Pre-Induction Time Out Lauren McLaughlin, DO Tyler Morrissey, MD Jacob Loyd, MD Olivia Romano, MD Jason Brainard, MD
Introduction Currently, 3 of 4 training hospitals perform pre- induction timeouts All members of the surgical team, anesthesia team, circulator, and scrub nurse involved Goal to improve communication, quality, and safety Concern for disrupting work flow, perform TO after anesthesia induction
Background Concerns of preinduction TO include disruption of surgical work flow, delay of procedure start, patient anxiety They found that preinduction TO allowed more time to correct equipment errors, obtain necessary blood products, and administer preoperative medications. No change in elapsed time to incision. Another study found that not only was preincision work flow not disrupted, but there was a significant decrease in work-flow disruptions during the operation Anxiety found not to be an issue in one study, appropriate pre- medications given, 65% of pts did not remember the TO, 29% remembered and felt reassured, 6% remembered and were indifferent Preinduction TO can improve team communication and perception of improving safety. OR staff felt more actively involved with improving patient safety (95%), vs the rest of the hospital staff (55%)
Methodology Institute Pre-Timeout Process trial for 2 weeks (Apr 3-14) using pre- made Timeout Sheets PACU Resident would attend Timeouts, time process, instruct participants, and collect data. Trial would occur in OR 9 (TACS) only Same surgical residents for 2 weeks Potentially unpredictable cases Proximity to PACU Trial would be difficult to implement and measure if attempted OR-wide
Pre-Induction Checklist Circulator Nurse: Introduce self Verify consent, pt full name and MRN Procedure and Laterality Site Marked Allergies SCD’s applied Post-op Dispo- home, floor, ICU? Any concerns?
Scrub Tech: Introduce self Instruments available Implants available Equipment available Supplies and suture per preference card Any concerns?
Surgery: Introduce self Procedure and laterality Patient position Heparin? Antibiotics ordered T&S or T&C- units available EBL estimate? Any concerns?
Anesthesia: Introduce self Type of anesthesia- General, MAC, regional? Confirm antibiotics Anesthetic concerns?
Does this support team building? RN- Yes or No Scrub- Yes or No Surgery- Yes or No Anesthesia- Yes or No Did this improve patient safety? 1=not at all, 3= somewhat, 5=absolutely RN- 1 2 3 4 5 Scrub- 1 2 3 4 5 Surgery- 1 2 3 4 5 Anesthesia- 1 2 3 4 5 Did this change management?
Limitations Apr 10-14, TACS cases were limited Surgery did not arrive in time for 3 timeouts Pre-Induction timeout did not occur for ”unstable” patients At discretion of PACU resident PACU resident did not make it to all first case starts Differences in answers depending on who was filling out questionnaire
Conclusion Successes: Areas to improve on: Improved team building Increased patient safety Areas to improve on: Minimal effect on changing management However this was possibly under-reported Could be more time efficient with more familiarity
Conclusion How can we improve: Surgery team: Nursing team: Increase compliance through improved communication and more advanced notice Point out ways in which the pre-induction TO benefits them 2 minutes at the beginning could save 5-10 minutes later Get surgical attending involved as an advocate, such as Dr. Meguid Nursing team: Outline expectations and educate OR nurses ahead of time Focus on clear and expeditious pre-induction timeout process Anesthesia team: Take on a leadership role Advocate for increased team building and communication Highlight when pre-induction timeout changes management
Conclusion Future implementation Successful rollout of pre-induction TO relies on overcoming the stigma that it is a waste of time Work with surgical department on how to ensure compliance and cooperation Focus on communication and education of all teams prior to implementation Timeout whiteboard split into pre/post induction checklists may expedite and clarify process for all teams