Time-Out & Patient Safety - Development & the way forward at the Prince of Wales Hospital Paul B S LAI Cluster Coordinator for Surgical Services (NTEC) & Honorary Chief of Service, Department of Surgery at the Prince of Wales Hospital

Murphy’s Law - "if anything can go wrong, it will." "If there's more than one possible outcome of a job or task, and one of those outcomes will result in disaster or an undesirable consequence, then somebody will do it that way." http://en.wikipedia.org/wiki/Murphy's_law

Manager: Dr. Peter YH Tam Quality & Risk Management Accountability Structure Chief of Service Prof. Paul BS Lai Dept Q & RM Coordinator Dr. Danny TM Chan Information & Performance Manager: Dr. John Wong -Performance reporting -Disease coding -Data quality -Web communication Clinical Quality Manager: Prof. Simon Ng -Clinical protocols -Clinical standards -Clinical audits System & Risks Manager: Dr. Peter YH Tam -Manpower -Equipment -Workload -Workflow/process

Time out Initiative from Surgery, PWH in January 2008 To prevent (Task force by Dept Q & RM Coordinator with representatives of 9 surgical teams) To prevent Wrong patient Wrong side Wrong site Wrong surgical procedure Final verification before surgery Good practice – reminder to surgeons

Key checks Operating surgeon, Circulating OT nurse & Anaesthetist Consent vs. Bracelet + Operation list Patient name HKID Diagnosis Side Operation

The day before surgery A good practice

Input and/or check with OT list before publish

The evening before surgery Check the published OT list vs. Informed consent

Name (Bracelet) ID (Bracelet) Diagnosis (OT list) Side (OT list) Operation (OT list) (Consent) Name ID Diagnosis Side Operation

(Time out Record) Ticks & Sign

Time Out Form (Current version)

Implementation of Time-out in 2008 Milestones Date Trial run in Neurosurgery Team (elective) 18 Jan 2008 Live run in Department of Surgery (elective) 18 Feb 2008 Live run in Department of Surgery (elective AND emergency) 1 Apr 2008 Live run in all elective cases, PWH 1 Jul 2008 Live run in all elective AND emergency cases, PWH 21 Jul 2008 + Briefing & Debriefing +

Journey of a Surgical Patient Covered in current time-out Time-out and Briefing & Debriefing Consenting Process Ward Nurse Reception OT Nurse check Nurse check Anaesthetic check Marking Ward OT Reception OT up-stream mid-stream down-stream mid-field back-field Goal keeper Goal keeper cannot survive alone ! Mid-field and back-field are important !

1-2-3 Surgical Safety 1-2-3 Adapted from WHO Safety Checklist Critical processes of surgical patient journey combined into ONE single checklist And…….

More crucial points addressed… Blood loss Anaesthetic issues Drug Allergy Surgical concerns Post-operative care Surgical device issues (more complex in modern surgery)

Near-to-Final Version (Front page – Ward to OT Reception)

Near-to-Final Version (Back page - Theatre)

Improved Communication OT Nurse Anaesthetist OT Reception Nurse Ward Nurse Surgeons

Time Line TRIAL RUN IN Elective Cases Evaluation Jan Feb Mar Apr May Consultation done Survey on user’s satisfaction & safety attitude Compliance Flow Trouble shooting +/- workshop Audit