Optimal utilisation of operating theatres has a significant impact on the ability of an institution to deliver productive, value for money surgical services. With the recent introduction of the national ‘Productive Theatres’ programme and in the current economic climate it is receiving increasing attention. In addition, it improves patient satisfaction and outcomes, reduces adverse events and has positive influences on staff morale. The aim of this study was to highlight factors influencing trauma theatre utilisation in general, whilst also addressing any problems identified with a view to improving trauma services locally. We conducted a prospective analysis of activity in the trauma theatre at our institution over 1 month. Direct observation was performed by a single independent observer. In the absence of any published guidelines, all theatre lists were assessed against pre-determined standards for each component of the theatre pathway. Overall end utilisation (combined time utilised for anaesthesia and surgery) was found to be low at 65%. A number of factors were found to contribute to inefficiencies including delay in sending for patients (mean 42mins, range 0-105), prolonged patient transit times to theatre (mean 22% of all sessions), late starts to lists (mean 43 mins, range 15-105 mins) waiting for x-ray availability (mean 21mins, range 10-45) and knock on delay from previous lists. Surgeons and anaesthetists were found to be, overall, arriving on time or early for all lists. Strategies for maximising trauma theatre productivity are essential. This study has identified common issues, of potential benefit to numerous institutions when planning trauma services.