How We Really WHO: Assessing Completeness, Team Engagement, Distractions and Authority Gradient During 'Time Out'...

Area of Science:

• Medical Safety
• Surgical Procedures
• Healthcare Quality Improvement

Background:

• The World Health Organization (WHO) Safer Surgery Checklist is intended to improve patient safety.
• Anecdotal evidence suggests the checklist, particularly the "Time Out" component, may be treated as a procedural formality rather than a tool for active engagement.
• Variable team engagement and efficacy have been reported, potentially undermining the checklist's intended benefits.

Purpose of the Study:

• To evaluate the quality and completeness of the "Time Out" phase of the WHO Safer Surgery Checklist.
• To assess the level of team engagement during surgical procedures in obstetrics and gynaecology.
• To identify factors, such as distractions and authority gradients, that influence team communication and participation during "Time Out".

Main Methods:

• An observational study was conducted across 70 obstetrics and gynaecology cases.
• Data collected included the percentage of "Time Out" items correctly addressed, the type and duration of distractions, and team engagement levels.
• The Visual Analogue Scale was used to assess the authority gradient and the likelihood of team members speaking up.

Main Results:

• "Time Out" was announced in 91.4% of cases and performed in all, but not always with the correct "challenge and response" format.
• An average of 92% of "Time Out" items were appropriately challenged and responded to, with a mean duration of 92 seconds.
• Significant distractions (auditory, visual, chatter, traffic) were noted, and in 92.8% of cases, at least two team members were disengaged, performing non-essential tasks. The likelihood of speaking up was high (8.78/10) and independent of role.

Conclusions:

• Despite being performed, "Time Out" procedures are frequently not clearly announced or completed using the intended "challenge and response" method.
• "Time Out" is often compromised by avoidable distractions and suboptimal team engagement, reducing its potential effectiveness.
• Enhanced awareness and adherence to proper "Time Out" protocols are crucial for ensuring complete team involvement and maximizing surgical safety.