Never Taking Time Outs for Granted

The number of wrong surgeries reported to The Joint Commission continued to decline in 2022, with 85 events disclosed to the accrediting body. The number of reports of these types of incidents, which include procedures involving a wrong site, procedure, patient or implant, has gone down each year since 2019, when 126 were reported.

While that news is encouraging on the surface, the fact remains that wrong surgeries have been in the top five most prevalent sentinel events during that time, according to TCJ’s annual review of its 2022 sentinel event data. Sixty-five percent of the last year’s incidences were wrong-site events, 17% were categorized as wrong-procedure, while wrong-patient and wrong-implant events were 9% each.

These sobering statistics should serve as a stark reminder that time outs should never be taken for granted, or rushed through as just one more routine task before an incision is made. As National Time Out Day on June 14 approaches, the day should be considering an opportunity for surgical facilities across the country to refine their practices as a key way to prevent avoidable errors.

The Association of periOperative Registered Nurses’ has released a series of 2023 tips to empower your team to improve its processes. AORN, which represents more than 43,000 RNs nationally and abroad, notes the TJC report cited the following common errors that contributed to sentinel events last year:
• Less than universal attention by team members during time outs
• Inaccurate and hard-to-see marking of surgical sites
• The lack of a culture empowering all team members to speak up if they see a mistake, even if they are new to the job

To combat these issues, AORN suggests that facilities refine their site-marking process, having leadership instill “speak-up cultures” that OR teams know are valued and will be enforced as well as empowering a single team member to lead time outs and ensure that all team members pay attention during the pauses. At the University of Virginia’s Department of Orthopaedic Surgery, for example, surgeons began leading the time outs about two years ago, when nurses used to do it before. Joseph S. Park, MD, an associate professor and head of the department’s foot and ankle division, thinks the change was appropriate.

“Even though I used to observe the nurses read the consent forms and other parts of the timeout, I realized that I wasn’t always as engaged as I would have been if I were the one reading it,” says Dr. Park.

Now, Dr. Park and other orthopedic surgeons at UVA oversee the time outs. They confirm that all the needed imaging is in the room, and that the implants on the table are correct. They then confirm that the intended procedure is about to be performed on the correct side of the right patient. The physician-led time outs make sense, says Dr. Park.

“I’m the one who signed the leg, so I’m the one who should confirm that I signed the correct one and I don’t think it’s fair to put that responsibility on the nurses,” he explains. “Nurses obviously play obvious critical roles, including catching mistakes during time outs, to any perioperative team and are hugely important in an institution’s ability to perform complex surgery. But because we’re most familiar with the case, I believe the surgeon should be leading the time out,” he says.

Be it a nurse of a physician who runs the pause, Dr. Park notes it doesn’t have to be perfect to be meaningful and safe. The key is for the patients to confirm their identity, the body part and, if it’s an extremity, which side is about to be worked on. OSM