Awareness and implementation of the time-out procedure among surgical teams: current status and influencing factors

In China, the Time-out procedure has been officially promoted and required for clinical use since 2010. Nevertheless, the overall cognition and practical compliance of surgical staff still need to be improved, and relevant influencing factors have not been fully clarified. Therefore, this study was conducted to investigate the current status of cognition and implementation of the Time-out procedure among surgical team members, and further analyze its related influencing factors.

A structured questionnaire comprising three sections was administered: a general demographic survey, a self-developed instrument to assess awareness and implementation of the time-out procedure, and an operating room safety culture scale. The self-developed questionnaire underwent expert review and a preliminary validation study (Cronbach's α = 0.817) to confirm its internal consistency. Sample size was determined based on multiple regression requirements, ensuring at least 10 subjects per independent variable with an expected non-response rate accounted for.

Primary outcome: time-out implementation. Secondary indicators: Individual cognition; professional knowledge; safety culture.

The score of the Time-out Procedure Knowledge Test was 3.80 ± 0.90, total cognitive score of the Time-out procedure was 72.95 ± 14.82. Occupation, participation in Time-out team training, and operating room safety culture were the main factors affecting the perception of the Time-out procedure (p < 0.05). In addition, occupation, working period, Time-out initiator title, the completeness of the Time-out procedure, supervision and management system, and hospital safety atmosphere were the main factors influencing the implementation rate (p < 0.05).

The results showed that surgical team members had moderate cognition regarding the Time-out procedure, yet their execution scores and implementation levels were comparatively low. This study also distinguished different influencing factors for cognition and implementation. Subsequent research could adopt stratified random sampling and carry out multi-center studies, together with objective observation to minimize self-report bias and improve the generalizability of research findings.