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Holding an Effective Operating Room “Time-Out”

An effective operating room “time-out” is when the surgical team, right before starting, confirms that the surgery involves the correct patient, procedure, and site. These steps greatly increase the chances of surgical success. This article looks at the essential steps of an effective surgical time-out.

What is an operating room time-out?

A surgical or operating room time-out is a short, dedicated period to get the OR team aligned and, ultimately, lead to the best surgical outcome possible. A time-out:

  • Confirms that the surgery involves the right patient, procedure type, and body part or site.
  • Lets any member of the surgical team (surgeons, anesthetists, nurses, or medical students) to pause the procedure and express concerns or get clarification.
  • Should usually take under 1 minute.
  • Reduces mistakes, surgical complications, and mortality.
  • Builds a healthy rapport between surgical team members.

Holding an effective operating room time-out means keeping to a fixed checklist of ordered safety steps. The main steps are as follows.

Ensure open communication

An operating room time-out begins with a confirmation that each team member has introduced themselves by name and role.

The time-out ideally creates an environment where each member of the surgical team can speak up at any point during the procedure. Any team member, independent of role or rank, must be able to stop the procedure to obtain clarification or express their concerns about any discrepancies they might notice.

Open communication and mutual understanding between members give rise to better cooperation, which improves patient safety.

Inadequate communication can lead to errors during surgical procedures. The time-out can prevent these in several ways:

  • All relevant staff members should take part in it.
  • It should not be rushed if at all possible.
  • Senior team members must show leadership and empower other members.
  • Staff should feel active and able to give suggestions.
  • Staff should be educated about procedures before entering the operating room. An example of a safety policy is the fire risk assessment tool, aimed at preventing OR fires.

Verify the patient’s identity

A surgical time-out should ensure the correct patient is in the operating room. The Joint Commission recommends that the surgical team members verify the patient’s identity by using at least two of the following:

  1. Reviewing the patient’s data on their medical records
  2. Checking the patient’s identification wristband
  3. Asking the patient their full name and date of birth (if the patient is awake)

As obvious and simple as it may sound, verifying the patient’s identity is crucial for avoiding performing the wrong operation on the wrong patient.

Review the surgical consent forms

Before surgery, surgeons must clarify that the patient understands the procedure and consents to it. The patient must always be informed of the potential risks associated with the surgery. Their consent forms give their approval for undergoing the procedure.

acquire patient consent
Patient consent should be reviewed in an OR time-out

During an operating room time-out, the surgical team reviews the patient’s consent forms as follows:

  • Confirms that the patient in the operating room has signed the necessary forms.
  • Verifies that the specified procedure in the forms aligns with the planned procedure.

Confirm the surgical procedure

A time-out should verbally confirm the type of surgical procedure to be performed. This step is especially important in surgeries on lateralized organs or limbs, such as the kidneys. This step ensures that the procedure is what the patient needs.

First, the senior surgeon reiterates the patient’s name and declares the planned procedure. Then, the other team members, such as nurses or anesthetists, can review the type of procedure on the patient’s consent forms and records to make sure they agree with the surgeon.

Mark and confirm the surgical site

Wrong-site surgery is a rare but tragic event. The operating room time-out ensures the correct surgical site is identified and marked clearly. The operating room team agrees on the type and site of the surgery after comparing the operative plan with the patient’s papers. The surgeons in charge mark the surgical site externally or internally, if applicable.

External skin marking involves marking the skin incision site preoperatively. This is typically done with an external surgical pen while the patient is awake and aware, if possible.

Internal surgical marking, however, is done inside the body. It uses sterile surgical marker pens, dyes, clips, or sutures to mark internal tissues. This type of marking is typically done intraoperatively.

Surgeons must ensure the marks are visible even after the skin is prepared and draped.

Discuss potential complications and special considerations

During a time-out, the surgical team members discuss and review patient-specific considerations and anticipated critical events. This time-out phase establishes that the team is ready to face any challenge that might arise intraoperatively.

The surgeons in charge inform the other members about:

  • Operative plan and duration of the procedure
  • Previous surgeries and their complications, if any
  • Noteworthy anatomical variations
  • The possibility that unexpected events can occur. These events can include blood loss or any procedural modifications. An example of an unexpected event is a uterine rupture during gynecological procedures.

The anesthesia staff discusses other operation-related aspects, such as:

  • Patient allergies
  • Drug history
  • Laboratory tests
  • Previous consultations with other medical specialists
  • Prior exposure to anesthesia, including any difficult intubations, vital complications, or adverse reactions to anesthetics.

Confirm antibiotic prophylaxis

This part of the time-out prompts confirmation that antibiotics are infused before the surgery.

During a time-out, the surgical team members discuss the chosen antibiotics and the time of administration. Alternatively, they can declare that antibiotics are not indicated.

antibiotic administration

Moreover, a time-out can be used to discuss a plan for antibiotic redosing. This practice applies to procedures that last longer than three hours.

Antibiotic prophylaxis greatly reduces the patient’s chances of incurring a surgical site infection.

Perform a final equipment and supply check

During a time-out, the nursing staff confirms that the operating room is sterile. They verify that all the necessary equipment is present and in working order. They also report on any potential equipment issues.

The necessary equipment in the operating room includes the following:

  • Surgical instruments
  • External and internal markers
  • Necessary supplies
  • Special equipment, such as implants or prosthetics

It is worth mentioning that imaging is often needed during surgeries. Thus, the time-out is additionally used to check the presence and functionality of the imaging equipment.

Conclude the time-out with purpose

An operating room time-out ideally includes a collective agreement from the team that all checks are complete.

Each staff member should know their responsibility on the team. They should act accordingly and report on the information that they have. A universal agreement can be reached only after all the team’s suggestions and concerns have been addressed.

Reaching an agreement after completing the checks means proceeding with the surgery is safe.