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Making the Surgical Safety Checklist Even Safer: A Team Timeout Checklist to Improve Information Exchange and
Mona Weiss1, Claudius Reimer1, Alexander Budnitskiy1
1From the Department of Psychology, Friedrich-Schiller-University, Jena, Germany.
Anesthesia and Analgesia
|July 22, 2026
Summary
A new nurse-led team timeout checklist (TTOC) significantly improved surgical safety communication. The TTOC enhanced information exchange and team participation during the critical pre-incision phase.
Area of Science:
- Healthcare Quality and Safety
- Surgical Team Communication
- Patient Safety Protocols
Background:
- The World Health Organization Surgical Safety Checklist (WHO SSC) aims to standardize preoperative safety but faces challenges in adherence and nurse engagement.
- Variations in checklist item understanding and implementation highlight the need for improved preoperative safety procedures.
- Operating room (OR) professional groups exhibit differential involvement, with nurses often less engaged than other team members.
Purpose of the Study:
- To introduce and evaluate a 16-item Team Timeout Checklist (TTOC) designed to enhance preoperative safety communication.
- To improve information exchange, closed-loop communication, and participation of all OR professional groups during the pre-incision timeout.
- To address limitations in the existing WHO SSC by clarifying items and empowering nurses to lead the timeout process.
Main Methods:
- A prospective pre-post interventional design was employed, observing live team communication during the pre-incision phase.
- Surgical teams were assessed before and after the implementation of the TTOC checklist.
- Communication outcomes measured included information exchange of checklist items, participation rates, explicit coordination behaviors, and closed-loop communication sequences.
Main Results:
- Median information exchange increased from 62.5% to 100% post-TTOC implementation (P < .001).
- Participation rates significantly increased for circulating nurses, scrub nurses, surgical residents, and anesthesia staff (P < .05).
- Closed-loop communication patterns per operation were more frequent with the TTOC (20.4) compared to without (16.4) (P = .004).
Conclusions:
- The nurse-led TTOC significantly enhanced the exchange of safety-critical information during the pre-incision phase.
- The TTOC facilitated closed-loop communication and increased the participation of diverse professional groups in surgical safety protocols.
- Integrating the TTOC into the WHO SSC before-incision protocol shows potential for substantial patient safety advantages.
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