From left to right: Joshua Brown, BSN, RN, CNOR, Jennifer String, CRNA, Sunilka Thompson, MSN, RN, CPXP, Margaret Vance, MSN, RN, CNOR, Anna Lee Sigueza, MSN, RN, CPAN, NE-BC, Kaitlin Ronning, MSN, RN, CPAN, Neil Layden, MSN, RN, CNOR
Not Pictured: Frances Strauss, DNP, MBA, MHA, RN, CNOR, NE-BC, Kevin Schmanek, CRNA
The Pre-Procedure Time-Out Taskforce
Penn Medicine: Pennsylvania Hospitals
The Pre-Procedure Time-Out Taskforce at Pennsylvania Hospital, an entity of Penn Medicine, was created in response to a troubling increase in safety events occurring prior to patients’ arrival in the operating room. The team designed and implemented a process that ultimately reduced consent and wrong-site/wrong-patient safety events per day by over 87%.
Between February 2019 and the start of 2020, perioperative personnel entered 103 Safety Event Reports under the category of Surgical Consent, 26 of which concerned issues surrounding potential wrong-site/wrong-patient surgery. The final time-out, which occurs immediately before incision and after the induction of anesthesia, comes too late to rectify consent issues. The Taskforce developed a formal pre-procedure briefing process incorporates The Joint Commission and Association of periOperative Registered Nurses (AORN) recommendations, the hospital’s electronic medical record (EMR), and the goal of putting the patient at the center of care.
In the EMR status board, the preoperative nurse turns the patient “pink” only after completing the day of surgery, history, and physical updates along with all necessary consents. Then, when the surgical suite is prepared for patient arrival, the operating room (OR) nurse updates the status board with a green smile. The pink and green signals in place, the licensed anesthesia provider, preop nurse, and intraop nurse meet at the patient’s bedside for the Pre-Procedure Bedside Time-Out, which includes review of a standardized checklist in the EMR. Including the patient in the time-out helps ensure the accuracy of all information and gives them the opportunity to have any last-minute concerns addressed. The checklist includes verification of the patient’s identity with two unique identifiers; correct site, laterality, and procedure; correct, signed, and dated surgical and anesthesia consents; availability of relevant lab and radiology studies; and patient allergies.
In February 2020, the Taskforce provided education to all 200-plus team members at a weekly staff in-service, which included review of actual safety events to emphasize that the new time-out was designed to address real patient safety concerns. All staff completed an electronic attestation indicating they understood the new process. Post-implementation data shows significant and sustained decrease of surgical consent related safety events from March 2020–October 2021. Consent-related safety events fell from 103 over a 10-month period to only 24 over a 20-month period. Eight of those 24 post-implementation safety events were good catches discovered and rectified in the new preoperative time-out process. Only three of these reported events could have led to a wrong-patient/wrong-site surgery, a 93.67% reduction on a per day basis.