Tune-in and Time-out: Toward Surgeon-Led Prevention of 'Never' Events

Introduction: The World Health Organization (WHO) distributed a surgical safety checklist in 2008 in a bid to improve patient safety and quality of care in the operating theater. Adherence to the checklist has been shown to reduce “never” events, for example, wrong site surgery. The aim of this quality improvement study was to determine the current adherence by surgeons to the checklist at The Royal Hobart Hospital.

Methods: This is a retrospective audit of the digital medical records of 100 consecutive emergency operations performed at The Royal Hobart Hospital. The time-out section of the WHO Surgical Safety Checklist was assessed for completeness. Second, an anonymized survey of theater nursing staff was performed to determine current adherence by surgeons with the time-out.

Results: The time-out was completed in 79% of emergency procedures. There were no never events in the patient cohort studied. There was overwhelming support among theater nurses for a surgeon-led time-out. Formal education on the use of the WHO Safe Surgery Checklist is lacking. Most theater nurses have experienced hostility from surgeons when conducting a time-out.

Discussion: This work is a step on the way to surgeon-led prevention of never events. Finding a completed time-out in the patient notes does not guarantee surgeon support for or contribution to the time-out process. The findings will inform combined nursing and surgeon education sessions, and together with executive-level support, improved surgeon cooperation with the time-out will inculcate a culture of safety for patients and improve harmony among staff groups.