The timeout procedure in pediatric surgery - effective tool or lip service? A randomized prospective observational study

Abstract

Background: For over a decade, the preoperative timeout procedure has been implemented in most pediatric surgery units. In our hospital, a standardized team-timeout is performed before every operation. However, the impact of this intervention has not been systematically studied. Purpose: This study evaluates whether purposefully-introduced errors during the timeout routine are picked up by the operating team members. Methods: After ethics board approval and informed consent, deliberate errors were randomly and clandestinely introduced into the timeout routine for elective surgical procedures by a pediatric surgery attending. Errors were randomly selected among wrong name, site, side, allergy, intervention, birthdate, and gender items. The main outcome measure was how frequent an error was picked up by the team, and by whom. Results: Over the course of 16 months, 1800 operations and timeouts were performed. Errors were randomly introduced in 120 cases (6.7%). Overall, 54% of the errors were picked up, the remainder went unnoticed. Errors were picked up most frequently by an anesthesiologists (64%), followed by nursing staff (28%), residents-in-training (6%) and medical students (1%). Conclusions: Errors in the timeout routine go unnoticed by the team in almost half of cases. Therefore, even if preoperative timeout routines are strictly implemented, mistakes may be overlooked. Hence, the timeout procedure in its current form appears unreliable. Future developments may be useful to improve the quality of the surgical timeout and should be studied in detail.