Happy National Time Out Day! This day is set aside to recognize the important role that we all play in patient safety by being involved in the Time Out. It takes a team to perform a surgical case, and together, as a team, we work to ensure the accuracy of the procedures that we perform.
How do we ensure patient safety and the accuracy of our procedures?
One key component is the Time Out. According to The Joint Commission's Universal Protocol:
"The time out should be conducted immediately prior to starting the invasive procedure or making the incision.
A designated team member should start the time out.
The time out process should be standardized.
The time-out involves the immediate members of the procedure team: the individual performing the procedure, anesthesia providers, circulating nurse, operating room technician, and other active participants who will be participating in the procedure from the beginning.
All relevant members of the procedure team actively communicate during the time-out.
During the time-out, the team members agree, at a minimum, on the following: correct patient identity, correct site, correct procedure to be done.
When the same patient has two or more procedures: If the person performing the procedure changes, another time-out needs to be performed before starting each procedure.
Document the completion of the time-out. The organization determines the amount and type of documentation."
It's very important that we follow a standardized process within our organizations. In some facilities, the surgeon leads the time out. In others, anesthesia or the OR circulator calls the time out and leads it. No matter who calls it, every member of the team is to be involved. We are to actively communicate and verbally agree to the accuracy of the patient, procedure, and surgical site - at a minimum.
Do you know what shouldn't happen?
It shouldn't be the circulator screaming over the noise of the OR while draping is occurring, conversations are going on, the music is blaring, and no one is paying attention or cares about the time out process. Unfortunately, this occurs more often than you may realize. Or maybe this is your experience and you know exactly what it's like to be ignored or to get pushback every time you call the time out.
Here are some frightening statistics that reinforce the need for the time out:
"Wrong surgeries include surgeries or invasive procedures that are performed at the wrong site or on the wrong patient, or that are the wrong (unintended) procedure for a patient regardless of the type of procedure or the magnitude of outcome.
There were 112 sentinel events classified as wrong surgeries in 2023—a 26% increase from 2022.
Severe temporary harm (39%), unexpected additional care/extended stay (39%), and permanent harm to the patient (14%) were leading outcomes.
Most wrong surgery sentinel events (62%) were surgeries or invasive procedures performed at the wrong site.
Leading contributors to wrong surgeries included no or insufficient time-out procedures, preoccupation/task fixation limiting situational awareness, and no or inadequate shared understanding among team members."
These types of statistics highlight the need for a sufficient time out among our surgical teams, a mutual respect from all parties for the time out, and proper communication and information sharing about our patient's needs and condition. Numbers like these can also empower you to demand a proper time out, even when you face push back.
Let me tell you about a difficult time out experience:
Several years ago, I was working in a different service area than I usually do, with a physician and team that I wasn't used to working with. They were setting up for the case, playing loud music, and talking about non-case related topics. I went to do my pre-op assessment and brought the patient back. The music was still playing and was still very loud. I immediately turned the music off so we could focus on the patient. We did our pre-procedure time out, but our scrub wasn’t actively involved. They simply said, “Yup, I agree,” while still setting up. I went over to him and showed him the consent and he was really confused as to why I did this.
We then got the patient safely transferred to the operating table, off to sleep, and positioned. The surgeon walked in, and I introduced myself since I had never met him and he had never met me. He quickly said hi as he walked over to plug in his phone and turn on his music. When we finished prepping, the First Assist and Scrub Tech began to drape. The surgeon came in to begin the procedure and I said, “Ok, time out everyone," and I turned the music down. “Why did you do that?” he said, very annoyed. “We need to time out and it needs to be quiet,” was my reply. “One of those circulators huh?” I heard him say...
“Yes sir, I am one of those nurses and I’m not sorry about it. This is patient Joh Smith, his date of birth is ______, and he is here for [insert procedure name here]. Does everyone agree?” I got some mumbles, so I loudly, almost yelling, said again, “Does everyone agree with what we’re doing?” That got their attention, and everyone provided clear and audible agreement to the accuracy of the patient and procedure.
I hope that you never experience annoyed, rushed, or irritating team members, but chances are high that you will encounter these attitudes at some point in your career. But I hope that you realize that it's never wrong to fight for your patient's safety. You can use your voice, you can insist on patient safety, and you can demand that your team do the right thing.
The OR is a busy place. I don’t have to tell you that. We work in a world that is driven by a routine of: set up, do the case, get that quick turnover, and get in with the next patient. And then repeat until the day is done. I’m all about moving efficiently and keeping things moving, but when we need to stop and pause, we need to stop and pause. Time Out Day gives us the opportunity to stop and pause and to remind ourselves and the entire surgical team what surgery is really about.
It’s not about slowing you down or checking the right boxes. It’s about ensuring that the invasive procedure we’re about to do on an unconscious human who can’t speak for themselves is what they have agreed to have done. It’s to remind everyone in the room they are an advocate for the patient.
Remember:
Safety is our number one priority and Time Out Day reiterates this. It’s a reminder to us to stay vigilant and to encourage anyone on the team to speak up if there is an issue.
Stay safe out there,
Lindsey
