A two-minute “time-out” before an operation significantly reduces risk of surgical mistakes while creating a more collaborative atmosphere in the OR, according to surgeons at the Johns Hopkins Medical Institutes in Baltimore.
Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires pre-surgical briefings, it does not spell out their content or structure. Surgeons at Hopkins wanted to establish a standard procedure and mea-sure its effectiveness. The results of their pilot study are in the Journal of the American College of Surgeons (2007;204:236-243).
The time-outs take place after the patient goes under anesthesia and be-fore the first incision. Everyone in the OR tells their names and their roles; the surgeon takes the lead, as required by JCAHO, to identify the patient, the procedure and the site; and the entire team then discusses potential complications and hazards.
The personal introductions are important, said lead researcher Martin A. Makary, MD, MPH, director of the Johns Hopkins Center for Surgical Outcomes Research. Nurses, surgeons, and anesthesiologists work in frequently shifting teams.
“They will not necessarily know one another, especially in a large facility,” he said. In addition, the introductions “create an atmosphere where people feel comfortable speaking up, so that harm can be identified early and brought to the attention of the group,” Dr. Makary added.
All participants were trained in how the briefings would proceed and were surveyed before the program began and again three months later. Respondents included 147 surgeons, 59 anesthesiologists, 187 nurses, and 29 other personnel.
The briefings heightened awareness of the surgical plan. In the pre-briefing survey, 88% of respondents said the surgical site “was clear to me before incision.” That proportion rose 97% in the post-briefing survey. Similarly, the proportion of participants who agreed “A preoperative discussion increased my awareness of the surgical site and the side being operated on” increased, from 52% to 64%.
The most dramatic results involved collaboration in the OR. Asked whether “surgery and anesthesia worked together as a well-coordinated team,” the proportion agreeing soared to 92% from 68%. Almost 11% more participants agreed that “decision-making utilized input from relevant personnel” after the briefings, rising from 78.7% to 89.6%.
Only one factor didn’t change. Each time they were asked, more than 93% of the participants agreed that a “team discussion before a surgical procedure is important for patient safety.”