Effectiveness of Surgical Timeout Procedure PDF

**Effectiveness of surgical timeout procedure in surgical settings to improve patient safety: Systematic review and meta-analysis** **Problem statement and research question** **By Awal Khan** **Problem statement** **Patient safety in surgical units is a serious issue where even a small error ca...

**Effectiveness of surgical timeout procedure in surgical settings to improve patient safety: Systematic review and meta-analysis** **Problem statement and research question** **By Awal Khan** **Problem statement** **Patient safety in surgical units is a serious issue where even a small error can lead to serious consequences such as wrong patient -surgery, wrong site surgery and wrong procedures(Freundlich et al., 2020).** World Health Organization (WHO) has adopted the surgical time-out technique as one of the universally recommended measures that comprise the principal feature of the Surgical Safety Checklist to address those risks. The surgical team needs to confirm certain details of the patient and the intended operation in this surgery and this may only be done before the first cut, thereby warranting a brief pause. Thus, to enhance communication, enhance identification, and ultimately optimize the avoidance of postoperative errors (Al-Khatib et al., 2019; Treadwell et al., 2014).While the majority of healthcare organizations have implemented the time-out procedure, its effectiveness in enhancing patient safety is still contentious. While some studies claim that time-out procedures have managed to bring down the rates of surgical errors to a very low level, other argue that there are problems that affect its applicability, such as poor compliance, problems involving low levels of engagement with the surgical team and existence of system barriers(Storesund et al., 2020; Treadwell et al., 2014). For instance, some of the investigation points at communication and coordination during time out as essential components that contribute to its efficiency while, other investigations reveal that lack of compliance is likely to have negative impacts on it (Berlinger & Dietz, 2016; Storesund et al., 2020). Considering these findings the study the need arises for a systematic review of the available literature that would establish the actual effects of time-out procedures on patient safety in the surgical environment. With a view of ascertaining the usefulness of the surgical time-out procedure in minimizing the rate of wrong-site, wrong-patient, and wrong-procedure surgeries, this systematic review aims to compare the incidence rates. Furthermore, it will include those patterns, conditions and circumstances that affect the degree of adherence to the process by different teams of surgery and its settings and in doing so, it will try to discuss perspectives on best practices that may contribute to the improvement of the safety of patients in the context of surgery. **Research question** This systematic review will seek to answer following research question: How effective is the surgical time-out procedure in safety of patients across various surgical settings? **PICO framework** **Population (P): Patients who are undergoing surgical procedure in the healthcare facility including hospitals, and surgical centers.** ** Intervention (I): WHO surgical safety checklist or Timeout process (a formal checklist done before the operation to ensure the right patient is scheduled for the right operation in the right body part).** ** Comparison (C): Operations where timeout was not utilized either because no such tool was employed or an intervention different from timeout was applied.** ** Outcome (O): outcome measures include general patient safety parameters, postoperative morbidity and mortality and compliance to safety processes.** **Dependent Variables:** **Outcome measure: Patient safety outcomes, such as the overall rate of surgical complications including re-admissions within 30-day post-surgery, infections, wound rupture/bleeding, patient mortality,** **Independent Variables:** **Intervention: Implementation of surgical timeout procedures** **Databases searched** **PubMed, Medline complete, ProQuest,** **Search string** **Concept 1: Timeout Procedure** MeSH: \"Time Out, Healthcare\"\[Mesh\] OR (\"Checklist\"\[MeSH\] OR \"Safety Management\"\[MeSH\]) OR(\"Surgical Procedures, Operative\"\[MeSH\] Key words: "surgical safety checklist\*"\[tw\] OR "WHO checklist\*"\[tw\] OR "surgical timeout"\[tw\] OR "time-out procedure\*" OR\[tw\] "World Health Organization Checklist\*"\[tw\] **Concept 2: Surgical errors** MeSH: \"Medical Errors\"\[Mesh\] OR \"Intraoperative Complications\"\[MeSH\] OR Keywords: "surgical error\*"\[tw\] OR "adverse event\*"\[tw\] OR "wrong site surger\*"\[tw\] OR "wrong patient surger\*"\[tw\] OR "wrong procedure\*"\[tw\] **Concept 3 : Effectiveness** MeSH: \"Treatment Outcome\"\[Mesh\] OR \"Risk Management\"\[MeSH\] OR \"Patient Safety\"\[MeSH\] Keywords: "impact"\[tw\] OR "effect\*"\[tw\] OR "outcome\*"\[tw\] 1\. \"Time Out, Healthcare\"\[Mesh\] OR \"Checklist\"\[MeSH\] OR \"Safety Management\"\[MeSH\] OR \"Surgical Procedures, Operative\"\[MeSH\] OR "surgical safety checklist\*"\[tw\] OR "WHO checklist\*"\[tw\] OR "surgical timeout"\[tw\] OR "time-out procedure\*" OR\[tw\] "World Health Organization Checklist\*"\[tw\] 2\. \"Medical Errors\"\[Mesh\] OR \"Intraoperative Complications\"\[MeSH\] OR "surgical error\*"\[tw\] OR "adverse event\*"\[tw\] OR "wrong site surger\*"\[tw\] OR "wrong patient surger\*"\[tw\] OR "wrong procedure\*"\[tw\] 3\. \"Treatment Outcome\"\[Mesh\] OR \"Risk Management\"\[MeSH\] OR \"Patient Safety\"\[MeSH\] OR "impact"\[tw\] OR "effect\*"\[tw\] OR "outcome\*"\[tw\] **References** Al-Khatib, T. A., Mirza, A. A., Malakah, M. A., Jiffri, A. E., Abdalwassie, L. K., & Hijazi, D. M. (2019). An Audit on Compliance of Surgical Time Out after a Decade of Implementation at an Academic Tertiary Care Hospital. *Journal of King Abdulaziz University - Medical Sciences*, *26*(1), 19--27. https://doi.org/10.4197/med.26-1.4 Berlinger, N., & Dietz, E. (2016). STATE OF THE ART AND SCIENCE Time-out: The Professional and Organizational Ethics of Speaking Up in the OR. In *AMA Journal of Ethics* (Vol. 18, Issue 9). www.amajournalofethics.org Freundlich, R. E., Bulka, C. M., Wanderer, J. P., Rothman, B. S., Sandberg, W. S., & Ehrenfeld, J. M. (2020). Prospective Investigation of the Operating Room Time-Out Process. *Anesthesia and Analgesia*, *130*(3), 725--729. https://doi.org/10.1213/ANE.0000000000004126 Storesund, A., Haugen, A. S., Flaatten, H., Nortvedt, M. W., Eide, G. E., Boermeester, M. A., Sevdalis, N., Tveiten, Ø., Mahesparan, R., Hjallen, B. M., Fevang, J. M., Størksen, C. H., Thornhill, H. F., Sjøen, G. H., Kolseth, S. M., Haaverstad, R., Sandli, O. K., & Søfteland, E. (2020). Clinical Efficacy of Combined Surgical Patient Safety System and the World Health Organization's Checklists in Surgery: A Nonrandomized Clinical Trial. *JAMA Surgery*, *155*(7), 562--570. https://doi.org/10.1001/jamasurg.2020.0989 Treadwell, J. R., Lucas, S., & Tsou, A. Y. (2014). Surgical checklists: A systematic review of impacts and implementation. In *BMJ Quality and Safety* (Vol. 23, Issue 4, pp. 299--318). BMJ Publishing Group. https://doi.org/10.1136/bmjqs-2012-001797