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Time-Out: Working to Ensure Operating Room Mistakes Don’t Happen

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Time Out: Working to Ensure Operating Room Mistakes Don’t Happen

July 11, 2024

Did you know that the “time-out” performed in healthcare operating rooms was adapted from the aviation industry’s practices? Aviation’s pre-flight checklist and communication protocols reduced errors and enhanced safety. In the early 2000s, these standards were studied and reworked for the healthcare sector, and the resulting protocols were introduced into the OR to enhance patient safety and prevent errors.

The OR environment demands clear communication and coordination among surgical teams. During the time-out, the entire operating room team stops – takes “time out” – for the crucial communication step of reviewing and verifying the patient’s identity, the planned procedure, and the designated surgical site. Only after the time-out checklist is successfully completed can the incision be made or the procedure start. The time-out process also empowers all team members to express any concerns about the procedure or the patient’s safety.

Surgical teams must perform the time-out as described in Standard 10.01.01 Surgical Procedures: Standardized Identification Process for deemed ambulatory surgery centers and Standard 10.01.01 Verification Process for non-deemed centers and the organization’s written policies and procedures:

A time-out must be completed immediately before the invasive procedure starts or an incision is made.
A designated team member – surgeon, RN or circulating professional, or other designee – starts and leads the time-out process.
The team follows and adheres to the organization’s established time-out process.
The immediate members of the procedure team – individual performing the procedure, circulating nurse or other professional, anesthetist(s), operating room technician(s), and other active participants – should actively participate and communicate during the time-out. Team members must verify and agree upon patient and procedure details:
- Patient name.
- Procedure site, including the marking of the site, as appropriate.
- Procedure to be performed.
  Presence of tools, equipment, and supplies required.

The completion of the time-out should be documented according to the organization’s written policies.

Surgical teams must perform the time-out as described in Standard 10.01.01 Verification Process for office-based surgery practices and the organization’s written policies and procedures:

A time-out must be completed immediately before the invasive procedure starts or an incision is made.
A designated team member – surgeon, RN or circulating professional, or other designee – starts and leads the time-out process.
The team follows and adheres to the organization’s established time-out process.
The immediate members of the procedure team – individual performing the procedure, circulating nurse or other professional, anesthetist(s), operating room technician(s), and other active participants – should actively participate and communicate during the time-out. Team members must verify and agree upon patient and procedure details:
- Patient name.
- Procedure site, including the marking of the site, as appropriate.
- Procedure to be performed.
- Presence of tools, equipment, and supplies required.

The completion of the time-out should be documented according to the organization’s written policies.

Tips for Compliance

Learn from each time-out. Conduct audits to evaluate the engagement of team members during each step of the safety checklist established at your organization.
Review audit findings with improvement in mind. Empower all team members in discussions of the findings to agree upon improvement needs and then propose improvements.
Emphasize that patient safety is everyone’s priority. Ensure everyone has access to training and information needed.

Download this useful checklist adapted from the World Health Organization (WHO).