Even though wrong site surgeries happen in about 1 of 112,000 procedures, that single instance is what the surgical timeout process aims to prevent.
However, since the pandemic postponed some surgeries The Joint Commission reported an increase in these sentinel events. That issue is further compounded by the ongoing shortage of clinicians nationwide.
The practice, according to The Joint Commission, should focus on three key things:
- Clearly marking the surgical site as close to the planned incision area as possible.
- Using radiographic imaging for site marking if a surgical site is not visible, such as for organs.
- Ensuring the site is visible throughout the procedure during the timeout period and the time of first incision.
But, there are other secrets to success too. Each surgeon leads the assembled team of clinicians — many of whom may be meeting or working together for the first time in this capacity — through the timeout process differently than the next.
Clifford Ko, MD, the director of the division of research and optimal patient care at the American College of Surgeons, told Becker's his secret to successful timeouts before procedures is to level the playing field and make everyone on the team comfortable.
Rather than "Dr. Ko," he usually begins by introducing himself by his first name to remove any intimidation factor there may be, and build an atmosphere where everyone feels safe to speak up regardless of their position or rank.
"What we are here to do have a safe high quality operation. So even in the beginning, I'm not just saying, 'Call me Cliff,' what I'm also saying is, 'Look, I trust you and want you to tell me anything that you see that's going wrong because I don't have eyes everywhere. I'm trying to concentrate on this operation. If you see something that is potentially an issue, communicate it,'" he said. "We need to be in constant communication because if there are 15 people in this room — 30 eyes are better than two."
Daniel von Allmen, MD, the surgeon in chief at Cincinnati (Ohio) Children's Hospital said another key is to foster a culture of speaking up, not just within the operating room, but in every department across a system overall.
"The culture of speaking up is not just in the operating room. It is an expectation for people to speak up if they have a concern, so it's something that we've tried to build into the DNA of the entire organization," Dr. von Allmen said. "So that's not just the way you behave in the operating room. As I said before, it tends to be a fairly hierarchical place. The reality is that the surgeon sets the tone in the operating room. If you come in and set the wrong tone, then it makes it harder for someone to speak up. Conversely, if you come in, and you set the expectation that people will speak up and that you all are here for the patient, then it's a lot easier."
The process is something Dr. Ko and Dr. von Allmen agree is likely to continue to evolve with time and technology.
"One of the hardest things to do — because everybody is busy and everybody wants the case to get done and is taking care of the patient — is really to have the ability to really stop and pause," Dr. von Allmen said. "And to pause in a way so that full attention is given to the timeout may be something technology can help us continue to improve in time."