What happens beyond OR doors? How peri-operative nurses and quality leaders help make every surgery safer

A mother coos at her baby and bobs him up and down. She’s soothing him, but also admittedly herself, as she quietly cries and looks down at his tiny, scrunched face.  

She’s about to hand him to someone she only just met, who will take him behind the closed doors in front of her. She’s terrified, because though she’s been briefed and has run through it in her mind a thousand times, nothing prepares you to put your baby in someone else’s hands for a surgery that could change his life.  

A peri-operative nurse smiles gently at her and receives the baby as his mother places him in her arms. Before leaving, she lingers and says what she knows his mother needs to hear. 

“When you see me going through those doors, it'll be about one minute until we get to the Operating Room, and then your child will be asleep within one minute after that,” she tells mom. “The surgery is booked for three hours, but don't get worried if it goes longer. It often just means we're taking our time. You're in the best hands. There will be seven of us in that room, and everyone is there for your child.” 

The mother thanks her, already visibly comforted. They say goodbye, and the nurse takes him through the doors.  

That nurse was Erin Hempel. Today, she is a Quality Leader in the Operating Room (OR) alongside Chloe Prentice and Mariam Elsohemy. Earlier in her career, moments like this were a regular part of her work as a peri-operative nurse.

Peri-operative nurses at SickKids care for babies, children and youth during a part of their hospital journey that families and caregivers rarely get to see. 

Working with surgeons, anesthesiologists and other members of the interprofessional team, peri-operative nurses support patients before, during and after surgery.  

"Someone is really trusting you with one of the most important days of their life for their child, and they just met you,” says Prentice, a Quality Leader and former Peri-Operative nurse who works closely with Hempel.

Also referred to as OR nurses, peri-operative nurses connect the many moving parts of an OR while keeping the patient at the centre. They hold a view of the whole room and the whole child at the same time. 

"One of the biggest misconceptions about an OR nurse is, 'Oh, you just hand a surgeon an instrument,’” says Hempel.

The role isn't reactive, Prentice also explains. It's "proactive and anticipatory." 

The prep begins before a child even enters the OR. Peri-operative nurses meet patients and families in the pre-operative area and assist patients to transition into the OR, supporting them as anesthesia is given. Once surgery begins, their responsibilities shift with the needs of the patient and procedure.  

At a quaternary paediatric centre like SickKids, that preparation can be made even more elaborate by extraordinarily complex cases, including procedures performed only rarely. Sometimes, teams perform surgeries that are the first of their kind.  

Making every surgery safer 

After years working as peri-operative nurses, Hempel and Prentice brought their frontline experience into quality leadership in the OR, with Hempel becoming a Quality Leader in 2022 and Prentice in 2025. Their focus now extends beyond individual patients and procedures to identifying opportunities to improve safety across the peri-operative environment. 

They review safety trends, lead quality-improvement initiatives and work alongside the same interprofessional teams to determine how systems and processes can be improved. 

"Erin and Chloe are leading exciting, uniquely peri-operative work that makes the invisible aspects of surgical care safer," says Lisa Pendergast, Clinical Director of Child Health Services. "Their frontline expertise, curiosity and collaborative leadership are transforming how we anticipate risk, learn, and improve across the entire surgical journey."  

One recent project introduced a safe positioning and position check guideline in the OR. The work includes a pressure injury prevention bundle that recommends positioning devices based on a child’s specific surgical needs, supporting SickKids’ Precision Child Health movement. They also introduced a position check process to ensure regular patient assessments are completed throughout surgery. 

Another area Hempel and Prentice have worked to strengthen is the briefing that happens with a patient before surgery. This briefing was already part of the surgical safety checklist process at SickKids, but Hempel and Prentice helped adapt how that conversation happens in a complex paediatric care environment. 

In paediatric care, a young child may not be able to confirm what procedure they're having or answer important questions themselves. Hempel and Prentice helped move the briefing into the pre-operative area, where the nurse, surgeon and anaesthesiologist can engage collaboratively with the patient and caregiver before entering the OR. 

They also helped redesign the briefing checklist and its language to invite families into the conversation. Instead of simply checking off a box that says something like, “procedure and laterality checked,” for example, the team is now prompted to ask: “Can you tell me what you're having done today and where?” 

It's a shift designed to make families active participants in the safety process and feel psychologically safe to bring up concerns or misunderstandings, rather than simply having information confirmed. 

In a survey following the change, 89 per cent of responding families agreed or strongly agreed that participating in the briefing improved their sense of safety. 

“In one of our early briefings, I remember one mom turned to me afterwards and she said, ‘That was amazing. We should do this for all cases. I’ve never been part of something like that before,’" says Hempel. "It was really encouraging, and we knew we were on the right track." 

Families may never see most of what happens after their child goes through the OR doors. But Hempel and Prentice hope families know what continues on the other side. Their child is seen as a whole person, their safety and comfort are a top priority, and they are deeply cared for.