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Association of periOperative Registered Nurses      Joint Commission

Statement on National Time Out Day: The Joint Commission and the Association of periOperative Registered Nurses make time for time out

June 1, 2022

Surgery on the wrong patient or wrong body part is called a “never event” because it’s never supposed to happen. The reality is that wrong site surgery occurs with depressing regularity, and it’s unacceptable. Wrong site surgeries occur an estimated 40 times a week, or five times a day, in the United States.

The human damage of a wrong site surgery is immeasurable. Patients are physically and emotionally scarred, and sometimes a life is lost. The entire surgical team is devastated, and we are only starting to recognize the extent of second victim syndrome.

National Time Out Day, this year on June 8, draws attention to the need for everyone on the surgical team to pause before the procedure begins in order to make sure all are on the same page about the right patient, right site and right procedure. As we mark this milestone, we shift our focus from recognizing the importance of the surgical time out to ensuring that surgical teams are making adequate time for the time out. 

The Joint Commission addresses the surgical time out in its 2022 National Patient Safety Goal of our Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™. As the nation’s top accreditation agency for healthcare organizations, we first introduced hospitals to a simple process for preventing wrong site surgery in 2004.

The Universal Protocol, as it is named, calls for the patient and the licensed independent practitioner to confirm the procedure and mark the body part to be operated on; and for every member of the surgical team to participate in a time out before operating to ensure that the correct procedure is about to begin on the correct part of the correct patient.

The Association of periOperative Registered Nurses (AORN) responded to the Universal Protocol by creating National Time Out Day to raise awareness. AORN also developed a Comprehensive Surgical Checklist to enable individual facilities to meet The Joint Commission’s Universal Protocol and the World Health Organization’s standards while customizing the checklist according to surgical specialties.

AORN has heard from members concerned that time outs in 2022 are being conducted hastily, likely as a result of surgical teams working through a backlog of operations postponed by the pandemic. Operating rooms (ORs) are increasingly staffed by travel nurses who may not be comfortable enough to speak out. There has been a significant uptick in wrong site surgeries in the last three years, so it’s time to recommit to fully engaging in the time out process.

While our organizations continue to gather and analyze evidence for which approach works best to wipe out this “never event,” patients, administrators and the surgical team can take four very important actions:

Step 1: Observe time out best practices

Audit time outs to see how engaged team members are in every step of the time out as part of the Comprehensive Surgical Checklist established at your organization. Here are questions to ask during a time out audit:

  • Is the person designated to lead the time out always leading the time out?
  • Are all members of the team engaged for the complete duration of the time out?
  • Are all other activities in the OR halted for the complete duration of the time out?

Step 2: Review time out observations as a team

Findings from a series of time out audits should be reviewed by all members of the team in a non-punitive way so improvements can be discussed and agreed upon. From this discussion, the team should develop proposed time out improvements.

Step 3: Test time out improvements

Proposed time out changes should be tested prior to implementation to assess effectiveness and “fit” for every team member. For example, if a team decides that the Mayo stand for instruments will not be moved to the OR table until the fully engaged time out is completed, this new process should be tested to ensure feasibility and timing.

Step 4: Enlist a time out champion on every team

Whether it’s the surgeon, the RN circulator, or a different team member leading the time out, a designated person should champion every time out. This person should feel equally confident to address safety concerns and encourage others on the team to address any concerns they may observe. 

We can reverse this trend and work toward a day when wrong site surgeries never happen. To get there, patients and their advocates, and surgical teams and their administrators, need to work together to reduce the risk of this catastrophic event.