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Building Quality Improvement Into Your Time-Out
Abstract Number: S-10
Abstract Type: Other
Introduction: Time out procedures may improve patient safety.1 However, research suggests that the use of a more procedure specific pre-incision safety checklist may further reduce morbidity and mortality.2 We present the creation and implementation of a quality improvement driven time out board specific to cesarean delivery on our obstetric floor.
Methods: A multi-disciplinary team including an obstetric anesthesiologist, obstetricians, midwives, nursing staff, surgical technicians and a representative from the safety office were recruited. Quality data from our unit was used to identify targets for improvement to incorporate into the time out checklist. Targets for improvement included surgical site infections and foreign body retention. The board was divided into verification, final time out and debriefing sections and an abbreviated list was created for emergency procedures. After gaining IRB exemption to use previously collected quality audit data during elective cesarean deliveries, we compared data collected in the three months prior to the time-out board implementation and three months post implementation for rates of surgical site infections and time out quality measures.
Results: In the pre and post-intervention time period, time out compliance was 100%. The final time out occurred at the correct time (defined as after draping and prior to incision) in 79 of 104 cases (75%) pre-intervention and in 105 of 131 cases (80.5%) post-intervention. The providers ceased other activities during time out in 94 of 104 procedures (90.4%) pre-intervention and in 128 of 131 cases (97.6%) post-intervention. Full verification (with two patient identifiers and surgical consents) was performed in 96 of 104 cases (92.3%) pre-intervention and in 129 of 131 cases (98.5%) post-intervention. Surgical site infections decreased from 6.4% (pre) to 3.2% (post). No retained foreign bodies were reported in the 8 months following the intervention.
Conclusion: Procedure specific time-out boards are easy to design and can be used to target areas for unit specific performance improvement. The presence of a time-out board in the operating room may improve the quality of the time out procedure.
1) Conley et al (2011) J Am Coll Surgeons 212: 873-879
2) Mainthia et al (2012) Surgery 5:660-666