Developing a Surgical Time-Out Procedure: 5 Best Practices
Although they’re called never events in healthcare, particularly shocking medical errors like wrong-site surgeries still occasionally happen. Surgical time-out procedures, adapted from aviation industry communication protocols, are strategic pauses for one last confirmation that the surgical details are in order. This is an effective solution that’s gained significant traction within healthcare.
By implementing a standard surgical time-out, Joint Commission national patient safety goal requirements become aligned with real-time practice. If you’re looking for assistance with achieving surgery-specific patient safety goals, we’ve got you covered with this helpful overview and recommendations for best practices, complete with a customizable template for use in developing your organization’s procedure time-outs.
What Is a Time-Out Procedure?
At its core, it’s a formal checklist. A time-out in surgical procedures is meant to be a stop gap event that forces the entire care team to pause and give all their attention to ensuring that verification safety measures are correct and confirmed.
Because the procedure time-out was implemented as part of the Joint Commission’s standards of practice for preventing surgical never events, it’s often exclusively associated with operative procedures. However, a medical time-out is a useful safety tool in any setting where invasive or critical (non-emergency) events occur.
Let’s answer a few more key questions about the tool before we move on.
Is the importance of time-out in surgery more critical than with other healthcare procedures?
The answer to this question is complex because healthcare is complex. Often, the stakes associated with surgical errors are higher; therefore, a formal pause to confirm the proper safety checks has higher value. However, errors at the bedside also have the potential to become sentinel, devastating events, and could be prevented with the use of a time-out checklist.
When should a surgical time-out be performed?
A time-out procedure for surgery settings should occur just before the start of any invasive procedure or incision. Some protocols — like those used by the World Health Organization — recommend multiple surgical time-out procedures, occurring before and after anesthesia. Another example of dual time-outs includes using both a time-in and time-out in surgery safety checklist.
What are some procedure time-out examples that aren’t surgical?
A non-surgical time-out procedure example might include utilizing a stop-gap safety checklist to ensure the safe administration of radiation for an oncology patient. Another healthcare time-out example in non-surgical settings is the time-out procedure nursing staff often employ to ensure correct patient, correct blood type, and correct product safety checks during blood administration.
The Benefits of a Time-Out Procedure in Healthcare Settings
The benefits of employing a time-out procedure before surgery or other invasive events are multifold. Let’s examine some of the main advantages of a well-developed time-out protocol in the table below.
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| Fewer Medical Errors | An effective time-out in surgery settings can prevent common errors (like wrong patient, wrong site) from occurring. |
| Better Interprofessional Communication | By enforcing a necessary pause and establishing communication protocols, interprofessional collaboration becomes more routine, helping make effective communication a pattern and organizational habit. |
| Improved Patient Safety | Establishing programs that ensure patient safety contributes to an overall culture of safety that can have far reaching effects interdepartmentally and across healthcare tasks. |
Develop a Surgical Time-Out Procedure: 5 Best Practices
Here are five best practices to guide the implementation of a new medical or surgical time-out protocol. These best practices are also helpful for any organizations looking to revise their current programs to better align with updated safety goals.
1. Standardize the Time-Out Procedure
The expectation around when the procedure time-out occurs (right before the invasive procedure takes place) should be standard, and the stop-gap checklist employed should be, too. This will improve consistency and ease of use while decreasing variability and the risk for errors.
Tips:
- Utilize a specific procedural time-out template and ensure that it’s widely and publicly available, informing and including the patient and family members as participants in the time-out whenever possible.
- Allow specific departments to customize the time-out checklist so that it’s specific to their needs as long as safety teams or unit leadership has approved the customization.
2. Train Staff on Implementation of Time-Out Protocols
Training often ensures the quality and effectiveness of a new program’s rollout. By developing a training program that helps walk staff through the reasons behind this extra step in an already lengthy process, staff are less likely to view the time-out event as a hurdle, instead valuing the additional safety step as a preventative measure that protects patients and staff alike.
Tips:
- After the program’s rollout, include informational training within onboarding sessions and materials to ensure that the surgical time-out procedure’s value is clear across the organization.
- Offer simulated training that involves the entire interdisciplinary team to demonstrate that the safety tool is efficient and to address any communication breakdowns or necessary template revisions prior to implementation in clinical care.
3. Require Active Participation
For the time-out procedure to be effective, it must be implemented as a stop gap before any invasive procedure, requiring the full attention of all participating staff. If a member of the team is distracted or not present, the safety check has not been accomplished to the required extent — leaving room for errors and patient harm.
Tips:
- Work to gain buy-in for the program across all departments and at all healthcare staffing levels by leveraging leadership’s cooperation and influence.
- Utilize surgical time-out protocols that clarify the necessary participants, requiring all members of the procedural team to suspend all other activities until the procedural time-out is complete.
4. Employ Structured Communication
The time-out procedure is only successful if the entire team is willing to speak up when there’s a checklist issue. Empowering your staff to voice concerns (even in the face of potential hierarchical disparities) ensures that the time-out checklist is effective.
Tips:
- Arm staff with resources such as the ARCC communication tool, helping them to confidently and succinctly address concerns or issues with intended procedures.
- Assign certain staff roles to key aspects of the procedure time-out to boost engagement across the team and foster more comfort with interdisciplinary communication.
5. Audit and Update the Program
Gather data about the consistency of procedural time-out usage and adherence by performing regular audits. Track the data to help identify patterns in the program’s application and to inform updates so that reform is backed by evidence and specific organizational needs.
Tips:
- Consider developing a time-out procedure compliance audit tool similar to a hand hygiene compliance auditing tool.
- Monitor for regulatory and best practice standard updates to ensure that your program remains relevant with shifting patient safety goals and technological changes that affect care delivery.
Need Help Staying Current With Regulatory and Practice Updates?
Surgical time-out procedures have been a safety device mainstay for a number of years, but technology continues to shift the approach to ensuring patient safety. Stay on top of all the changes with our latest facility guides and best practice recommendations.