Time-Out in the OR Competition

During a regional collaborative to prevent wrong-site surgery, discussed elsewhere, operating room managers at 27 facilities noted the durations of the time-outs. The median for 227 observations was 1 minute and the mean was 90 seconds. Atul Gawande, MD, has stated that the aviation industry has a rule of thumb that, to maintain effectiveness, a routine checklist addressing a single task should take less than 90 seconds to perform (personal communication). The Authority's Time-Out in the OR Competition, entries listed below, included only the parts of a time-out script that identify the patient, procedure, and side or site of the procedure. Implant availability, antibiotic administration, allergies, and other additions to the Universal Protocol not related to preventing wrong-site surgery have been eliminated from the time-out scripts. Elements of the time-out that involve confirmation or documentation not based on conversation have also been eliminated.  

Scripts for Mary Jones (DOB 01/01/1921, MR# 007) Left Total Hip Replacement (Supine Position)

Script #1

Circulating nurse, holding the informed consent and preoperative checklist (to the anesthesia provider): "What is the patient's name and date of birth?"

Anesthesia provider, reading from the patient label on the anesthesia record after it has been confirmed with the patient's identification bracelet: "Mary Jones, January 1, 1921."

Surgeon: "I concur that this is Mary Jones. I am doing a left total hip replacement in the supine position."

Circulating nurse (to the scrub technician): "Do you agree?"

Scrub technician: "Yes."

Circulating nurse (to the anesthesia provider): "Do you agree?"

Anesthesia provider: "Yes."


Script #2

Circulating nurse (to all members of the operating team): "It's time for the time-out."

Circulating nurse (to the anesthesia provider): "What is the patient's name and date of birth?"

Anesthesia provider, reading from the armband: "Mary Jones and her date of birth is January 1, 1921."

Circulating nurse (to the surgeon): "What is the intended procedure?"

Surgeon: "A total hip replacement."

Circulating nurse: "That information matches the consent."

Circulating nurse (to the surgeon): "What side is to be done?"

Surgeon: "The left side."

Circulating nurse: "That information matches the consent."

Circulating nurse (to the surgeon): "Is the site mark visible?"

Surgeon: "Yes."

Circulating nurse (to the surgeon): "Do we have the correct position?"

Surgeon: "Yes."

Circulating nurse (to the surgeon): "Are relevant x-rays available, labeled, and displayed?"

Surgeon: "Yes."


Script #3

Circulating nurse (to all members of the operating team): "Let's do our time-out."

Circulating nurse, after checking around the room to see that all members of the operating team involved in the patient's care have stopped what they are doing and are paying attention: "This is Mary Jones (looking at the name bracelet); her date of birth is January 1, 1921."

Circulating nurse, reading directly from the surgical consent: "Left total hip replacement."

Circulating nurse (to all members of the operating team): "Do you agree?"

Other individual members of the operating team: "I agree."

Circulating nurse: "The left hip is in the supine position and has been marked."


Script #4

Surgeon (to all members of the operating team): "Let's do the time-out."

Circulating nurse—after all members of the operating team have stopped what they are doing, have turned off any music, and are paying attention—reads from the informed consent: "This is Mary Jones; date of birth January 1, 1921; total hip replacement; left side; supine position."

Anesthesia provider, referring to the visible site marking and available documents: "I verify that we are doing a left total hip replacement on Mary Jones, medical record number 007."

Scrub technician, referring to the visible site marking: "I see the mark on the left hip. I have set up for a left total hip replacement."

Surgeon, referring to the visible site marking: "I agree that I am doing a total hip replacement on the left side. Available x-rays confirm the left side. I can see and verify the mark. Knife please."


Script #5

Circulating nurse (to all members of the operating team): "It's time for the time-out."

Circulating nurse, looking at consent (to the surgeon): "Please give me the patient's name."

Surgeon, from memory: "The patient is Mary Jones."

Circulating nurse, looking at consent (to the anesthesia provider): "What is the name and date of birth on the wristband?"

Anesthesia provider, reading from wristband: "The wristband says 'Mary Jones, January 1, 1921.'"

The circulating nurse checks that the surgeon's and anesthesia provider's responses match the consent before proceeding to the next question.

Circulating nurse, looking at consent (to the scrub technician): "What procedure are you set up to do?"

Scrub technician: "I'm set up for a total hip replacement."

Circulating nurse, looking at consent (to the surgeon): "What procedure do you intend to do?"

Surgeon, from memory: "Total hip replacement."

Circulating nurse, looking at consent (to the anesthesia provider): "What procedure is listed on the schedule?"

Anesthesia provider, reading from OR schedule: "Total hip replacement."

The nurse checks that the scrub technician's, surgeon's, and anesthesia provider's responses match the consent before proceeding to the next question.

Circulating nurse (to the surgeon): "Please indicate on the x-ray the side the pathology is on."

Surgeon, pointing to the fracture on the x-ray image: "The pathology is on the left."

Circulating nurse (to the anesthesia provider): "What position is the patient in?"

Anesthesia provider: "The patient is in the supine position."

Circulating nurse (to the surgeon): "Please indicate the side the mark is on."

Surgeon, pointing to mark: "The mark is on the left."

Circulating nurse, looking at consent (to the anesthesia provider): "Which side is listed on the schedule?"

Anesthesia provider, reading from schedule: "The schedule says 'the left.'"

The nurse checks that the surgeon's and anesthesia provider's responses match the consent.

Surgeon (to all members of the operating team): "If anyone has a concern, please speak up." 

©2018 Pennsylvania Patient Safety Authority