University of California, Los Angeles, surgical time-out process: evolution, challenges, and future perspective

Abstract

<jats:p>Since the development of the WHO Safe Surgery Saves Lives initiative and Surgical Safety Checklist, numerous hospitals across the globe have adopted the use of a surgical checklist. The UCLA Health System developed its first extended Surgical Safety Checklist in 2008. Authors of the present paper describe how the time-out checklist used before skin incision was implemented and how it progressed to its current form. Compliance with the most recent version of the checklist has been closely monitored via documentation and observance audits. In addition, the surgical team's appreciation of the current time-out has been assessed. Cultural, practice, and human resource challenges are discussed, as are potential future avenues for innovations in the emerging field of the surgical checklist in neurosurgery.</jats:p>

Value-based neurosurgery: the example of microvascular decompression surgery

“…Introducing a comprehensive time-out, with an official team pause, team member introductions, review of the surgical safety checklist, and a team safety statement, represented a major change in culture and practice at UCLA. 23 Surgical Technique. All surgical procedures were performed by a single surgeon (N.A.M.)…”

“…The strategy was to identify an ensemble of key outcomes that matter to patients and commit to measuring and reporting them (Neurosurgery Clinical Dashboard). 23 After opportunities for improvements were identified, we planned the program's tactics, by mapping out various processes, elaborating and implementing interventions, and measuring their results with respect to outcome. The Clinical Quality Program's operation logistics included building a team, identifying a driving leader, empowering team members, and coordinating recurrent meetings (Care Coordination Committee).…”

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery

“…The importance of efficient team communication the day before surgery, at the beginning of a case through a comprehensive time-out, and at the end of a case through a team debrief was emphasized, as was open communication throughout the case. 33 In Groups 2 and 3, parallel instead of sequential teamwork was encouraged and emphasized to get the patient ready in a timely fashion, as surgical preparation time and anesthesia induction time are longer for neurosurgical procedures. 33 Our data showed a persistent decrease in the average pre-incisional preparation time from Group 1 (73 minutes) to Groups 2 and 3 (65 and 45 minutes, respectively).…”

“…33 In Groups 2 and 3, parallel instead of sequential teamwork was encouraged and emphasized to get the patient ready in a timely fashion, as surgical preparation time and anesthesia induction time are longer for neurosurgical procedures. 33 Our data showed a persistent decrease in the average pre-incisional preparation time from Group 1 (73 minutes) to Groups 2 and 3 (65 and 45 minutes, respectively). We recognize that the overall duration of the operative procedure in all three groups may be longer at our institution, as is the case in other tertiary care centers with residency programs.…”

“…33 For the IOM cost, brainstem auditory evoked potentials (BAEPs) monitoring and facial nerve electromyography were removed from the standard monitoring protocol for TN. Experts in the field of MVD have recognized that once surgeons show proficiency in the technique, BAEPs monitoring can be withdrawn from "standard practice."…”