The Association of periOperative Registered Nurses’ (AORN) National Time Out Day is an initiative that calls for surgeons and surgical teams to hit the pause button before starting an operation and review the importance of creating a safe environment for every patient, every time. The initiative also contributes to the development of a safety culture for surgical teams by introducing each other, initiating a dialogue, and enhancing the relationships of the entire team so that every member feels comfortable speaking up during the entire procedure.
This year’s National Time Out Day is Wednesday, June 8. And with the national incidence rate for wrong patient, wrong site, and wrong procedure surgeries estimated as high as 40 a week, according to the Joint Commission Center for Transforming Healthcare, the need for surgical teams to use time outs effectively is more important than ever.
Avoiding sentinel events
A total of 111 sentinel events involving wrong patient, wrong site, and wrong procedure operations were reported to The Joint Commission in 2015, making it the second-most reported sentinel event in the data from that year. Since 2004, the number of reported sentinel events of such cases is 1,215. The most reported root causes identified by The Joint Commission for these sentinel events included: leadership (1,656 times), human factors (1,335), communication (1,319), and assessment (509).
The Joint Commission Center for Transforming Healthcare identified several factors that may contribute to this failure, including:
- Having multiple surgeons involved in one case, such as when multiple procedures are performed on the same patient or when a patient is transferred to a different surgeon
- Multiple procedures conducted on the same patient in a single visit to the operating room (OR)
- Time-related issues
- Patient characteristics that may complicate setup or positioning of the patient (physical disability, morbid obesity, and so on)
In 2003, the Joint Commission’s Board of Commissioners approved the original Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery for all accredited hospitals, ambulatory care centers, and office-based surgery facilities. The three principal areas of focus were pre-procedure verification, site marking, and the time out. Toward the end of the first decade of this century, a more elaborate checklist process had been developed, which is still used today in some ORs.
Ensuring effectiveness of time outs
An effective time out is the last line of defense against an adverse event of the nature described in this month’s column. These events may happen infrequently, but when they do, they can have drastic consequences for patients.
Some errors related to time outs/checklists as determined by The Joint Commission include the following:
- Time outs occurring before all staff members are ready or before prep and drape occurs
- Performing time outs without full participation of the staff
- Lack of senior leadership engagement in the time out
- Staff feeling passive or unable to speak up
- An inconsistent organizational focus on patient safety
- Policy changes made with inadequate or inconsistent staff education
- Distractions or rushed time outs
In 2012, the Joint Commission Center for Transforming Healthcare launched its Targeted Solutions Tool (TST) for Safe Surgery. It serves as a step-by-step guide—including tips for time outs—for accredited health care organizations to identify, measure, and reduce risks in key processes that contribute to wrong patient, wrong site, and wrong procedure operations.
The TST provides tools and tips for observing and recording failures when scheduling and preparing a patient for surgery, as well as other guidelines to enhance the safety of an operation. After using the TST for Safe Surgery and implementing the suggested solutions, the participating organizations that worked on the project with the center reduced the number of cases with risks by 46 percent in the scheduling area, 63 percent in the preoperative holding area, and 51 percent in the OR.
For more information about the TST, go to the Targeted Solutions Tool® for Safe Surgery. For more information about time outs, see Time Out: Commit, Encourage and Engage for every patient, every time.
The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.