The Intraoperative Setting: Performing a Time Out

Introduction

In the intra-operative setting, even the slightest mistakes may lead to a profoundly adverse impact on the patient outcomes. It is most unfortunate that errors still do occur in that setting, and some of them are not minor. For instance, sometimes a wrong operation is performed on a patient; in certain cases, a surgery is even performed on a wrong individual (van Schoten et al., 2014). To avoid such mistakes, it is pivotal to carry out a procedure called a time out prior to skin incision. The current paper elaborates what a time out is, and explains why this procedure is essential before starting a surgical intervention. At the end of the paper, a summary of the main points is provided.

The Time Out

Time out is a procedure that takes place at the last stage prior to the beginning of a surgical procedure (i.e., before skin incision), in which the surgical team reviews the patient, the planned surgical procedure, and the surgical site or side (van Schoten et al., 2014). More specifically, the time out usually includes the following steps (World Health Organization [WHO], n.d.):

  1. It is confirmed that each of the team members correctly states their name and role;
  2. The surgeon, anesthesiologists and nurse orally confirm the patient, the procedure, and the site at which the operation is needed;
  3. Anticipated critical events are reviewed by the surgeon, the anesthesiologists, and the nurse according to the checklist;
  4. Administration of antibiotic prophylaxis is verified;
  5. The presence of essential imaging is checked (WHO, n.d.).

The checklist is stated not to be intended to be totally comprehensive; modifications and additional items for a particular type of practice are encouraged by the creators of the checklist (WHO, n.d.).

The Importance of Time Outs for Patient Safety

In the intra-operative setting, various aspects of surgery are performed, and errors may sometimes occur. For instance, performing an operation at a wrong site, on a wrong patient, or carrying out a wrong procedure, sometimes occur. The wrong site surgery involves a procedure done on or at a wrong part, side, place, or site on the body of the patient. The wrong patient surgery is a procedure conducted on a wrong patient. The wrong procedure surgery is an operation that differs from the one that was planned for the patient (Kim et al., 2015).

Therefore, it is clear that any wrong surgery can be detrimental to the safety of a patient. For example, a surgical procedure carried out on a wrong part of the patient’s body will usually cause additional injury to the patient, and that patient will also not gain the surgical treatment that they require, which, in certain cases, might be lethal. Performing surgery on a wrong patient also means that the individual who requires surgical attention will not get it, possibly suffering profoundly adverse consequences (up to death) as a result; in addition, the patient who is operated on will usually receive injury, exacerbating his or her condition, often rather severely. Finally, if a wrong operation is performed, the patient receives an operative intervention that does nothing to address his or her condition, and receives an additional injury as well; this may also have lethal consequences for the patient (Oszvald, Vatter, Byhahn, Seifert, & Güresir, 2012).

On the whole, it is stressed that the described errors are not uncommon in the intra-operative setting. For instance, it is stated that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) found out that wrong site surgeries were performed, on the average, in 0.09 – 4.5 cases for every 10,000 surgical procedures between 1995 and 2005 (as cited in van Schoten et al., 2014).

To prevent such problems, various attempts have been made to prevent wrong surgeries on patients. For example, time out procedures are known to reduce the number of errors in the operating room by focusing on aspects of surgery in which a mistake could be made (Kim et al., 2015). It offers a final opportunity for correction on the three main areas in which errors are frequent; namely, the patient, the procedure, and the site or side. Consequently, the team is able to initiate corrections to avoid such mistakes. Taking a small amount of time for a time out in order to assess the whole perioperative process is critical for hospitals to avoid wrong surgeries. It is worth observing that checklists should be used irrespectively of the past successes in performing operations due to the fact that risks of performing wrong surgeries are always present.

Different hospitals may have various methods of conducting time outs with regard to documentation, contents, and timing. In the checklist, the content needs to provide ways to ensure that the correct information about the patient, the correct patient, the correct site, the correct equipment, and the correct procedure are all present. Moreover, hospitals and hospital departments need to adopt wider patient safety measures in their time outs so as to adapt the time out checklists to the specifics of a given facility or department (Kim et al., 2015). This may allow for ensuring that some other particular criteria for performing a surgery in a certain department have also been met prior to the initiation of the surgical procedure itself.

In addition, a preoperative meeting helps the surgery team to identify and correct possible inconsistencies or missing information on the documentation concerning the impending surgical procedure. It is important to check all documents and subsequently confirm that all the conditions from the time out checklist have been met. The team must correct any discrepancies that are observed before the procedure. Also, to ensure that value is derived from time out, all members of the team must participate (Oszvald et al., 2012). Challenges are observed when some members fail to take part in the process. Additionally, team leaders should also not tolerate the use of inappropriate materials, such as pens used to mark the site of the surgery. Some marker pens usually wash off when preparation is done and the patient is draped. This scenario may lead to a missed surgical site.

Conclusion

All in all, it should be stressed that patient safety is one of the most essential concerns in the operating room. Therefore, it is paramount to take steps so as to reduce the frequency of mistakes that may have adverse effects on the patient. In particular, it is crucial to implement time outs in the intra-operative setting – procedures that involve the utilization of checklists so as to avert common mistakes such as performing a wrong surgery, carrying out a surgical intervention on a wrong site, or operating a wrong patient. Not conducting the time out procedure may have a considerably adverse, potentially lethal impact on the patient. Thus, carrying out this simple procedure may be crucial for saving the lives of numerous individuals in the operation room.

References

Kim, F. J., da Silva, R. D., Gustafson, D., Nogueira, L., Harlin, T., & Paul, D. L. (2015). Current issues in patient safety in surgery: A review. Patient Safety in Surgery, 9(26), 1-9. doi:10.1186/s13037-015-0067-4

Oszvald, Á., Vatter, H., Byhahn, C., Seifert, V., & Güresir, E. (2012). “Team time-out” and surgical safety-experiences in 12,390 neurosurgical patients. Neurosurgical Focus, 33(5), E6. doi:10.3171/2012.8.FOCUS12261

Van Schoten, S. M., Kop, V., de Blok, C., Spreeuwenberg, P., Groenewegen, P. P., & Wagner, C. (2014). Compliance with a time-out procedure intended to prevent wrong surgery in hospitals: Results of a national patient safety programme in the Netherlands. BMJ Open, 4(7), 1-9. doi:10.1136/bmjopen-2014-005075

World Health Organization. (n.d.). Surgical safety checklist (first edition). Web.