Standardization and Visualization of the Surgical Time-Out

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Surgical Procedures

Background:

• The traditional time-out (TO) process can suffer from low engagement, posing a potential patient safety risk.
• Staff patient safety culture surveys highlighted the passive nature of the current TO as a concern.

Purpose of the Study:

• To hypothesize that transforming the TO into an auditable, active process would improve compliance and engagement.
• To enhance patient safety through improved surgical team communication and adherence to protocols.

Main Methods:

• A quality improvement initiative, "Time Out Engagement and Standardization," was developed.
• This initiative included a whiteboard checklist with 15 role-specific elements for operating room use.
• Plan, Do, Study, Act cycles were employed, with pre- and post-intervention audits of TO engagement and content.

Main Results:

• Pre-intervention, anesthesia provider and surgeon engagement was low (18%), with no TO including all 15 elements.
• Post-intervention, anesthesia and surgeon participation increased to 100% and 76.5% respectively (P < 0.0001, P = 0.006).
• Completion of standardized TO elements increased from 57.1% to 98.8% (P < 0.001).

Conclusions:

• Staff concerns regarding TO engagement were validated through auditing.
• A team-driven intervention utilizing rapid Plan, Do, Study, Act cycles led to measurable improvements in surgical TO compliance and engagement.