had received.  This was truly a transition of care as the nursing staff spoke to patients groggy from anaesthetic, introduced themselves and explained to the patient what was happening.
Matt explained how he monitors patients using various tools whilst they are anaesthetised and that his ear is so tuned to the equipment that he is always aware of certain monitoring noises.  It’s this kind of situational awareness which it is hard to observe and fascinating to understand.  I was further struck by the level of responsibility for the lives of others, when, before another operation it was explained to me that, once anaesthetised, if a person is not properly ventilated within 4 minutes, they will die.  I discovered more about the complexities of the types of anaesthesia and the issues in giving anaesthetics became clear during the day as I saw problems with finding veins and the various methods needed to locate a vein capable of receiving anaesthetic, finding the best way of ventilating someone when the structure of their neck made the process problematic and making adjustments to the bed or where someone is anaesthetised according to the needs of the patient.
It was only when I changed out of my scrubs and into my still damp shoes and clothes that I wondered what the weather was doing outside and yes, it was still raining, so as life outside the theatres had continued with umbrellas and raincoats, inside the theatres life- saving and improving work had been going on (and was still going on when I left for the day).  It was hugely inspiring and humbling to see how all of the individuals and teams work together and I feel honoured to have been part of their world for a short time.”
With thanks to Dr Matt Hill, Plymouth Hospital and all of the staff in the theatres teams.