Expanded Surgical Time Out: A Key to Real-Time Data Collection and Quality Improvement

Altpeter, Terry; Luckhardt, Kitty; Lewis, John N.; Harken, Alden H.; Polk, Hiram C.

doi:10.1016/j.jamcollsurg.2007.01.009

Cited by 69 publications

(35 citation statements)

References 26 publications

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“…The pause, or surgical time-out (STO), before incision has also been recognized as an opportunity to improve communication among surgical team members, and in many centers it has also been used to incorporate quality parameters suggested by the Surgical Care Improvement Project. 2 Some centers also use the timeout for a formal briefing for the entire surgical team, similar to the safety practices in the aviation industry. 3,4 Finally, formal checklists have also been added to this process, with promising results.…”

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confidence: 99%

The Extended Surgical Time-Out: Does It Improve Quality and Prevent Wrong-Site Surgery?

Lee¹

2010

permj

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. AbstractPurpose: To review the initial results of implementing an extended surgical time-out (STO) in pediatric surgery.Methods: Starting in January 2006, all members of our surgical team implemented and used an extended STO, confirming the patient's identity, technical and anesthetic details, administered and available medications, and need for blood products and special equipment. To avoid disrupting work flow, the STO was initially after anesthesia induction. Starting in October 2007, the STO was done before anesthesia induction. Initial results, elapsed time to incision, and surgical team surveys were reviewed before and after implementing the preinduction STO.Results: The elapsed time to incision was similar for elective and urgent operations before and after implementing the preinduction STO. All antibiotics were administered and confirmed during the STO. Four significant equipment findings were detected, altering the planned procedure (two before and two after implementing the preinduction STO). Operating room staff felt more confident and prepared for the operations because communication was improved. One near-miss occurred during the postinduction STO. One wrong-site operation occurred despite the preinduction STO, because of inadequate marking. Root-cause analysis demonstrated that this was due to a systems error.Conclusions: Using the extended STO before anesthesia induction improved communication among the surgical team members and did not disrupt work flow. An extended STO may also have broader value, such as confirming timely antibiotic administration or meeting other quality measures. The extended STO did not eliminate wrong-site surgery. However, implementation of the STO placed the responsibility for wrong-site surgery with the whole team and system, rather than with the individual surgeon.The Joint Commission's Universal Protocol aims to prevent wrong-site, wrong-procedure, and wrongperson surgeries. Currently, the protocol consists of a preprocedure verification, marking of the procedure site, and a time-out before starting the procedure. Site-verification protocols vary across hospitals and must balance safety, simplicity, and efficiency. The pause, or surgical time-out (STO), before incision has also been recognized as an opportunity to improve communication among surgical team members, and in many centers it has also been used to incorporate quality parameters suggested by the Surgical Care Improvement Project.2 Some centers also use the timeout for a formal briefing for the entire surgical team, similar to the safety practices in the aviation industry. 3,4 Finally, formal checklists have also been added to this process, with promising results. 5Despite all of these safety measures, implementation of the protocol and how effective the protocol will be at preventing patient harm is not known. 6 In addition, application of the Universal Protocol has not been well studied in pediatric patients. When developing protocols for pediatric surgical patients, such factors as how to mark infants and...

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confidence: 99%

The Extended Surgical Time-Out: Does It Improve Quality and Prevent Wrong-Site Surgery?

Lee¹

2010

permj

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“…Perhaps a more realistic tool to avoid cognitive errors is the "diagnostic time-out" [19]. Patient safety has been shown to improve in surgical and procedural suites because of such time outs [20]. The ED team can implement a similar process by taking a "diagnostic time-out" to review the data and consider an expanded differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Types of diagnostic errors in neurological emergencies in the emergency department

et al. 2014

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Background: Neurological emergencies often pose diagnostic challenges for emergency physicians because these patients often present with atypical symptoms and standard imaging tests are imperfect. Misdiagnosis occurs due to a variety of errors. These can be classified as knowledge gaps, cognitive errors, and systems-based errors. The goal of this study was to describe these errors through review of quality assurance (QA) records. Methods: This was a retrospective pilot study of patients with neurological emergency diagnoses that were missed or delayed at one urban, tertiary academic emergency department. Cases meeting inclusion criteria were identified through review of QA records. Three emergency physicians independently reviewed each case and determined the type of error that led to the misdiagnosis. Proportions, confidence intervals, and a reliability coefficient were calculated. Results: During the study period, 1168 cases were reviewed. Forty-two cases were found to include a neurological misdiagnosis and twenty-nine were determined to be the result of an error. The distribution of error types was as follows: knowledge gap 45.2% (95% CI 29.2, 62.2), cognitive error 29.0% (95% CI 15.9, 46.8), and systems-based error 25.8% (95% CI 13.5, 43.5). Cerebellar strokes were the most common type of stroke misdiagnosed, accounting for 27.3% of missed strokes. Conclusions: All three error types contributed to the misdiagnosis of neurological emergencies. Misdiagnosis of cerebellar lesions and erroneous radiology resident

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“…registry [8] and adapted the constructs of the World Health Organization's surgical safety checklist [9] and the "surgical time out" [10].…”

Section: A Proactive Approach To Ed Information Technology: the Case mentioning

confidence: 99%

A proactive approach to ED information technology: the case of pediatric procedural sedation

Samuel

Shavit

Steiner

et al. 2016

The American Journal of Emergency Medicine

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Expanded Surgical Time Out: A Key to Real-Time Data Collection and Quality Improvement

Cited by 69 publications

References 26 publications

The Extended Surgical Time-Out: Does It Improve Quality and Prevent Wrong-Site Surgery?

The Extended Surgical Time-Out: Does It Improve Quality and Prevent Wrong-Site Surgery?

Types of diagnostic errors in neurological emergencies in the emergency department

A proactive approach to ED information technology: the case of pediatric procedural sedation

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