Lee Steven L
Pediatric Surgery, Harbor-UCLA Medical Center; David Geffen School of Medicine, UCLA, CA, USA.
Perm J. 2010 Spring;14(1):19-23. doi: 10.7812/TPP/10.997.
To review the initial results of implementing an extended surgical time-out (STO) in pediatric surgery.
Starting in January 2006, all members of our surgical team implemented and used an extended STO, confirming the patient's identity, technical and anesthetic details, administered and available medications, and need for blood products and special equipment. To avoid disrupting work flow, the STO was initially after anesthesia induction. Starting in October 2007, the STO was done before anesthesia induction. Initial results, elapsed time to incision, and surgical team surveys were reviewed before and after implementing the preinduction STO.
The elapsed time to incision was similar for elective and urgent operations before and after implementing the preinduction STO. All antibiotics were administered and confirmed during the STO. Four significant equipment findings were detected, altering the planned procedure (two before and two after implementing the preinduction STO). Operating room staff felt more confident and prepared for the operations because communication was improved. One near-miss occurred during the postinduction STO. One wrong-site operation occurred despite the preinduction STO, because of inadequate marking. Root-cause analysis demonstrated that this was due to a systems error.
Using the extended STO before anesthesia induction improved communication among the surgical team members and did not disrupt work flow. An extended STO may also have broader value, such as confirming timely antibiotic administration or meeting other quality measures. The extended STO did not eliminate wrong-site surgery. However, implementation of the STO placed the responsibility for wrong-site surgery with the whole team and system, rather than with the individual surgeon.
回顾在小儿外科实施延长手术暂停（STO）的初步结果。
从2006年1月开始，我们手术团队的所有成员实施并采用了延长的STO，确认患者身份、技术和麻醉细节、已给药和可用药物以及对血液制品和特殊设备的需求。为避免扰乱工作流程，STO最初在麻醉诱导后进行。从2007年10月开始，STO在麻醉诱导前进行。在实施诱导前STO前后，回顾了初步结果、切开时间以及手术团队的调查情况。
在实施诱导前STO前后，择期和急诊手术的切开时间相似。所有抗生素均在STO期间给药并确认。检测到四项重大设备问题，改变了计划的手术（实施诱导前STO之前两项，之后两项）。手术室工作人员对手术更有信心且准备更充分，因为沟通得到了改善。在诱导后STO期间发生了一起险些失误的情况。尽管有诱导前STO，但仍发生了一例手术部位错误的手术，原因是标记不充分。根本原因分析表明这是由于系统错误。
在麻醉诱导前使用延长的STO改善了手术团队成员之间的沟通，且未扰乱工作流程。延长的STO可能还具有更广泛的价值，如确认抗生素的及时给药或满足其他质量指标。延长的STO并未消除手术部位错误的手术。然而，STO的实施将手术部位错误手术的责任归咎于整个团队和系统，而非个别外科医生。
