1 | Please tick your job role (from Nurse, Midwife, Doctor, Technician, Other) |
2 | Nurses only – what role did you work in for most of today (from Scrub / Scout Nurse, Anaesthetic Nurse, Recovery Nurse, Relieving Nurse, Admissions Nurse, DPU Nurse) |
3 | Doctors only – what role did you work in for most of today (from Anaesthetist, Anaesthetic registrar, Surgeon, Surgical registrar, Obstetrician and Gynaecologist, Obstetrics and Gynaecology registrar, Other proceduralist, Other proceduralist registrar) |
4 | Did you know the name of all of the anaesthetists (and registrars) you worked with today? (from Yes or No) |
5 | Did you know the name of all of the surgeons or obstetricians (and registrars) you worked with today? (from Yes or No) |
6 | Did you know the name of all of the nurses you worked with today? (from Yes or No) |
7 | Did you know the name of all of the technicians you worked with today? (from Yes or No) |
8 | Was there any point today where you couldn’t communicate with the team effectively about something? (from Yes or No) |
9 | How many staff in theatre in total did you NOT know the name of today? |
10 | Rate the teamwork you experienced in theatre on your shift today, from 0 – 5 (1 = completely unsatisfied, 2 = somewhat unsatisfied, 3 = neutral, 4 = somewhat satisfied, 5 = completely satisfied) |
11 | Did formal team introductions occur during time out? (from Yes, No and I’m not sure) |
12 | Which craft groups were present for the team introductions phase of the team time out during this list (tick all that apply) – from Scrub Nurses, Anaesthetic Nurses, Midwives, Surgeons, Obstetricians and Gynaecologists, or Other Proceduralists, Anaesthetists, Technicians, Paediatricians and team (if applicable) or None |