The Joint Commission is drawing attention to National Time Out Day on June 8, which focuses on the need for everyone on the surgical team to pause before the procedure begins in order to make sure all are on the same page about the right patient, right site and right procedure.
Surgery on the wrong patient or wrong body part is called a “never event” because it’s never supposed to happen. The reality is that wrong site surgery occurs with depressing regularity, and it’s unacceptable. Wrong site surgeries occur an estimated 40 times a week, or five times a day, in the United States.
The human damage of a wrong site surgery is immeasurable. Patients are physically and emotionally scarred, and sometimes a life is lost. The entire surgical team is devastated, and we are only starting to recognize the extent of second victim syndrome.
The importance of the surgical time out to ensuring that surgical teams are making adequate time for the time out.
The Joint Commission addresses the surgical time out in its 2022 National Patient Safety Goal of our Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery. As the nation’s top accreditation agency for healthcare organizations, it first introduced hospitals to a simple process for preventing wrong site surgery in 2004.
The Universal Protocol, as it is named, calls for the patient and the licensed independent practitioner to confirm the procedure and mark the body part to be operated on; and for every member of the surgical team to participate in a time out before operating to ensure that the correct procedure is about to begin on the correct part of the correct patient.
The Association of periOperative Registered Nurses (AORN) responded to the Universal Protocol by creating National Time Out Day to raise awareness. AORN also developed a Comprehensive Surgical Checklist to enable individual facilities to meet The Joint Commission’s Universal Protocol and the World Health Organization’s standards while customizing the checklist according to surgical specialties.
AORN has heard from members concerned that time outs in 2022 are being conducted hastily, likely as a result of surgical teams working through a backlog of operations postponed by the pandemic. Operating rooms (ORs) are increasingly staffed by travel nurses who may not be comfortable enough to speak out. There has been a significant uptick in wrong site surgeries in the last three years, so it’s time to recommit to fully engaging in the time out process.
