The extended surgical time-out: does it improve quality and prevent wrong-site surgery?

Area of Science:

• Pediatric Surgery
• Patient Safety
• Surgical Workflow Optimization

Background:

• Surgical time-outs (STOs) are critical for patient safety.
• Implementing an extended STO aims to improve communication and reduce errors.
• Previous STO protocols may have limitations in comprehensive pre-operative checks.

Purpose of the Study:

• To evaluate the initial outcomes of an extended surgical time-out (STO) in pediatric surgical settings.
• To assess the impact of pre-induction STO on surgical workflow and team communication.
• To identify any changes in patient safety metrics and operational efficiency.

Main Methods:

• An extended STO protocol was implemented, confirming patient identity, technical/anesthetic details, medications, and equipment needs.
• The STO timing was shifted from post-induction to pre-induction to optimize workflow.
• Data collected included elapsed time to incision and surgical team surveys before and after the pre-induction STO implementation.

Main Results:

• Elapsed time to incision remained consistent for both elective and urgent pediatric surgeries.
• The extended STO ensured timely antibiotic administration and identified critical equipment needs.
• Improved communication led to increased staff confidence, though one wrong-site surgery occurred due to a systems error.

Conclusions:

• The pre-induction extended STO enhanced surgical team communication and did not disrupt workflow.
• Extended STOs offer potential for broader quality improvements, including medication timing.
• While not eliminating wrong-site surgery, the extended STO promotes a systems-based approach to accountability.