![]() The universal protocol was designed by the Joint Commission to reduce the occurrence of wrong-site, wrong-procedure, and wrong-person surgery. Meaning: We conclude that the simple act of performing a preprocedure checklist may be completed quickly and that distractions are common.Findings: Direct observation of 166 time-outs in 2016 revealed that time-outs may be completed quickly and efficiently critical team members are frequently distracted during the time-out (10.2% of observations).Question: What is the quality of execution of the preoperative time-out in routine clinical practice?.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. CONCLUSIONS:Ĭompliance with preincision time-outs is high at our institution, and nonroutine events are a rare occurrence. At least 1 member of the operating room team was actively distracted in 10.2% of the time-out procedures observed. Ten time-out procedures were stopped due to a safety concern. ![]() The most common reason for an interruption was to verify patient information. 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. METHODS:ĭirect observations of surgical time-outs were performed on 166 nonemergent surgeries in 2016. 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. 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. ![]() Īlthough 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. Freundlich, MD, MS, Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Ave S, MAB 422F, Nashville, TN 37212. Reprints will not be available from the authors.Īddress correspondence to Robert E. Institutional review board: Vanderbilt University Human Research Protection Program, Linda Gooch, Administrative Assistant, 1211 Medical Center Dr, Nashville, TN 37212. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website. Supplemental digital content is available for this article. The authors declare no conflicts of interest. received support from the National Institutes of Health–National Center for Advancing Translational Sciences (1KL2TR002245) and received grant support and consulting fees from Medtronic for work unrelated to the content of this manuscript. ‖Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.Īccepted for publication February 7, 2019.įunding: This work was supported by the Department of Anesthesiology. ‡Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois †Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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