The Surgical Timeout
A timeout is something that is performed before every single surgical procedure. The timeout is where the RN, or sometimes the surgeon, will list off pertinent information for the case. During the timeout, everyone must stop what they are doing and actively listen. There should not be music playing, the team shouldn’t be organizing the sterile field, everything must stop. Why is the timeout so important? Have you heard of a wrong-site surgery? Or a surgical fire? Or a wrong procedure completely? The timeout is essentially the last line of defense against something like this happening. Fun fact, I was lucky enough to be the chosen RN to perform the timeout during a Joint Commission survey. I was about 36 weeks pregnant and (jokingly) told my leader that I just went into labor and couldn’t do it. But, I did it and it went perfectly fine.
Incidence of Wrong Site Surgery
According to The Joint Commission’s 2022 sentinel event report, wrong-site surgery incidence ranged from 0.09 to 4.5 per 10,000 procedures. To some, that may not sound like much, but to me that’s way too many! Can you imagine being the patient who has consented to a left mastectomy due to cancer and you wake up with your right breast missing and the cancerous breast still attached to your body? Imagine you consented to a hysterectomy, but woke up with your uterus, both fallopian tubes, and both ovaries removed. Things like this DO happen—it is 100% preventable. Follow your facility’s guidelines on patient readiness and you should not have an issue.
Before the Timeout
Prior to even bringing the patient to the room you should discuss the procedure with the team—this typically includes the CRNA, the surgical tech, and the assist (if there is one). The surgeon is typically not involved in this discussion because they are waiting in the surgeon’s lounge for you to be ready, or in the swing room. They’ve already done their part in this by submitting the proper information for the patient to be scheduled appropriately for the procedure. They (should have) already seen the patient, marked the patient (if applicable), and completed their day of H&P.
Patient Interview
When you meet the patient and perform the interview—always read directly from the consent. Ensure the consent matches what the procedure is scheduled as. Ensure the patient is marked (if applicable). If there is laterality for the procedure, the patient MUST be marked. For example, if a patient is scheduled for a bilateral inguinal hernia repair, your facility may not require the patient to be marked. However, if the patient is scheduled for a left inguinal hernia repair, the patient MUST be marked. If the patient is scheduled for a cholecystectomy, most facilities do not require the patient to be marked, they only have one gallbladder! Always visualize with your own eyes the marking. Verbally confirm with the patient—we’re repairing a LEFT inguinal hernia today, correct? My last ‘informal’ verification is when I get the patient into the room and verbalize with the surgical tech and/or assistant that the correct side is marked.
Timeout Time
Now that you’ve done all the preoperative checks, it’s time to do the timeout and get the surgery started. By this time, the patient is already prepped and drying (3 minutes!) I like to use this time to do the timeout. Why? Because there are 3 minutes that the team can’t get the patient draped, fidgeting with things on the field, etc. Also, if the prep is drying, the surgeon’s marking should be clearly visible. So, what’s included in the time out? The basics are…
-Patient Name
-Patient D.O.B (for two identifiers)
-Scheduled Procedure
-Laterality marked (if applicable)
-Surgeon
-Allergies
-Fire Score
-Antibiotics
-Anesthesia Type
These are the absolute musts. Each facility has its own policy on what is covered during the timeout. Some can get a little excessive (not that they aren’t equally as important). If there is something you find pertinent to the procedure the timeout is a good time to announce so everyone is on the same page.
Inattention to Timeout
Unfortunately, there are times when team members are not attentive during the timeout. If you notice side conversations during the timeout, you need to stop, get the attention of everyone and restart. Do this a time or two and the individual causing the disruption will understand. If you notice fidgeting of the drapes by the surgeon, tech, or assist… just pause and stare until they notice you’ve stopped, they’ll get it.
What happens if there is a discrepancy? STOP everything- do whatever is needed to identify the correct way to move forward. If you are participating in the timeout and have any inkling that something is off, speak up!!! There is absolutely NO excuse to not speak up.
ALWAYS ensure that a timeout is performed accurately and documented appropriately. This is one of the many ways the RN is the patient’s advocate when they cannot advocate for themselves.
What a coincidence…
I wrote this post last night to review today before posting… who shows up at the hospital today? The Joint Commission. Who gets to do another timeout that gets observed by one of the surveyors? If you guessed me, you’d be right!
