The “Time Out”
The “time out” is one part of the Universal Protocol developed by the Joint Commission to prevent wrong-site, wrong-procedure, and wrong-person surgery. Each are considered never events by the National Quality Forum and sentinel events by the Joint Commission. The “time out” creates a culture of safety and has been shown to decrease patient injury and improve teamwork (JCAHO 2006).
Wrong Surgeries Up 26% in latest data
Reported wrong site, wrong procedure, wrong patient and wrong implant surgeries increased 26% in 2023, according to new numbers from The Joint Commission’s Sentinel Event Data 2023 Annual Review. Leading contributors to wrong surgeries cited in the report include:
- No or insufficient Time-Out procedures
- Preoccupation/task fixation limiting situational awareness
- No or inadequate shared understanding among team members
Nelson (2017) talks about the traditional “time out” which includes the patient (name and medical record number confirmation); the correct procedure, site, side, and level (including required site marking); patient positioning; implant and equipment availability; labeled and displayed images; patient allergies; antibiotics (name, time, dose); safety precautions preparedness (e.g. fire safety measures, prophylaxis of deep vein thrombosis); and a verbal agreement that all requirements have been met.
Identify Patient Risks
To start the “time out” the team should introduce themselves and then pause while the “time out” is taking place so that the entire team is on the same page. The “time out” gives the team an opportunity to identify patient risks, and to verbalize what interventions will be happening during the case. For instance, if the patient is high risk for skin injury, that would be stated during the time out along with the planned micromovements every 3 hours. This information will allow the team to agree on the intervention and help hold each other accountable for the best patient care. In addition, they can identify the diabetic patient and the expectations for blood sugar monitoring, identify if the patient is at risk for surgical site infection and that a “clean closure tray” will be used.
Team Communication
The surgeon may want to let the team know that there will be lab specimens needed throughout the case. The anesthesia provider could let the team know that the patient has a history of emersion delirium and measures need to be taken when the patient wakes up to keep them safe. The surgical technologist may want to let the team know that they have an orientee that will be handing the instrumentation and so on.
Create a “time out” for intraoperative planning to ensure the whole team is working together. This takes away the element of surprise and confusion. Whatever the case may be, the “time out” is the teams safety net and should not be taken for granted. Use that “time out” to strengthen the team, improve communications, enhance expectations, and most of all improve patient outcomes.
Resources
https://www.aorn.org/events/national-time-out-day — “wrong surgeries up 26% in 2023 data”
2023’s Joint Commission’s “Sentinel Event Data 2023 Annual Review” https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/2024/2024_sentinel-event-_annual-review_published-2024.pdf
https://www.aorn.org/outpatient-surgery/article/script-your-time-outs-to-keep-them-consistent
Nelson, P. E. (2017). Enhanced time out: An improved communication process. AORN Journal, 105(6), 564-570. doi:10.1016/j.aorn.2017.03.014
Sentinel event policy and procedures. The Joint Commission. http://www.jointcommission.org/sentinel_event_policy_and_procedures/
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