The perioperative education time-out and its impact on patient safety outcomes

Clear communication between members of the surgical team is necessary for perioperative patient safety. Miscommunication in the operating room (OR) is common between attendings and residents. It's unknown whether surgical education tools targeted at improving communication between faculty and residents, such as an Education Time-Out (ETO), can also improve patient safety outcomes. We aimed to assess the impact of the ETO on patient safety outcomes during and after gynecologic surgery.

From April to June 2022, we recruited and enrolled primary and adjunct gynecologic surgical faculty from any sub-specialty associated with the University of Utah OBGYN residency program. Enrollment included a simulation to practice the ETO. We then abstracted safety outcomes from patient records of participating faculty 6 months pre-intervention and 9 months post-intervention. Our primary outcome was a composite score of 30-day morbidity and mortality We compared pre- and post-intervention complication rates using paired t-tests. Logistic regression assessed the likelihood of experiencing a complication pre- and post- intervention. Study conducted on surgeries performed at 4 hospitals where University of Utah residents operate. We reviewed 1409 charts: 572 pre-intervention and 837 post-intervention from 25 surgeons.

Type of surgical case was similar between pre- and post-intervention groups with 20% vs 18% gynecology oncology surgeries and 40% vs 41% major surgeries, respectively. Bivariate analysis showed a non-significant improvement in composite patient safety outcomes overall (pre = 9.8%, post = 8.1%, p = 0.3). Adjusted analysis showed surgical cases post-intervention were 24% less likely to experience a complication (OR = .76, 95%CI = 0.5-1.1, p = 0.2). Cancer and major surgery indicators strongly predicted complications both pre- and post-intervention.

We did not find a significant improvement in patient outcomes; however, we were not powered for outcomes and as a pilot study the trend toward improvement in patient safety outcomes following ETO implementation is promising.