Taking a break before and during a surgical procedure can reduce the risk of surgical error and adverse medical events.
The Joint Commission, an accrediting agency for hospitals across the United States, includes a time-out as a part of the universal procedure to prevent wrong site, wrong person, or wrong surgery “never events.” The protocol was applied to all accredited in-patient, office, and ambulatory surgical care centers in approximately 2003.
A time-out involves the core personnel present and involved in the surgical suite and is intended to verify information about the patient and the procedure to be performed. Overall, a time-out is a brief baseline communication to ensure medical personnel are in agreement about what is about to occur and whether complicating questions have been addressed prior to the procedure.
A time-out may include an audible call-out to verify patient and process details, or it may involve a checklist documented within the electronic health record (EHR).
In recent research published in the journal Anesthesia and Analgesia, researchers documented 166 surgeries in 2016. None of the surgeries were emergencies. Study authors wanted to determine compliance with the time-out protocol. The study concluded that the time-out procedure was in use during all of the surgical procedures.
However, the observation was made that one or members of surgical teams were commonly distracted during the time-out period, which was usually completed in less than one minute. A time-out requires active attention and engagement by the full surgical team, rather than a passive nod of the head. In this study, no medical errors resulted from the distraction of surgical team members.
While surgical time-outs are routine, the problem of adverse surgical events remains. The Agency for Healthcare Research and Quality (AHRQ) describes events that continue to occur including:
- Spinal surgery at the wrong level of the spine
- Removal of a healthy organ or body portion rather than the intended target
- Removal of healthy organs and tissue from the wrong patient due to similar last names
Primary issues with time-outs remain. According to The Joint Commission, some of those problems are:
- Time-outs performed without full staff present, or before they are ready
- Lack of senior leadership and staff that is unwilling to speak out about potential problems or errors
- Process changes, inadequate education, poor briefing by members of the surgical team
While most patients focus on surgical performance, it is the surgical time-out that occurs before an incision is made that may determine whether a patient has a safe and healthy outcome.
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