Elements that were clearly verbalized by the member of the operating room team performing the time-out were considered compliant. For each case, the investigators did not reveal their purpose when they entered the operating room to limit the impact of observation on surgical team behavior.įor each time-out procedure observed, the investigators recorded compliance for each element of the time-out. The observations were conducted by trained study staff using a standardized scoring sheet to assess surgical team compliance with the time-out protocol and to record general observations of the operating room environment ( Supplemental Digital Content, Appendix A, ).
No complete team was observed more than once. Although observations were not randomized and were sampled by convenience, no single service, type of surgery, or operating room location was specifically targeted for observation. 10 Direct observations of preincision time-outs were performed on 166 nonemergent surgeries performed in December 2016 at Vanderbilt University Medical Center, a large, 1019-bed, tertiary academic hospital with 74 operating rooms in 6 semicontiguous locations. The Standards for QUality Improvement Reporting Excellence guidelines were consulted in the preparation of this manuscript. Our study was approved by the Vanderbilt University Medical Center Institutional Review Board (#121049) with a waiver of informed consent.
Time out during surgery verification#
Finally, as an additional verification of observed data, we queried our institution’s perioperative data warehouse for the electronic time stamps associated with each step of the electronic time-out that occurred between August 2010 and December 2016. We therefore sought to identify nonroutine events that occur during the time-out procedure in the operating room, including distractions and interruptions, deviations from protocol, and the problem-solving strategies used by operating room team members to mitigate these nonroutine events. Poor time-out execution, caused by nonroutine events, may diminish the expected beneficial effects of the time-out. 9ĭespite those findings, little is known about the quality of execution of the time-out in routine clinical practice. Two previous studies conducted at Vanderbilt University Medical Center demonstrated that this electronic time-out application has both improved overall compliance with performing time-outs 8 and decreased wrong-surgery events relative to estimates of national wrong-surgery rates. A nurse then documents these responses electronically by checking boxes within the electronic time-out application, which brings up the next question. As each step of the time-out is verbalized by a team member, the operating room team members are expected to respond. The circulator nurse normally runs the electronic time-out application using an operating room computer and is responsible for guiding the team through each item. 8, 9 The electronic time-out uses an electronic whiteboard (40-inch television screen) to display a checklist with checkboxes for each component of the time-out.
4– 7 At Vanderbilt University Medical Center, an interactive electronic time-out was implemented in 2010 to increase surgical team compliance with the time-out procedure and to improve communication between team members in the operating room.
Implementation of the time-out procedure has been associated with a decrease in preventable medical errors, patient morbidity, patient mortality, and surgical complication rates. 3 The time-out is also a time designated for team members to voice any concerns about the patient’s safety or the procedure. 2 During the time-out, the entire operating room team reviews the patient’s identity, the procedure, and the surgical site before surgical incision or the start of the procedure. 1 According to the protocol, organizations must conduct a “time-out” before the start of any surgical procedure. The universal protocol was designed by the Joint Commission to reduce the occurrence of wrong-site, wrong-procedure, and wrong-person surgery.
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