monitors on carts and other large pieces of equipment (including robotics) may also be needed in an Operating Room, and space for
them must be considered.
The Surgical Team in a VA Teaching Hospital
Surgeon: The surgical team leader, under whose supervision the operation is performed. Assisting the surgeon in major operations
are one or more assistants, frequently the surgical residents. Under controlled teaching programs, medical students may also
participate as assistants. The maximum number of surgeons and/or assistants is typically four: two on each side of the operating
table.
Anesthesia Staff: Anesthesia is administered by the anesthesia staff, which can include anesthesiologists, anesthesia assistants,
anesthesia residents, anesthesia technicians, and certified registered nurse anesthetists (CRNAs). One or more anesthesia staff
may be assigned to each Operating Room. It is the responsibility of the anesthesia staff to consult with the patient before surgery and
identify family/friends that will speak to the surgeon after the procedure, to administer the anesthetic agent before and during surgery,
and to monitor the patient's vital signs. Anesthesia staff remain with the patient during the entire surgical procedure. Following the
surgery, the patient remains under the care of the anesthesia staff and the assigned recovery room nurse until the patient has met
the discharge criteria.
Nursing Staff: Every major surgical procedure performed in the Operating Room is staffed by at least one registered nurse and
scrub personnel. The scrub person, together with the first assistant to the surgeon, is the main support person for the operating
surgeon. The scrub personnel are responsible for the sterile supplies and instruments and for handing them to the surgeon. More
complicated surgical procedures may require the presence of two scrub personnel, one assisting the surgeon at the operating room
table and one responsible for the instruments at the instrument table.
The circulating nurse, known as the circulator, does not function within the sterile field, but performs many of the required tasks
outside the sterile field. This person also acts as the "non-sterile" hands of the surgeons and scrub person, placing films in the X-ray
view box, bringing required supplies, instruments and equipment into the Operating Room, maintaining surgical records in the
Operating Room, etc. Although the surgeon performing the operation has the ultimate responsibility for the care of the patient in the
Operating Room, it is the circulator who is responsible for maintenance of sterile conditions and is in charge of personnel. This
person is the primary advocate ensuring that correct surgery is performed by confirming proper patient identification and surgical
site(s), confirming that a history and physical is on the patient chart, and confirming that a signed surgical consent is present. The
circulator also enters safety measures into the computer, records time out, and assures that the proper prosthetics, if required, are
available.
Design Guide - Surgical Service
Narrative
Guide Plate:
2d
Page 4 of 14
Date: August 2005
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