We conclude that the simple act of performing a preprocedure checklist may be completed quickly, but that distractions are common.
Despite distractions, there were no wrong-site or wrong-person surgeries reported at our hospital during the study period. It is common for ≥1 member of the operating room team to be actively distracted during time-out procedures, even though most time-outs are completed in under 1 minute.
At least 1 member of the operating room team was actively distracted in 10.2% of the time-out procedures observed.Ĭompliance with preincision time-outs is high at our institution, and nonroutine events are a rare occurrence. Ten time-out procedures were stopped due to a safety concern. Some believe that it is important to conduct the time-out before anesthesia for several reasons, including involvement of the patient. This requirement focuses on those minimum features of the time-out. The most common reason for an interruption was to verify patient information. The purpose of the time-out is to conduct a final assessment that the correct patient, site, and procedure are identified. Most time-outs were completed without interruption (92.8%). Most observed time-outs were completed in <1 minute. An announcement was made to indicate the start of the time-out procedure in 163 of 166 observed surgeries. The time-out procedure was performed before the first incision in 100% of cases. For each time-out, the observers recorded compliance with each step, any nonroutine events that may have occurred, and whether any operating room team members were distracted. During the time-out, the entire operating room team reviews the patients identity, the procedure, and the surgical site before surgical incision or the start. We 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 them.ĭirect observations of surgical time-outs were performed on 166 nonemergent surgeries in 2016.
An interactive electronic time-out was implemented to increase surgical team compliance with the time-out procedure and to improve communication among team members in the operating room. Although the surgical pause or time-out is a required part of most hospitals' standard operating procedures, little is known about the quality of execution of the time-out in routine clinical practice.
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