As someone who participated in the development and initial application of the World Health Organization (WHO) surgical safety checklist, I became convinced early on that there is no better time to establish the necessary “bond for the day” of my team than a well-executed initial time-out. It is important to note that strong team member commitment is key to the successful implementation of checklists in preventing harm to patients and in improving quality. When practiced in this step-by-step manner, with true involvement of all members of the team led by the senior surgeon, checklists are extremely effective during the operation and postoperatively as they contribute to improved patient outcomes. A final debriefing takes place at the conclusion of the operation.
Another pause before the end of the procedure turns the team’s attention toward ensuring that no foreign bodies are left behind and that all aspects of the operation have been successfully concluded. At different stages of the operation, even at initiation of the incision, other elements are verified, including the plan for the procedure and team member assignments, as well as the best ways to communicate with team members during the procedure. The original time-out took the form of checklists, to which the surgical care team refers at different phases of a surgical procedure. While initially viewed as a safety measure to prevent harm as a result of operating on the wrong patient or the wrong site or performing the wrong procedure, time-outs evolved to include quality patient care and enhanced performance of the surgical team. A time-out, which The Joint Commission defines as “an immediate pause by the entire surgical team to confirm the correct patient, procedure, and site,” was introduced in 2003, when The Joint Commission’s Board of Commissioners approved the original Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery for all accredited hospitals, ambulatory care centers, and office-based surgery facilities.
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