Initiative to Increase the Rate of Emergency Department Physician Preprocedure Time-out Documentation

Abstract

Introduction: The preprocedure time-out is an important safety measure to verify patient identity and accuracy of a planned procedure. The time-out is an institutional and Joint Commission requirement. However, physicians in our emergency departments (EDs) document it inconsistently. We aimed to improve physician preprocedure time-out documentation for deep sedation (ketamine and/or propofol) from 75% to 90%, and separately for cutaneous abscess incision and drainage (I&D) from 94% to 98% by June 2020. Methods: We analyzed 1 year of baseline data and weekly electronic medical record (EMR) reports from November 2019 through June 2020. Our outcome measures were the rate of physician time-out documentation for deep sedation and I&D, respectively; our process measure was physician engagement. Our interventions included education, monthly reminders and updates, individualized feedback for insufficient documentation, EMR deep sedation, and I&D procedure note optimization, and academic and financial incentives. We used statistical process control chart quality improvement rules for discerning special versus common cause variation. Results: Physician documentation of a preprocedure time-out improved from 75% to 100% for deep sedation and from 94% to 99.3% for I&D. These improvements remained sustained. All physicians were eligible for the financial bonus, and 40 (63%) met Maintenance of Certification credit requirements. Conclusions: Using quality improvement methodology, we increased physician time-out documentation for deep sedation and I&D through education, feedback, and systems enhancement. We improved Joint Commission regulatory compliance and reduced potential harm through these safety checks. Future studies may quantify patient safety effects and examine the efficacy of similar interventions for other procedures.