Publish Date: May 27, 2020
This June 10, the perioperative community celebrates National Time Out Day—the 16th year that we recognize the value of taking a Time Out before any surgical procedure.
As surgical teams are focused on adhering to COVID-19 protocols to keep staff and patients safe from disease transmission, they are also talking more, collaborating more for safety, and recognizing the value of consistently taking time to ensure all details are confirmed for a safe surgical procedure.
That’s why this year marks a unique opportunity to recognize the value of using safety tools such as the Time Out to connect as a team for safety.
Look at the Data
Time Out can look very different depending on the procedure, the team and setting, but every Time Out must have one common thread—team engagement. If every member of the team isn’t part of the conversation, mistakes can still happen, and they do.
Last year 83 wrong side, wrong site and wrong procedure surgeries were reported to The Joint Commission, and this number is projected to represent only 5% of these sentinel events that occur annually, according to The Joint Commission’s Lisa DiBlasi Moorehead, EdD, MSN, RN, CENP, CJCP, associate nurse executive.
She says it’s important to look at these numbers because one wrong site, wrong side or wrong procedure surgery is too many and it’s up to every member of the surgical team to take actions that reduce these numbers. “When we drill down further, we see that 52 of these sentinel events were the result of miscommunication or lack of communication leading to surgery at the incorrect surgical site—if teams focus on eliminating wrong site surgery alone, that would cut down these surgical error numbers considerably.”
Get to Zero Wrong Site Surgeries
We have an arsenal of tools to protect patients from harm associated with wrong site surgery, and we have to use them, together, DiBlasi Moorehead stresses.
She notes resources such as the Universal Protocol that require patient identification, site marking and the Time Out, as well as the Comprehensive Surgical Safety Checklist and other safe surgery tools and processes. “If we had these processes down, and completed them consistently, as a team, I can’t help but think we would significantly reduce the number of wrong site surgeries.”
Focus on Consistency
As a former hospital surveyor, DiBlasi Moorehead has witnessed a number of Time Outs. She still remembers the best Time Out process she ever saw at a hospital in an urban setting. “No matter what surgical procedure or setting, the Time Out was done consistently, whether for an ortho case, a scheduled C-section, or an interventional radiology procedure.”
What made this facility’s Time Outs the best boils down to three consistent practices she observed:
- The Time Outs were led by the same person—at this facility it was the physician.
- Every team member stopped what they were doing to engage in the Time Out.
- Each team member introduced themselves and shared their role in the procedure.
What really set these Time Outs apart were the physicians’ request to each team member saying, “safety is important to me, I want you to stop me and tell me if I’m doing something that makes you uncomfortable or puts the patient or a team member at risk,” she noted.
“It was profound to see the Time Out develop as a true conversation—it was the team coming together, everyone knew the purpose, everyone was empowered to speak up, and the physician looked to each member of the team to play an active role in safety.”
As the patient’s advocate, nurses are often that team member who stands between the patient and a harmful event and we have to be brave, she encourages. “Nurses working on the frontline have to speak up when a member of the team needs to be called out. Leaders have to support nurses and ensure they feel safe enough to speak up when their team is not following Time Out procedures.”
Frontline nurses and nurse leaders also must connect with scheduling staff to ensure an error is caught upstream, long before the day of surgery. “I’ve seen organizations put some innovative ideas in place, such as enforcing read-back strategies to ensure surgery site, side and procedure are correct from the moment surgery is scheduled.”
Ready to refresh your team Time Out for better engagement? Check out these safe surgery resources to help your team improve the Time Out process:
- Review The Joint Commission’s Universal Protocol.
- Access AORN’s Comprehensive Surgical Checklist to tailor a role-inclusive Time Out in your OR.
- Work with your team to review educational resources from AORN’s Correct Site Surgery Tool Kit.
- Find ways to commemorate Time Out with your colleagues and community