Get Their Attention, Then Perform a Flawless Time Out

The staff at The Plastic Surgical Center of Mississippi considers a perfect time out before every procedure to be non-negotiable. So when too many members of the perioperative team graded many time outs as “satisfactory” or even “poor,” the facility’s leadership knew it had to act.

The results should serve as an inspiration for same-day surgical facilities everywhere since National Time Out Day just took place on June 14. Since implementing changes, the surgical center in Brandon, Miss., went from 38% “excellent” grades to 100% just five months later.

The first course of action was for Director of Quality & Education Brianna McLemore, RN, CEN, CNAMB, CAIP, to create an audit tool for the time outs. The one-page document asks when the time outs started and ended, who ran them, if there were any good catches as a result of the preoperative pauses, as well as whether any unanticipated issues were identified.

When the original results came in, it was determined that the subpar time outs where due to distractions and the lack of full-team participation. So, Ms. McLemore purchased Clappers – the hand-shaped noisemakers for children – for each OR.

Dubbed “Hands Off, Time Out,” a checklist that includes several of the components of a perfect time out, was attached to each Clapper. The device has been so successful that it’s not needed before every surgery now, although it’s still close by and is used as needed if the time out devolves into the circulator talking while surgical technicians, the anesthesia team and the surgeon are doing other things.

“What’s the point of one person simply reading from a piece of paper?” says Ms. McLemore. “I want our staff at a place where they all agree on all the items discussed during the time out so everyone is in a position to prevent a wrong surgery or catch an allergy that might have been overlooked.”

Having every team member involved is part of a perioperative team’s duty to conduct strong time outs for their patients, adds Ms. McLemore.

The 2023 data on sentinel events recently released by The Joint Commission (TJC) shows that 8% of the incidents reported included wrong-site, wrong-procedure, wrong-patient or wrong-implant surgeries. The statistic underscores the importance of pausing immediately before the start of all procedures to conduct a quick but comprehensive assessment that what is about to take place is correct. TJC has said that less-than-universal attention paid to time outs by perioperative team members has been a contributing factor to sentinel events. OSM