Time Out Policy

[Silver_Rik, ASN, RN]

We are getting audited pretty heavily on conducting proper timeouts. One point of emphasis is doing a new timeout before any new procedure.  For example in urology if we are doing a cysto with stent placement followed by ESWL we have to timeout before the cysto and again before the lithotripsy.

I want to propose that we do subsequent timeouts by exception. The only elements required in a timeout per Universal protocol are patient identification, procedure, and anatomical site.  I want to suggest that subsequent timeouts cover only those three items plus anything that changed from the original timeout. Why do we need to repeat the prophylactic antibiotic, that the patient has SCDs on, or the fire risk score if they haven’t changed?

does this make sense? How is it handled in your OR?

[11Blader]

If the ESWL is done on the same table, without moving the patient, and, all the personnel in the room were present for the first timeout, I can see why you are questioning the repetition. In other institutions the personnel starting the case may not be the same as when it started (relief, lunches, etc). Or, the ESWL may be performed after repositioning on an outside vendors equipment (pt intubated and paralyzed) from a stent placement on the hospital's cysto table. With many moving parts it is more prudent to do another timeout before moving on to another procedure.

Case in point. I did a job at a large Denver hospital that did not enforce marking the skull for craniotomies, in violation of their own policy. The RN Neuro Service Coordinator allowed one particular goofus surgeon to 'slide' on this policy. I personally knew a person who had wrong sided craniotomy for tumor surgery because of that kind of slip. I REFUSED to take the patient to the OR until that doctor marked the head, and, I had to get OR admin and RIsk Management involved to get him to do it. 

I have a colleague who was the scrub nurse on a wrong patient in the wrong OR case, at another famous Houston medical center long before timeout procedures were instituted. 

It may seem redundant, but there are many ways things can get missed, so another timeout isn't going to hurt...

[Silver_Rik, ASN, RN]

On 5/14/2022 at 5:26 PM, 11Blader said:

If the ESWL is done on the same table, without moving the patient, and, all the personnel in the room were present for the first timeout, I can see why you are questioning the repetition. In other institutions the personnel starting the case may not be the same as when it started (relief, lunches, etc). Or, the ESWL may be performed after repositioning on an outside vendors equipment (pt intubated and paralyzed) from a stent placement on the hospital's cysto table. With many moving parts it is more prudent to do another timeout before moving on to another procedure.

Case in point. I did a job at a large Denver hospital that did not enforce marking the skull for craniotomies, in violation of their own policy. The RN Neuro Service Coordinator allowed one particular goofus surgeon to 'slide' on this policy. I personally knew a person who had wrong sided craniotomy for tumor surgery because of that kind of slip. I REFUSED to take the patient to the OR until that doctor marked the head, and, I had to get OR admin and RIsk Management involved to get him to do it. 

I have a colleague who was the scrub nurse on a wrong patient in the wrong OR case, at another famous Houston medical center long before timeout procedures were instituted. 

It may seem redundant, but there are many ways things can get missed, so another timeout isn't going to hurt...

This makes sense, if there are any changes in personnel or position, and even without planned changes it could catch errors or unintended changes.

wrong site / side surgery is super scary and our cross town affiliate hospital has had it happen in the past 6 months which is why they’ve cracked down.