Time-Out and Its Role in Neurosurgery

Area of Science:

• Neurosurgery
• Patient Safety
• Surgical Protocols

Background:

• Safety checklists have improved surgical outcomes, particularly in general surgery.
• Existing literature on safety checklists primarily focuses on general surgery, with less emphasis on neurosurgery.

Purpose of the Study:

• To determine the role and current practice of time-outs in neurosurgery.
• To understand neurosurgeons' perceptions of time-out effectiveness and identify areas for improvement.
• To explore the potential for neurosurgery-specific safety checklists.

Main Methods:

• A cross-sectional study was conducted using a 15-item survey.
• The survey evaluated time-out practices across five hospitals within a single neurosurgery training program.
• Data were collected from neurosurgical faculty, fellows, and residents, achieving a 72.5% response rate.

Main Results:

• Time-outs involved surgeons, anesthesiologists, nurses, and circulators at all surveyed hospitals.
• While time-outs occurred pre-incision, consensus on precise timing was lacking.
• Respondents overwhelmingly believed time-outs enhance surgical safety and reduce errors, though pragmatic challenges and individual attitudes hindered standardization.

Conclusions:

• Multidisciplinary time-outs are standard in neurosurgery, but significant variability exists between institutions.
• This variability may stem from the general surgery origins of time-outs, suggesting a need for neurosurgery-specific adaptations.
• Optimizing time-out protocols with neurosurgery-specific considerations holds potential for further safety improvements.