![]() As such, the attending surgeon always corrected the error after the anaesthesiologist’s component of the timeout but before the nurses’ component. The authors, with input from their institutional review board, designed the study to be feasible and compliant with established human subjects protection principles. 11 Since you are less likely to catch an error if you do not address that item during the timeout, in institutions with lower adherence, the proportion of missed errors may be even higher. Yet, few organisations consistently attain timeout adherence above 90%. Because the investigators were leading the timeouts as part of a research study, adherence to all of the checklist items was reportedly 100%. This study also has important limitations. Of these, errors were most commonly reported by the anaesthesiologist (64%) and almost never by residents in training (6%) or medical students (1%). Overall, only about half (65 54%) of all errors were detected and reported by a team member prior to surgeon correction. The single error embedded in each of 120 of 1800 paediatric operations was randomly chosen from among wrong patient name, age, gender, allergy or surgical procedure, side or site. If the error was not verbalised, the attending surgeon corrected the error before the timeout was complete. In this issue of the journal, Muensterer and colleagues 14 describe a clever study in which the attending surgeon intentionally introduced errors during the preincision timeout while a medical student in the operating theatre surreptitiously noted whether the error was detected and reported by one or more members of the surgical team. ![]() 13 Moreover, we still do not understand the circumstances in which checklist use facilitates the detection, reporting and correction of errors. Although there is increasing guidance on how to optimally implement checklists at the local level, many questions remain. For example, we do not know whether checklist-based timeouts only decrease the occurrence of the undesirable events targeted by the checklist or, as many hypothesise, whether their use also facilitates teamwork and interprofessional communication. 11 12 Even with a robust implementation, effectiveness can be weakened by contextual factors, failure of leadership or deficient safety culture.ĭespite numerous studies, gaps in the evidence to guide optimal checklist use persist. For example, there is appreciable evidence showing that surgical teams skip or do not meaningfully respond to timeout checklist items. 10 Like all tools or processes intended to improve safety, ineffective implementation will reduce the desired benefits. 9 Checklist-based preincision timeouts appear to improve surgical outcomes in many settings, 4 5 yet, in other hospitals, the introduction of the SSC failed to improve outcomes. There are widely disseminated arguments recommending the use of checklists in healthcare 8 but also recognised limitations. However, preinduction briefings, and postcase debriefings in particular, are much less commonly performed. 4 5 Most hospitals in the developed world perform the SSC or an equivalent timeout prior to surgical incision. ![]() 3 It is divided into preinduction (or sign in, consisting of seven items performed by anaesthesia and nursing), preincision ( timeout, 10 items performed by the entire team) and postsurgery ( sign out, five items by the entire team). The most widely used approach globally is the Surgical Safety Checklist (SSC) recommended by the WHO. 1 2 For several decades, a hallmark of surgical quality and safety has been the use of checklists to prevent errors (eg, wrong site surgery) and assure that key tasks have been or will be performed. Patients are more likely to experience preventable harm during perioperative care than in any other type of healthcare encounter. ![]()
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