The Modified Cappuccini Test: A Proxy Indicator For Patient Safety in The Operating Theatre

We report our experience with a modified audit tool, the modified Cappuccini test used to assess the availability and readiness of senior and expert help and supervision for trainee anaesthetists in the operating environment.
We sought to provide assurance as to the level of supervision for surgical and anaesthetic trainees within our organisation, a large tertiary centre in an urban environment. We would expect this to have a direct impact on patient safety in the operative environment and also on the training experience. We modified the Cappuccini test so that it could be used for surgical and anaesthetic trainees .Over 11 days we visited operating theatres across our institution and interviewed 195 trainees (anaesthetists and surgeons) undertaking operating lists.
96 (49.2%) anaesthetic trainees and 99 (50.8%) surgical trainees were interviewed. 166 (85.1%) trainees were being directly supervised by a consultant. 29 (14.9%) trainees were being remotely supervised without a physical consultant presence16 (55.2%) of these were anaesthetic trainees and the remainder were surgical trainees2 (6.9%) trainees stated that they were unsure who was directly supervising them. For the 29 remotely supervised trainees, we contacted 19(65.5%) supervising consultants/senior doctors all of whom were aware that they were supervising the operating list and confirmed that they were available to attend if required.
The modified Cappuccini test is a simple and helpful tool, providing assurance as to the level of and access to senior and skilled supervision in the operating theatre and with the potential to be modified and deployed in a number environments. We suggest that it is a useful proxy indicator of supervision and potentially also, patient safety in the operating theatre environment. We recommend that for operating lists which are remotely supervised, the name and method of contact for the senior supervising anaesthetist or surgeon should be explicitly stated at the beginning of each case.