Script Your Time Outs to Keep Them Consistent

As The Joint Commission’s annual report on sentinel events shows each year, the problem of wrong-site surgeries is never solved. With eternal vigilance and strong strategies, however, these events can be reduced to as close to zero as humanly possible. That will be the message to surgical organizations on June 11, when National Time Out Day 2025 will be observed.

Penn Medicine’s Pennsylvania Hospital in Philadelphia is no exception. Despite its universal protocol that includes a policy on how to perform regional anesthesia block time outs, the facility identified inconsistent clinical practices surrounding the procedural pauses among its providers in 2024.

Leadership successfully took several steps to improve the process. Since interventions were implemented in July 2024, Pennsylvania Hospital has reported zero safety events related to injections or blocks at its ASC, procedure areas and main ORs.

Citing the Association of periOperative Registered Nurses (AORN), Penn Medicine/University of Pennsylvania Health System’s Clinical Director Sunilka Thompson, DNP, RN, CPXP, NE-BC, and Director of Nursing Education and Professional Practice Margaret Vance, DNP, RN, CNOR, NPD-BC, say the causes of wrong-site surgeries include a lack of attention by every member of the OR team and failure to instill a speak-up culture that makes team members comfortable to “say something when they see something” that could potentially be wrong.

Dr. Thompson’s and Dr. Vance’s poster detailing their regional block timeout initiative was exhibited at April’s AORN Global Surgical Conference & Expo in Boston.

The objectives of their improvement project were to convey the importance of standardizing time outs, identify ways for team members to collaborate during the pauses and improve speak-up culture by introducing scripting for team members to use when expressing concerns.

To achieve their goals, a regional block time-out form installed in the electronic medical record to document the pauses was standardized. Signage was created that defined the roles in the process for each team member, including surgeons and anesthesia. A communications tool was implemented that made it easier for team members to express concerns during stressful situations, which was particularly helpful for new employees. All team members received education that reviewed current policies and went over the introduction of the new processes.

Dr. Thompson and Dr. Vance say the time-out process should be consistent in every OR at your facility, and always performed with engagement from the entire interprofessional team. They add that providing perioperative teams with a standardized script for elevating concerns may contribute to a successful speak-up culture.