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Pamela Margas MaryLou Rowe Nursing Research 12/5/12 Fall 2012

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Utilization and Significance of Time Out Processes in Surgical and Procedural Settings. Introduction :

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Utilization and Significance of Time Out Processes in Surgical and Procedural Settings


The Joint Commission’s (JCAHO) Universal Protocol aims to prevent wrong-site, wrong-procedure and wrong-person surgeries. Currently, this protocol consists of a pre-procedure verification, marking of procedure site and a time-out before starting the procedure. The pause or surgical time-out before incision has been recognized as an opportunity to improve patient safety and communication among surgical team members. In many organization’s use of extended surgical time-outs (STO’s) are utilized to confirm patient identity, technical and anesthetic details, administered and available medications and need for blood products and special equipment. An extended STO may also have broader value such as incorporating quality measures and meeting national patient safety goals. Wrong-site surgery statistics vary, as reporting is not mandatory in many states, however JCAHO estimates the national incidence rate which includes wrong-site or even wrong-patient surgeries to be as high as forty times per week (Lee, S.L. 2010).

Search strategy:

 Utilizing the SUNY IT Cayan Library our research was completed as shown in the table below. :


The research study Wrong-Site Surgery is a descriptive quantitative research article involving 50 hospitals that perform more than 130,000 procedures annually were sampled to determine why wrong-site surgery continues to occur and identify root causes. The goal is to implement World Health Organization’s Surgical Safety Checklist by 2015 in every hospital in the US. The research suggests that a change in culture is necessary in organizations and all healthcare team members must be actively engaged in the Time Out Procedure. Gaps in the research include lack of detailed prescriptive approaches that are needed to address the time out processes. Limitations to the research include that not all hospitals are accredited by JCAHO, and this research is observing 50 organizations.

The purpose of the original research article The Extended Surgical Time-Out: Does It Improve Quality and Prevent Wrong-Site Surgery, was to implement an extended surgical time out processes in pediatric surgery. The research was conducted at Harbor-UCLA Medical Center to implement an extended surgical time out procedure which confirmed the patient’s identity, technical and anesthetic details, administered available medications, and need for blood products and special equipment. An extended STO may also have broader value, such as confirming timely antibiotic administration and meeting additional quality measures. A limitation in the research includes the limiting factor that only pediatric surgeries were included.

The aim of the research article Can the Surgical Checklist Reduce the Risk of Wrong Site Surgery in Orthopedics, was to estimate how many incidents of wrong site surgery occurred in orthopedics that could have been prevented by the WHO surgical checklist. The sample size in this article is hard to identify. It states that they used the NRLS database to identify incidence where wrong site surgeries took place. The date range was January 1st 2008 to December 31st 2008. The total numbers of incidents found were 316 wrong site surgeries; however a detailed review revealed wrong site surgeries events occurred in 133/346 procedures. The remaining 183 procedures were misclassified, and excluded from further analysis. The root cause identified was ineffective team communication, absence of a verification checklist, incorrect site marking, and no formal time out procedure.

The focus of the article Designing an Applied Model of Perioperative Patient Safety examined the relationship among the concepts of organizational safety culture, utilization of safety checklists and frequency of surgical error. Measurements of safety culture were obtained from 287 surgical team members between 2009-2010 under the Safe Surgery Saves Lives Campaign; an initiative commissioned by the World Health Organization (WHO). Interventions identified included focused team training, specialty team education and implementation of a safety checklist to improve teamwork, guide critical communication and achievement of optimal patient outcomes.

In Hospitals Collaborate to Preventing Wrong-Site Surgery research article, the purpose was one of numerous patient safety initiatives undertaken collaboratively by 30 participating hospitals in the Greater Philadelphia region since 2006 under the direction of The Partnership for Patient Care (PCC). Participating hospitals saw improvement in preventing wrong site surgery; this was measured through hospital surveys before and after, education workshops, observation assessments, and the incidents of wrong site surgery event reports.

In summary, all organizations have an ethical and moral obligation to prevent patient harm and provide safe, quality patient outcomes. Utilization of Universal Protocol practices and surgical safety checklists is paramount in eliminating wrong-site procedures/surgeries; commitment to vigorous, robust time out processes by all team members is key in making this issue a "never event". Research gaps include, Descriptive Quantitative Research Articles utilized only and Stratified Random Sampling on adult patient populations only.


Despite ongoing efforts of health care practitioners to provide quality care to patients, errors still occur every day in surgical/procedure settings across the U.S. Although the ultimate goal of any healthcare team is zero safety events, it remains imperative for organizations to incorporate cultural assessment, team training and use of checklists to guide critical communication, which will allow organizations to sustain excellence in patient safety and quality. Future studies would be useful in linking safety interventions to improved surgical outcomes and reduced errors, in addition to sustaining a change in culture.

Pamela Margas

MaryLou Rowe

Nursing Research


Fall 2012

References Attached