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Time-out designed to avoid surgical mistakes being largely ignored

Procedure meant to avoid performing wrong procedures or on wrong sites

February 15, 2013
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surgeryA “time-out” intended to eliminate mistakes during surgery is not being complied with by a significant number of medical personnel, according to a new study.

Methodology and Bias in Assessing Compliance with a Surgical Safety Checklist,” published in the February issue of Joint Commission Journal on Quality and Patient Safety, found that although surgical safety checklists -- which include a perioperative time-out -- have been shown to improve performance on a variety of patient safety measures, some of the items on it are being skipped.

The checklist protocol was created in 2003 by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in direct response to the ongoing incidence of wrong-site, wrong-procedure, and wrong-patient surgeries. It became required in 2004 for all healthcare organizations accredited by the Joint Commission.

For the study, time-out compliance of each of the 11 standardized items of the time-out was observed at an academic medical center. Methods: A total of 193 time-out procedures were observed, 48 by medical students and 145 by nurses.

The results? One item (procedure to be performed) achieved a 95% compliance rate. Three items (surgical site; availability of necessary blood products, implants, devices; and start of antibiotics) achieved 80%-95% compliance. Seven items achieved 80% compliance (presence of required members of procedure team, presence of person who marked patient, patient identity, side marking, relevant images, allergies, and discussion of relevant special considerations).

However, compliance with the four core time-out items was only 78.2%.

The study’s authors concluded that the low compliance of the time-out requirement called patient safety into question.

“Measures must be taken by large hospitals to regularly audit time-out compliance and create effective programming to improve performance,” according to the authors.

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