Would like info on the practice of "Sterile Cockpit" or "Timeout"

ShirleyM · Jun 2, 2005

HI this is the first time I have posted a new thread of my own. Usually I have just read yours to learn new info and find out what others are doing in their own O.R. I'm interested in knowing if anyone of you practice "Sterile Cockpit" or "Timeouts" and if you could give me feedback on to what your practice is. We currently do not have this in our O.R. but I think it is something that should really be looked at. I'd appreciate any input. Hope this isn't one of those "duh" questions. "Timeout" was mentioned in a previous thread and I'd like to know more about it and all that is involved.
Thanks much, Porsch65

Hey,

You didn't mention where you're from but Timeouts are supposed to be done on every procedure in healthcare faciities across the US. There are previous posts titled 'Timeout' or something to that effect, I encourage you to check them out. JCAHO also has a feature on Timeout on their website, www.jcaho.org, then do a search for 'timeout' and go to FAQ on timeout.surgical site marking. Timeouts are basically a time for the surgical team to verrbally confirm the patients' identity, procedure, laterality (if applicable), patient positioning and special needs (implants, equipement). The timeout can be initiated by any member of the surgical team, it does not involve the patient and it must be done before the first incision is made, preferably before the patient is position. Hope that helps...

porsch65 · Jun 7, 2005

Hey,
You didn't mention where you're from but Timeouts are supposed to be done on every procedure in healthcare faciities across the US. There are previous posts titled 'Timeout' or something to that effect, I encourage you to check them out. JCAHO also has a feature on Timeout on their website, www.jcaho.org, then do a search for 'timeout' and go to FAQ on timeout.surgical site marking. Timeouts are basically a time for the surgical team to verrbally confirm the patients' identity, procedure, laterality (if applicable), patient positioning and special needs (implants, equipement). The timeout can be initiated by any member of the surgical team, it does not involve the patient and it must be done before the first incision is made, preferably before the patient is position. Hope that helps...

HI Shirley,

Thanks very muchfor the web-site, very helpful. I'm from the "Great White North". I guess we have been doing all these things all along, just didn't have a title for it. I was wondering if it was more than what we already did.

Thanks again for your response P65

prmenrs, RN · Jun 7, 2005

I've never heard the phrase "sterile cockpit". Can you enlighten me, please?

porsch65 · Jun 7, 2005

I've never heard the phrase "sterile cockpit". Can you enlighten me, please?

Hi There!

"Sterile Cockpit" is a term that is used in the airline industry. It is kind of a code of conduct that is adhered to during crucial periods of flight, namely take-off and landing. It came about because it was found that the majority of "incidents" occurred during these phases of flight. During these times it was deemed imperative that pilots not be interrupted during these times. There was no unneccesary talking or activity or distraction that would interfere with the function of the crew. Crew focused solely on their required duties during these critical phases of flight. I see a distinct parralell between the cockpit and the O.R. I would relate landing and take-off to induction and reversal, to first count and final count. So many times silly mistakes happen during these times and it is often a direct result of unneccesary distraction during critical phases of surgery. Counts should never be interrupted, there should be no talking during induction and reversal. The concept is similar to "timeout" from what I can gather. Focusing on right side, right pt. etc... I was just curious if some of you incorportated the two together as the article I read on "Sterile Cockpit" was of American origin, and I thought that it was cool that this practice went on and was adhered to.

CRNA, DNSc · Jun 7, 2005

Hi There!
"Sterile Cockpit" is a term that is used in the airline industry. It is kind of a code of conduct that is adhered to during crucial periods of flight, namely take-off and landing. It came about because it was found that the majority of "incidents" occurred during these phases of flight. During these times it was deemed imperative that pilots not be interrupted during these times. There was no unneccesary talking or activity or distraction that would interfere with the function of the crew. Crew focused solely on their required duties during these critical phases of flight. I see a distinct parralell between the cockpit and the O.R. I would relate landing and take-off to induction and reversal, to first count and final count. So many times silly mistakes happen during these times and it is often a direct result of unneccesary distraction during critical phases of surgery. Counts should never be interrupted, there should be no talking during induction and reversal. The concept is similar to "timeout" from what I can gather. Focusing on right side, right pt. etc... I was just curious if some of you incorportated the two together as the article I read on "Sterile Cockpit" was of American origin, and I thought that it was cool that this practice went on and was adhered to.

Just to point out that I think you are referring to "Emergence" rather than reversal. And I agree, that from an anesthesia perspective, there should be no unnecessary chatter during induction of anesthesia or emergence from anesthesia. Reversal in anesthesia referrs to giving a drug that reverses the effect of another drug -usually muscle relaxants but could be narcan to reverse narcotic. :)

prmenrs, RN · Jun 7, 2005

Thanks, Porsche65! (Great car, too)

grimmy, RN · Jun 8, 2005

i agree with all of the above (since i also fly airplanes) - but keeping the residents and surgeons from chatting with each other, or on the phone, or dictating is darn difficult. counts are a major problem because if you've got quickie surgeon stitching like a bandit, counting can be crazy. i really hate that, especially when i have a couple chest pans, rib pans, retractor pans, a couple hundred sutures... :rolleyes: just yesterday we had a huge 2 part eight-hour esophagectomy case, and we were missing a lap sponge. i am frantically going through the garbage and the resident's pager goes off. he starts giving me crap about not getting to his page right away! :angryfire we do time-outs predictably and for the most part, the surgeons and residents take it seriously. i am often turning down music, etc. for the times the pt is in the room and awake. a few times i've gotten some question as to why i turned things off/down, and i do explain, but few get it.

ShirleyM · Jun 8, 2005

I ask those who are talking loudly during induction of anesthesia to either lower their voice or take the conversation outside the room. I haven't gotten flak over it and I don't expect to, it's only appropriate to keep it quiet during that critical time. And BTW, don't you ever take any flak from anyone about responding to pagers, especially during counts!! The next time they give you flak be sure to make it clear that their pagers can and will wait but doing counts can't wait. I know it's obvious, but it's so worth repeating...that patient on the table is our priority, not some damn pager. If they're so concerned about their pager then they need to give it to a med intern or student to carry it. I get mad just thinking about it. :angryfire

grimmy, RN · Jun 9, 2005

i ask those who are talking loudly during induction of anesthesia to either lower their voice or take the conversation outside the room. i haven't gotten flak over it and i don't expect to, it's only appropriate to keep it quiet during that critical time. and btw, don't you ever take any flak from anyone about responding to pagers, especially during counts!! the next time they give you flak be sure to make it clear that their pagers can and will wait but doing counts can't wait. i know it's obvious, but it's so worth repeating...that patient on the table is our priority, not some damn pager. if they're so concerned about their pager then they need to give it to a med intern or student to carry it. i get mad just thinking about it. :angryfire

well, this resident is responsible for emergent chest tube issues. our tcv service does not have nearly enough residents so even the 3rd and 4th year residents do plenty of scut work in addition to cases. granted, the residents work together rather well, but when the person paging is a 2nd year internal medicine resident for pain control issues, it is not emergent! it's not my thoracic resident's fault, but damnit, my time and resources are limited...i think he got the message.