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Timeout procedure in paediatric surgery: effective tool or lip service? A randomised prospective observational study
Oliver J Muensterer1,2, Hendrik Kreutz3, Alicia Poplawski4
1Pediatric Surgery, Johannes Gutenberg University, Mainz, Rhineland-Palatinate, Germany oliver.muensterer@att.net.
Insights
Surgical timeout procedures, intended to prevent errors, fail to detect mistakes in nearly half of cases. This highlights the unreliability of current timeout routines and the need for improvements in patient safety during surgery.
Area of Science:
- Medical safety
- Surgical procedures
- Patient care
Background:
- The preoperative timeout is a standard safety protocol in pediatric surgery.
- Its effectiveness in detecting errors has not been systematically evaluated.
- This study assesses the detection rate of introduced errors during timeouts.
Purpose of the Study:
- To evaluate the effectiveness of the preoperative timeout procedure in detecting deliberately introduced errors.
- To identify which team members are most likely to report errors during timeouts.
Main Methods:
- Deliberate errors (e.g., wrong patient name, incorrect site) were secretly introduced during timeouts for elective pediatric surgeries.
- The study monitored the frequency and source of error reporting by the surgical team.
- Data were collected over 16 months involving 1800 operations.
Main Results:
- Out of 1800 timeouts, errors were introduced in 120 cases (6.7%).
- Overall, 54% of introduced errors were detected and reported by the team.
- Anesthesiologists reported the majority of errors (64%), followed by nursing staff (28%).
Conclusions:
- The current preoperative timeout procedure is unreliable, with nearly half of introduced errors going unnoticed.
- Despite strict implementation, mistakes can be overlooked, indicating a need for enhanced safety measures.
- Further research is needed to develop and validate improved surgical timeout protocols for better patient safety.
Background:
For over a decade, the preoperative timeout procedure has been implemented in most paediatric surgery units. However, the impact of this intervention has not been systematically studied. This study evaluates whether purposefully introduced errors during the timeout routine are detected and reported by the operating team members.
Methods:
After ethics board approval and informed consent, deliberate errors were randomly and clandestinely introduced into the timeout routine for elective surgical procedures by a paediatric surgery attending. Errors were randomly selected among wrong name, site, side, allergy, intervention, birthdate and gender items. The main outcome measure was how frequent an error was reported by the team and by whom.
Results:
Over the course of 16 months, 1800 operations and timeouts were performed. Errors were randomly introduced in 120 cases (6.7%). Overall, 54% of the errors were reported; the remainder went unnoticed. Errors were pointed out most frequently by anaesthesiologists (64%), followed by nursing staff (28%), residents-in-training (6%) and medical students (1%).
Conclusion:
Errors in the timeout routine go unnoticed by the team in almost half of cases. Therefore, even if preoperative timeout routines are strictly implemented, mistakes may be overlooked. Hence, the timeout procedure in its current form appears unreliable. Future developments may be useful to improve the quality of the surgical timeout and should be studied in detail.
