From the Departments of Anesthesiology.
Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.
Anesth Analg. 2020 Mar;130(3):725-729. doi: 10.1213/ANE.0000000000004126.
Although the surgical pause or time-out is a required part of most hospitals' standard operating procedures, little is known about the quality of execution of the time-out in routine clinical practice. An interactive electronic time-out was implemented to increase surgical team compliance with the time-out procedure and to improve communication among team members in the operating room. We sought to identify nonroutine events that occur during the time-out procedure in the operating room, including distractions and interruptions, deviations from protocol, and the problem-solving strategies used by operating room team members to mitigate them.
Direct observations of surgical time-outs were performed on 166 nonemergent surgeries in 2016. For each time-out, the observers recorded compliance with each step, any nonroutine events that may have occurred, and whether any operating room team members were distracted.
The time-out procedure was performed before the first incision in 100% of cases. An announcement was made to indicate the start of the time-out procedure in 163 of 166 observed surgeries. Most observed time-outs were completed in <1 minute. Most time-outs were completed without interruption (92.8%). The most common reason for an interruption was to verify patient information. Ten time-out procedures were stopped due to a safety concern. At least 1 member of the operating room team was actively distracted in 10.2% of the time-out procedures observed.
Compliance with preincision time-outs is high at our institution, and nonroutine events are a rare occurrence. It is common for ≥1 member of the operating room team to be actively distracted during time-out procedures, even though most time-outs are completed in under 1 minute. Despite distractions, there were no wrong-site or wrong-person surgeries reported at our hospital during the study period. We conclude that the simple act of performing a preprocedure checklist may be completed quickly, but that distractions are common.
尽管手术暂停或暂停时间是大多数医院标准操作程序的必要组成部分，但对常规临床实践中暂停时间的执行质量知之甚少。实施了交互式电子暂停时间，以提高手术团队对暂停时间程序的遵守情况，并改善手术室团队成员之间的沟通。我们试图确定在手术室暂停时间过程中发生的非例行事件，包括分心和中断、偏离协议以及手术室团队成员用来减轻这些问题的解决策略。
2016 年对 166 例非紧急手术进行了手术暂停直接观察。对于每次暂停，观察者记录了每个步骤的遵守情况、可能发生的任何非例行事件以及是否有任何手术室团队成员分心。
在 166 例观察到的手术中，有 100%的手术在第一次切口前进行了暂停时间程序。在 163 例观察到的手术中，有 163 例宣布开始暂停时间程序。大多数观察到的暂停时间在<1 分钟内完成。大多数暂停时间没有中断完成（92.8%）。中断的最常见原因是验证患者信息。由于安全问题，有 10 次暂停时间程序被停止。在观察到的暂停时间程序中，至少有 1 名手术室团队成员在 10.2%的时间处于主动分心状态。
在我们的机构中，术前暂停时间的遵守情况很高，非例行事件很少发生。即使大多数暂停时间在 1 分钟内完成，手术室团队中仍有≥1 名成员经常主动分心。尽管存在干扰，但在研究期间我们医院没有报告错误部位或错误人员手术。我们的结论是，执行术前检查表的简单行为可能很快完成，但干扰很常见。
