1. 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

2. 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."

3. 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

4. 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

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

7. The day before surgery
A good practice

8. Input and/or check with OT list before publish

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

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

12. (Time out Record)
Ticks & Sign

14. Time Out Form
(Current version)

15. 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 +

16. 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 !

17. 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…….

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

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

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

21. Improved Communication
OT Nurse
Anaesthetist
OT Reception Nurse
Ward Nurse
Surgeons

22. 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